About 10% of choriocarcinoma of the testis and 15 % - 20 % of gonadal/stroma sex cord testicular tumors induce gynecomastia through their autonomous synthesis and secretion of estrogens. Tumor estrogen production may also cause decreased libido and poor sperm quality. The diagnosis of these hormone producing tumors is usually clinically evident from the finding of a testicular swelling that might be painless or painful. Occasionally the sole presenting feature is gynecomastia or very rarely decreased potency and no palpable testicular lesion (Lemack et al. 1995; Haas et al. 1989). Under these circumstances the diagnosis of testicular neoplasia may be missed. The presence of such occult tumors may be suspected from the biochemical findings of raised serum estrogens and depressed testosterone hormone levels. However, this does not always apply as some clinically recognizable estrogenic tumors have been reported in patients with normal hormonal profiles. Although gy-necomastia is a relatively common disorder with a benign cause in most cases, physicians should be aware that normal findings on testicular examination do not completely rule out the possibility of a testicular tumor, retroperitoneal metastasis or mediastinal germ cell tumors could be the cause. Because of the potentially high morbidity of testicular tumors and their known association with gynecomastia, early performance of testicular ultrasonography in a patient with gynecomastia of unknown cause is advised (Conway et al. 1988)
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