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Rapid response to:

Practice Lesson of the week

Testicular tumour presenting as gynaecomastia

BMJ 2006; 332 doi: (Published 06 April 2006) Cite this as: BMJ 2006;332:837

Rapid Response:

Gynaecomastia and Testicular Tumour

In response to the article (Lesson of the week) “Testicular tumour
presenting as gynaecomastia”1, we do not agree with the authors'
conclusion that “routine testicular ultrasonography should be performed in
all men presenting with gynaecomastia even if no abnormality is found on
testicular examination”.

We have retrospectively reviewed all men presenting with
gynaecomastia to the Chase Breast Unit in the years 2003 – 2006. 101
consecutive patients were assessed by a protocol, which includes clinical
examination of the testis and ultrasound scan where indicated, as well as
the usual investigations for gynaecomastia itself (fine needle cytology,
ultrasound, mammography etc.). The median follow up was 20 months. The
presenting complaint was swelling in 93, swelling and discomfort in 46 and
only discomfort in 6 patients. Definite aetiological factor was identified
in 58 of the 101 men (drugs, alcohol, gym, steroids, cirrhosis
and ductal carcinoma in situ). The remaining 38 were idiopathic.

None of the patients had testicular cancer at presentation or
developed one during subsequent follow up. In 3 patients, there was a
clinically palpable lump in the scrotum. Ultrasound in these particular
cases revealed hydrocele and epididymal cyst.

Testicular tumour is known to be a very rare cause of gynaecomastia
(3%)2. We would suggest that radiological assessment of the testis is
indicated only for clinically evident abnormality in the testis. Even
ultrasound and needle biopsy have failed to detect tumour in clinically
normal testes, where Leydig cell tumour became clinically apparent some
months later3. We do not feel that routine radiological test for
testicular cancer is necessary for all patients presenting with


1. Harris M et al. Testicular tumour presenting as gynaecomastia. BMJ
2006;332:837,8 April.

2. Daniels IR, Layer GT. Testicular tumours presenting as gynaecomastia.
Eur J Surg Oncol 2003;29:437-9.

3. Siegel SW, Thomas AJ. Gynaecomastia and Leydig cell tumours in the
adult. Cleve Clinic Q. 1984;51:395-9.

Competing interests:
None declared

Competing interests: No competing interests

11 December 2006
Juan McDonnell, Victor Jaffe
Barnet & Chase Farm NHS Trust, The Ridgeway, Enfield, Middlesex, EN2 8JL