A burned out testis tumour may be present if there is metastatic retroperitoneal lymphadenopathy, but the primary testicular tumor is a relatively occult, scarred intratesticular focus. Approximately 50% of the "burned out" tumors continue to harbor malignant cells.
Retroperitoneal germ cell tumors are more often secondary (unlike mediastinal and CNS germ cell tumors), and for secondary retroperitoneal germ cell tumors, the testicles are the most common origin. An occult burned out germ cell tumor may represent ~10% of apparently primary retroperitoneal germ cell tumors 3.
A germ cell tumor presumably "burns out" when it outstrips its blood supply and then regresses. Nonseminomatous germ cell tumors have the highest rate of regression.
- small echogenic intratesticular scar in a patient with metastatic-appearing retroperitoneal lymphadenopathy
- may be calcified
Treatment and prognosis
Orchiectomy is still performed because ~50% of "burned out" testicular tumors continue to harbor malignancy despite systemic chemotherapy 4. Radiotherapy is sometimes used.
History and etymology
The concept of the "burned out" testicular tumor was first described by Prim in 1927 1, but the term "Azzopardi tumor" arose in 1961 after Azzopardi described the phenomenon in patients who had died of metastatic choriocarcinoma and nonseminomatous germ cell tumors 5.
- testicular microlithiasis
- old testicular traumatic injury
- 1. Prim J. Spontanheilung eines bösartigen wahrscheinlich chorionepitheliomatosen: gewaches im hoden. Arch Pathol Anat 1927; 265:239–241.
- 2. Tasu JP, Faye N, Eschwege P et-al. Imaging of burned-out testis tumor: five new cases and review of the literature. J Ultrasound Med. 2004;22 (5): 515-21. Pubmed citation
- 3. Kühn MW, Weissbach L. Localization, incidence, diagnosis and treatment of extratesticular germ cell tumors. Urol. Int. 1985;40 (3): 166-72. Pubmed citation
- 4. Böhle A, Studer UE, Sonntag RW et-al. Primary or secondary extragonadal germ cell tumors?. J. Urol. 1986;135 (5): 939-43. Pubmed citation
- 5. AZZOPARDI JG, MOSTOFI FK, THEISS EA. Lesions of testes observed in certain patients with widespread choriocarcinoma and related tumors. The significance and genesis of hematoxylin-staining bodies in the human testis. Am. J. Pathol. 1998;38: 207-25. Free text at pubmed - Pubmed citation
Ultrasound - testicular and scrotal
- ultrasound (introduction)
testicular and scrotal ultrasound
unilateral testicular lesion
- testicular torsion
- testicular rupture
- germ cell tumours of the testis
- sex cord / stromal tumours of the testis
- testicular cyst
- testicular lymphoma
- bilateral testicular lesion
- paratesticular lesions
- tubular ectasia of the rete testis
- cystadenoma of the rete testis
- testicular sarcoidosis
- testicular tuberculosis
- spermatic cord
- fibrous pseudotumour of the scrotum
- scrotal leiomyosarcoma
- testicular adrenal rest tumours (TARTs)
- tunica vaginalis testis mesothelioma
- splenogonadal fusion
- unilateral testicular lesion