Risk factors for ITGCN development

There are several conditions that are believed to predispose an individual to the development of TGCTs. For example, in a patient with a testicular tumor, the contralateral testicle has a 25-fold increased relative risk (RR) of developing another tumor. The finding of contralateral testicular microlithiasis on ultrasound in a patient who has had a TGCT has been reported to increase the risk of having ITGCN by approximately 30 times [23]. The clinical importance of testicular microlithiasis remains a controversial subject. Several studies have shown the prevalence of tes-ticular microlithiasis to be approximately 2% in the asymptomatic population [24,25]. These studies disagree on the association of microlithiasis with TGCTs. Serter and colleagues [24] reported 2.4% of healthy male volunteers (age 17-42) had testicular microlithiasis on screening ultrasound, but none had palpable lesions on physical exam and all had undetectable levels of testicular tumor markers. Other known risk factors are cryptorchi-dism (RR 4.8), familial testicular cancer (RR 3 to 10) and gonadal dysgenesis (>6%) [26]. Studies of males with first-degree relatives having TGCTs have demonstrated a genetic defect on the X-chro-mosome at Xq27. Infertility, twin-ship, and testic-ular atrophy are other factors that have been considered as ''probable established associations" with the development of TGCTs. In the infertile population, the highest risk is for those men with extremely low sperm counts (<3 x 106/mL) and atrophic testicles (volume <12 mL) [27]. Scrotal trauma was thought to have been linked to testicular cancer but no biologic explanation has been established and data have not supported this association [28]. Likewise, inguinal hernia has been a popular condition thought to predispose to TGCTs. There are conflicting studies on the subject because congenital hernias often occur with cryptorchidism, which is a known risk factor. However, there is no associated risk of TGCTs in patients without an undescended testicle and an inguinal hernia [23].

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