Burned-out testis tumor

Burned-out testis tumors 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.

Pathology

Retroperitoneal germ cell tumors are more often secondary (unlike mediastinal and CNS germ cell tumors), and for secondary retroperitoneal germ cell tumors, the testes 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. Non-seminomatous germ cell tumors have the highest rate of regression.

Radiographic features

Ultrasound

• 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.

Differential diagnosis

• testicular microlithiasis
• old testicular traumatic injury