# Giant testicular germ‐cell tumours—An analysis of relative incidence and clinical features based on a clinical case series and a survey of the literature

## TL;DR

This study analyzed four new cases of giant testicular tumors and found that they are rare, with most cases linked to delayed diagnosis due to lack of awareness.

## Contribution

The study provides updated clinical insights into giant testicular germ cell tumors and highlights the role of diagnostic delay in their development.

## Key findings

- Giant testicular tumors occur in 0.5% of all germ cell tumor cases.
- Diagnostic delay due to personal misapprehension or lack of knowledge is a common cause of tumor growth.
- Most giant testicular tumors are nonseminomas and are often left-sided.

## Abstract

This work aimed to document four new cases with giant testicular germ cell tumour (GCT) and to evaluate their relative incidence and clinical characteristics based on a literature survey. Despite the well‐established trend over time towards declining tumour sizes in testicular GCTs, giant testicular tumours (>15 cm in diameter) are still reported in present times.

GCT patients treated during 2010–2025 were retrospectively evaluated with tabulating the following data: size of primary tumour (mm), age (years), histology, side and clinical stage (CS). The following parameters were calculated: relative frequency of giant GCTs; median tumour size in all GCTs and in various subgroups. A literature survey was conducted to identify previously published giant testicular GCTs followed by a descriptive evaluation of those cases.

Four (0.5%) giant GCTs were identified among 860 GCT patients, two seminomas and two nonseminomas, all having CS3 disease, two of whom were cured. The median tumour size was 32 mm in all GCTs, and 30 mm and 35 mm in seminomas (n = 541) and nonseminomas (n = 319), respectively. Median tumour size was significantly smaller in CS1 cases than in those with CS > 1 (32 mm vs. 38 mm). Of the 40 cases identified with the literature survey, 24 were nonseminomas, 62% were left‐sided, median age was 36 years, and 80% were cured. Diagnostic delay is the most frequent cause of excessive tumour growth.

Giant testicular tumours are observed in 0.5% of all GCT patients while the median tumour size of 32 mm observed herein is consistent with current reports. In most cases of giant GCT, personal misapprehension of the swelling, lack of knowledge or shame appears to be the key element causing diagnostic delay and consequently, extraordinary tumour growth. Information campaigns including individuals from socioeconomically underprivileged groups could help to increase men's awareness of genital diseases.