Gynecomastia and cancer of the testies

  My fifteen yr. old son was recently diagnosed with Gynecomastia.  He has a tender, enlarged right nipple.  I  have read about the connection between gynecomastia and testical cancer and am concerned.  The doctor did not perform an exam of the testies.  I have instucted my son to perform a self exam regularly.  My question is:  What are the other signs/symptoms of testical cancer and should I have my son return to the doctor now for a testical exam?
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Dear Kathleen:
Most gynecomastia in this age group are related to reaching puberty and of no significance unless the cosmetic aspects become significant.
Gynecomastia in children or young adults may be the result of a variety of conditions most of which are very rare such as interstitial cell tumors of the testes, feminizing adrenal tumors, or mixed gonadal dysgenesis, to name a few.  However, there are usually significant symptoms or abnormalities associated with some of these conditions (especially the last two mentioned) which rarely get missed beyond a very young age.  Therefore, I will try to answer your question specifically as it pertains to testicular tumors and gynecomastia.  Gynecomastia in patients with interstitial cell tumors are due to the endocrine (hormonal) activity of these tumors.  The incidence of these tumors is reported anywhere from 1.6 to 3 percent of all testicular tumors.  Therefore, considering the fact that the incidence of testicular tumors in boys is relatively rare, the overall incidence of this specific tumor falls dramatically.  Never the less, these patients develop gynecomastia and the associated symptoms are testicular mass, testicular pain, early (precocious) puberty, and diminished libido in individuals who have reached puberty. There maybe morning vomiting prior to the development of gynecomastia.  Treatment would start with an orchiectomy (removal of the testicle) with further treatment depending of the stage of the tumor. If you are concerned about a testicular mass that becomes evident on self examination, you should take your son to see a urologist who can assess him in person and make the appropriate recommendations.
Wish you the best.
This information is provided for general medical education purposes only.  Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653 6568).
Sincerely,
HFHS M.D.-JJ
*Keyword: gynecomastia, testicular tumors