In a few cases, GCT of the testis can present with systemic symptoms secondary to endocrine effects of the primary tumor itself. Gynecomastia (Figure 5-9) is a presenting feature in up to 5% of men with testicular tumors, due to an imbalance resulting from a relative deficiency of androgenic suppression and the predominance of estrogenic stimulation of the growth of breast tissue. This can be mediated by an increase in gonadotropin level, particularly that of human chorionic gonadotropin (hCG), and an increase in estradiol levels. Another factor is the low level of androgens produced by some men with tes-ticular atrophy, particularly those with a history of bilateral cryptorchidism. Interstitial cell testicular tumors such as Leydig cell and Sertoli cell tumors can manufacture hormones and raise estradiol levels, leading to gynecomastia.
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