The association of gynaecomastia and testicular tumours is well described in the literature. A testicular examination should be routine as part of the assessment of young males presenting with breast enlargement. We describe two cases where gynaecomastia preceded the appearance of testicular swelling by several months. Case reports Case 1 A 27 year old man was routinely referred to a general surgery department and assessed by a breast surgeon (RB) for bilateral gynaecomastia. On examination,

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... testes were normal. Six months later he was referred to the urology department with a history of persistent terminal haematuria. The patient mentioned during the examination that he had discovered a lump in a testicle since his attendance at the breast clinic. He had paid no attention to it and had not complained about it to his general practitioner. An abdominal examination showed an epigastric mass. An urgent ultrasound scan confirmed a testicular tumour measuring 2.4×2.0×1.6 cm and a retroperitoneal mass measuring 6.9×7.3 cm resulting from metastatic deposits in para-aortic lymph nodes. His fetoprotein was raised (639 700 IU/l (normal < 7000 IU/l)), as was his total human chorionic gonadotrophin (64.0 IU/l (reference range 0.1-3 IU/l )). The patient was admitted urgently for radical orchidectomy and endoscopic assessment. The cystoscopy showed venous congestion of the bladder neck as the likely source of haematuria. Histology testing of the orchidectomy specimen showed 80% classic seminoma and 20% mature teratoma. The staging computed tomogram confirmed the enlargement of para-aortic and inguinal lymph nodes consistent with metastatic disease. The patient was referred to the regional oncology service for further treatment in the form of chemoradiation.