Testicular carcinoma

Case contributed by A.Prof Frank Gaillard

Presentation

Previous Meckel's diverticulum resection. Now right sided abdominal discomfort / pain.

Patient Data

Age: 30 years
Gender: Male

CT abdomen / pelvis

Modality: CT

There is a large (45 x 33 x 48mm) centrally hypodense lesion with internal septations at the level of L4 anterior to and compressing the IVC. No other masses or lymphadenopathy. 

Surgical material in keeping with previous Meckels diverticulum resection with evidence of approach through right lateral wall. No evidence of appendicitis. 

There is a trace of free fluid in the pelvis. The liver, gallbladder, spleen, pancreas, kidneys and adrenals are unremarkable. The lung bases are clear. No destructive osseous lesion.

Conclusion:

Round mass anterior to the IVC resulting in IVC compression. The appearance is suggestive of metastatic lymphadenopathy. In this patient demographic right testicular tumour is suspected.

Ultrasound testes

Modality: Ultrasound

 RIGHT

Right testis measures 39 x 16 x 40 mm. There is a 12 mm hypoechoic mass in the right testis.  Throughout the right testis there are multiple hyperechoic foci in keeping with microlithiasis. Normal vascularity seen. The epididymus is unremarkable. No hydrocele/varicocele.

LEFT

Left testis measures 46 x 28 x 51 mm. The left testis is homogeneous in appearance with no focal lesion or microlithiasis. Normal vascularity seen.The epididymus is unremarkable. No hydrocele/varicocele.

Conclusion:

Right testicular mass (12 mm) highly suspicious for primary testicular tumour, with underlying microlithiasis.

Blood tests results:

  • AFP: 849 (Normal: <8.1)
  • tHCG: <1 (Normal: <3)
  • LDH: 544 IU/L (Normal: 210-420)

Orchiectomy

Modality: Pathology

MACROSCOPIC DESCRIPTION:

Right orchidectomy specimen, 33g, comprising testis, epididymis and spermatic cord. In the mid pole of the testis, a 12x12x10mm soft to rubbery unencapsulated white nodule is seen.  The borders are blurred and merge with adjacent parenchyma in areas.  The nodule is confined within the testis, with no extension into the hilum, spermatic cord or through tunica albuginea.  The surrounding parenchyma is soft and unremarkable.  There is no fluid accumulation in the tunica vaginalis.

The patient went on to have an orchidectomy. 

MICROSCOPIC DESCRIPTION:

The sections through the nodule show an unencapsulated, hypocellular area, confined within the testis and comprising predominantly pale eosinophilic stromal material with sparse stellate and spindle cells, small blood vessels and scattered mononuclear embedded within.  The stromal material merges into the space between the adjacent seminiferous tubules.  No viable tumour seen on H&E sections.  In the adjacent testis approximately 50% of tubules are atrophic.  A few show luminal calcification. The remainder show active spermatogenesis. There are foci of Leydig cell hyperplasia.  Intratubular germ cell neoplasia is not seen.  The cut end of the spermatic cord is normal.

In immunostains, there is no staining for AFP, HCG, PLAP or CD30. 

FINAL DIAGNOSIS: Scar 12mm in diameter; no viable tumour present.

Case Discussion

This case illustrates metastatic testicular germ cell tumour with a burnt-out primary tumour. The patient was treated with chemotherapy. The retroperitoneal mass has shrunk and he is awaiting resection of the retroperitoneal mass. 

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Case Information

rID: 22521
Case created: 5th Apr 2013
Last edited: 26th Nov 2016
System: Urogenital
Inclusion in quiz mode: Included

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