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Left testis is enlarged, and is almost completely replaced by a heterogeneous lobulated mass. Right testis has a normal appearance.
"Left radial orchidectomy": An orchidectomy specimen with testis (103g, 68x57x42mm) and spermatic cord (53mm length, up to 22mm diameter). The tunica vaginalis is shiny smooth and mobile, inked black.
Replacing almost the entire testis is a homogeneous lobulated soft tan-pink tumour 64x54x40mm. Tumour extensively abuts tunica albuginea but appears clear of tunica vaginalis. There is possible infiltration of rete however the epididymis appears clear of tumour. Adjacent to tumour there is a small rim of normal appearing testis parenchyma.
The sections of testis show a tumour comprising sheets and nests of polygonal cells separated by fibrovascular septa containing lymphocytes. Tumour cells have abundant pale cytoplasm, large vesicular nuclei and prominent nucleoli. Other germ cell tumour components and syncytiotrophoblastic cells are not identified. Tumour focally infiltrates rete testis however does not invade epididymis. Tumour abuts but does not invade the tunica albuginea and is clear of tunica vaginalis. Definite lymphovascular invasion is not present. The spermatic cord margin is clear of tumour. Adjacent testis parenchyma shows intratubular germ cell neoplasia.
Seminoma is the most common testicular tumour in the 40+ age group. Often serum markers such as LDH, bHCG and AFP are raised (as was the case in this patient).