Presentation
Scrotal lump.
Patient Data
The left testis is enlarged and is almost completely replaced by a heterogeneous lobulated mass. The right testis has a normal appearance.
Histopathology:
MACROSCOPIC DESCRIPTION:
"Left radial orchiectomy": An orchiectomy specimen with testis (103 g, 68 x 57 x 42 mm) and spermatic cord (53 mm length, up to 22 mm diameter). The tunica vaginalis is shiny smooth and mobile, inked black.
Replacing almost the entire testis is a homogeneous lobulated soft tan-pink tumor 64 x 54 x 40 mm. Tumor extensively abuts tunica albuginea but appears clear of tunica vaginalis. There is possible infiltration of rete however the epididymis appears clear of tumor. Adjacent to tumor there is a small rim of normal appearing testis parenchyma.
MICROSCOPIC DESCRIPTION:
The sections of testis show a tumor comprising sheets and nests of polygonal cells separated by fibrovascular septa containing lymphocytes. Tumor cells have abundant pale cytoplasm, large vesicular nuclei and prominent nucleoli. Other germ cell tumor components and syncytiotrophoblastic cells are not identified. Tumor focally infiltrates rete testis however does not invade epididymis. Tumor 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 tumor. Adjacent testis parenchyma shows intratubular germ cell neoplasia.
DIAGNOSIS: Seminoma.
Case Discussion
Seminoma is the most common testicular tumor in the 40+ age group. Often serum markers such as LDH, bHCG and AFP are raised (as was the case in this patient).