Testicular teratoma nodal metastases

Case contributed by A.Prof Frank Gaillard

Presentation

30 year old male with a testicular lump.

Patient Data

Age: 30
Gender: Male
Modality: CT

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Modality: Ultrasound

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Case Discussion

Ultrasound demonstrates a heterogeneous right testicular mass. 

CT demonstrates very large low density nodal masses. 

Pathologically proven testicular teratoma.

Histology

Macroscopic description

Specimen container labelled 'right testis'. Please note: fresh tissue from this specimen was sent  for tissue bank. A previously  extensively incised, ragged and  irregular testis  45mm x 30mm x  25mm with attached epididymis 25mm x 20mm  x 15mm  and spermatic  cord 80mm long  and 15mm in  diameter. Within the  testicular parenchyma, abutting  but not involving  the tunica albuginea is a firm, solid  and cystic white grey  tumour 17mm in diameter. Tumour lies adjacent  to, but does  not macroscopically  involve the hilum. The tumour is 15mm from the epididymis. The testicular parenchyma away from the tumour appears  unremarkable. 

Microscopic description

The entire macroscopic tumour has been  submitted for examination. It shows features of a teratoma.  This is unencapsulated, circumscribed with an area of fibrosis and calcification surrounding  the main mass of the lesion. The tumour comprises  cystic space  lined by  cytologically bland cuboidal and columnar   epithelial  cells.    Some of  the columnar cells  have  cilia recapitulating   respiratory type  epithelium  whereas others  have goblet cells, with  more enteric  like features.   These  cysts are  surrounded by dense fibrosis with  hemosiderin and macrophages. There is also one small nodule of atypical  epithelioid  cells measuring approximately  0.5mm, and these are positive  with  immunostains cytokeratin  AE1/3  and negative for inhibin, PLAP  and cytokeratin  CK 5/6. While  the cystic  component of the lesion is of a mature teratoma, the  small solid focus is felt to represent an immature  teratomatous  element.  No other  components of  invasive germ cell neoplasia are recognised.

Some seminiferous  tubules adjacent  to the teratoma  shows intraepithelial germ cell neoplasia (with  PLAP-positive large  cells). The tumour does not appear to involve the hilum or  epididymis.  There are areas of Leydig cell hyperplasia within the testicular parenchyma. The spermatic cord resection margin  is  clear  of  the  lesion.    There  is no  lymphvascular   space involvement.

Final diagnosis

Testicular teratoma with mature (more than 90%) and immature (less than 5%) elements; with areas of intraepithelial germ cell neoplasia (carcinoma in situ).

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Case Information

rID: 10982
Case created: 6th Oct 2010
Last edited: 1st Feb 2016
System: Urogenital
Tag: testis
Inclusion in quiz mode: Included

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