Testicular teratoma nodal metastases

Case contributed by Assoc Prof Frank Gaillard

Presentation

Testicular lump.

Patient Data

Age: 30 years
Gender: Male
Ultrasound

Abdomen

Abdominal ultrasound revealed large hypoechoic retroperitoneal masses of no internal vascularity.

CT

Abdomen

CT demonstrates very large retroperitoneal low-density nodal masses. They displace the IVC towards the right side with an intraluminal non-enhancing lesion at the infrarenal level consistent with a bland thrombus.

Mild bilateral hydronephrosis, more on left kidney.

Mild free ascites.

Ultrasound

Scrotum

Ultrasound demonstrates a heterogeneous right testicular mass with predominate cystic components and a hypoechoic solid component showing marginal calcific foci. 

Unremarkable left testis. Few left epididymal cysts are noted.

Case Discussion

Pathologically proven testicular teratoma.

Histology

Macroscopic description

Specimen container labeled 'right testis'. Please note: fresh tissue from this specimen was sent for tissue bank. A previously extensively incised, ragged and irregular testis  45 mm x 30 mm x  25 mm with attached epididymis 25 mm x 20 mm x 15 mm 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 tumor 17 mm in diameter. Tumor lies adjacent to but does not macroscopically involve the hilum. The tumor is 15 mm from the epididymis. The testicular parenchyma away from the tumor appears unremarkable. 

Microscopic description

The entire macroscopic tumor 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 tumor 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 0.5 mm, 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 recognized.

Some seminiferous tubules adjacent to the teratoma shows intraepithelial germ cell neoplasia (with  PLAP-positive large cells). The tumor 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 lymphovascular 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
Published: 6th Oct 2010
Last edited: 9th Apr 2021
Tag: testis
Inclusion in quiz mode: Included