PMC5645480_01
Right testicular ultrasound demonstrating heterogeneity, which obscured the diagnosis of a testicular mass during patient's initial presentation.
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Scrotal ultrasound was concerning for testicular rupture (Fig. 1).
A: Coronal section from the CT abdomen and pelvis obtained at the patient's second presentation demonstrating the large right testicular mass. B: Right testicular ultrasound obtained at the patient's second presentation demonstrating continued heterogeneity.
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The differential diagnosis included malignancy, intermittent torsion, and prior testicular rupture (Fig. 2A and B).
A: Syncytiotrophoblastic cell shown among classic seminoma cells. B: Tumor cells staining strongly positive for placental alkaline phosphatase.
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Histology was consistent with pure seminoma with syncytiotrophoblastic cells (Fig. 3A). demonstrates these classic histological findings of large, round-polyhedral seminoma cells with distinct cell membranes, abundant clear cytoplasm, large central nuclei, and prominent nucleoli with syncytiotrophoblasts (hematoxylin and eosin). In this case, immunohistochemistry demonstrated that the cells stained strongly positive for placental alkaline phosphatase, further supporting the diagnosis of seminoma (Fig. 3B).