PMC8263218_01
(a) Conglomerating bilateral paraaortic nodal mass circumferentially encases without narrowing the aorta. (b) The large left-side mass measures 9.5 x 7.5 x 10.5 cm containing a large internal necrosis. It is inseparable from the left gonadal vessels (arrow), superiorly extends to the renal vein level (arrowhead), and laterally it displaced the kidney and renal pelvis (*) causing mild hydronephrosis. The 3.5 x 5.5 x 4.5 cm right-side mass indents the inferior vena cava.
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CT showed a 12.1 x 10.8 x 8.6 cm mass encasing the aorta circumferentially in the retroperitoneum (Figure 1). Containing considerable internal necrosis, the 9.5 x 7.5 x 10.5 cm left-side mass displaced the left kidney and renal pelvis, which caused mild left hydronephrosis.
(a) Low power view infiltrative tumor cells mixed with lymphocytes. (b) High power view showing the infiltrating tumor cells with a sheet-like growth pattern with medium to large size, pale to clear cytoplasm, and polyclonal nuclei. (c) The tumor cells were positive for pan-cytokeratin. (d) The tumor cells are positive for MOC31. (e) The tumor cells were diffusely and strongly positive for Oct-3/4. (f) The tumor cells were diffusely and strongly positive for CD117.
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Microscopic examination revealed that the lesion was comprised of infiltrative malignant cells mixed with lymphocytes (Figure 2(a)). Some of them were undergoing mitosis (Figure 2(b)). TTF-1, CK7, CK20, CDX2, synaptophysin, chromogranin, and NKX3.1. The malignant tumor showed positive for pan-cytokeratin (Figure 2(c)) and MOC31 (Figure 2(d)). In comparison, the cells were diffusely and strongly positive for OCT-3/4 (Figure 2(e)) and CD117 (Figure 2(f)) which are the markers of germ cells.
(a, b) US demonstrate a 2.4 x 1.6 x 3.7 cm left intratesticular heterogenous hypoechoic mass ((a) sagittal view; (b) transverse view). (c) Color Doppler transverse view demonstrates asymmetrical enlargement of the left testicle (right side) containing a heterogeneous mass, compare to the right testicle (right side). (d) Mild internal vascularity of the mass in the left testicle.
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Testicular ultrasound revealed a 2.4 x 3.7 x 1.6 cm heterogeneous hypoechoic mass in the left testicle (Figures 3(a) and 3(b)). The Color Doppler showed asymmetrical enlargement of the left testicle containing a hypervascular tissue mass compared to the right testicle (Figures 3(c) and 3(d)).