PMC5671707_01
Coronal CT showing mass discreet from undescended left testicle.
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A CT scan obtained at the OSH revealed a 14 x 18 x 20 cm abdominopelvic mass causing ureteral obstruction and bilateral hydronephrosis, with no retroperitoneal lymphadenopathy (Figure 1).
Ultrasound of normal right testicle.
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Ultrasound of the right testis revealed no lesions (Figure 2).
FNA smears and core biopsy of abdominal mass. Malignant cells with high nuclear to cytoplasmic ratio, pleomorphic nuclei, and macronucleoli, singly and in loose clusters, in a background of small lymphocytes (Papanicolaou stain, x400) (a); core biopsy section shows similar tumor cells (H&E stain, x400) (b); tumor cells show immunoreactivity to Oct-3/4 (c) and c-kit (d).
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The percutaneous biopsy returned positive for metastatic seminoma (Figure 3).
Left testicle, orchiectomy. Atrophic seminiferous tubules with small diameters, absence of spermatogenesis, increased numbers of Sertoli cells, and thickened basement membranes (hematoxylin-eosin stain, x200).
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The left radical orchiectomy specimen contained no tumor (Figure 4).
Retroperitoneal mass, excision. Nonviable tumor with extensive hyalinization and xanthogranulomatous reaction, and epididymis (a) (H&E, x40); testicular parenchyma with extensive tubular atrophy, Sertoli cell hyperplasia, and clusters of small seminiferous tubules with pseudostratified Sertoli cells. Some tubules show Sertoli cell-produced basement membrane-like material inside the hypoplastic tubules (b) (H&E, x200); colonic wall adjacent to nonviable tumor showing xanthogranulomatous reaction (c); colonic mucosa with no pathologic changes (d) (c and d: H&E, x40). Immunoperoxidase stain with antibody against OCT 3/4 shows absence of germ cell neoplasia in situ in atrophic tubules (e) (DAB and hematoxylin counterstain, x200).
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PET imaging demonstrated pet avidity in the region of the residual mass, so the patient was taken back to the operating room, 5 months after completion of chemotherapy. Pathology from this specimen showed no viable tumor (Figures 5 and 6) but did contain testicular parenchymal tissue.
Gross photograph of retroperitoneal mass. A 4.3 cm lobulated solid white-yellowish mass with fibrous bands and extensive necrosis is seen adjacent to the undescended testis and a segment of colon.
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PET imaging demonstrated pet avidity in the region of the residual mass, so the patient was taken back to the operating room, 5 months after completion of chemotherapy. Pathology from this specimen showed no viable tumor (Figures 5 and 6) but did contain testicular parenchymal tissue.