PMC4367039_01
(a) Orchiectomy specimen showing a solid whitish mass with focal cystic and hemorrhagic areas and residual normal testicular tissue in upper pole (star) (b) photomicrograph showing gradual transition from normal rete testicular lining to dysplastic and malignant lining in the direction of arrow (H and E, x40) (c) photomicrograph showing tubules and cords of malignant cells in desmoplastic stroma infiltrating the seminiferous tubules (broken arrow) (H and E, x100) (d) photomicrograph showing retiform tubules and solid areas with kaposiform (broken arrow) channels (H and E, x100)
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F1
On cut section, a whitish-tan solid mass measuring 10.2 cm x 7.4 cm x 5.6 cm with focal cystic and hemorrhagic areas were found which almost replaced the normal testicular tissue [Figure 1a]. A distinct but gradual transition from normal rete testicular lining to dysplastic and malignant epithelium was noted [Figure 1b]. The epithelial tumorous part demonstrated varied patterns namely tubules and cords (sertoliform) in desmoplastic stroma, elongated and compressed branching tubules (retiform), solid areas with tiny slit-like channels (kaposiform) and slender papillae with thin fibrovascular cores [Figures 1c, d and 2a].
(a) Biphasic area of the adenocarcinoma showing papillary structures with fibrovascular core along with spindle cell component arranged in fascicles (H and E, x100) (b) photomicrograph showing epithelial tufts projected into the large dilated epithelium-lined channels of rete testis mimicking renal glomeruli (H and E, x100) (c) photomicrograph of lining cuboidal to columnar epithelial cells showing moderate pleomorphism (H and E, x400) (d) photomicrograph demonstrating epididymis (solid arrow) and ductuli efferentes (broken arrow) free from infiltrating tumor mass (H and E, x100)
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F2
The epithelial tumorous part demonstrated varied patterns namely tubules and cords (sertoliform) in desmoplastic stroma, elongated and compressed branching tubules (retiform), solid areas with tiny slit-like channels (kaposiform) and slender papillae with thin fibrovascular cores [Figures 1c, d and 2a]. The epithelial tufts projecting into the large cyst-like dilated epithelium-lined channels of rete testis, morphologically mimicking renal glomeruli was also appreciated [Figure 2b]. The epithelial lining cells were cuboidal to columnar with eosinophilic cytoplasm, focal areas of nuclear stratification and moderate pleomorphism [Figure 2c]. Solid cords of tumor infiltrated into the seminiferous tubules that showed maturation arrest, but appeared to spare the epididymis and ductuli efferentes [Figure 2d].
(a) Photomicrograph of sarcoma-like area of the tumor mass displaying spindle cells arranged in storiform pattern and compressed seminiferous tubules (H and E, x100) (b) photomicrograph showing spindle cells in storiform pattern, brisk mitotic activity and moderate pleomorphism (H and E, x400) (c) photomicrograph showing metaplastic bone formation and necrosis in sarcoma-like area (H and E, x100) (d) photomicrograph showing diffuse and strong positivity of vimentin in sarcoma-like area (x100)
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F3
Predominantly sarcoma-like areas revealed mostly storiform pattern and short fascicles of moderately atypical spindle cells with brisk mitotic figures, areas of necrosis and metaplastic bone formation [Figure 3a-c]. Vimentin was strongly and diffusely positive in spindle cells of sarcomatoid areas [Figure 3d].