PMC4555909_01
(a) Bilateral testicular enlargement (b) Computed tomography scan showing bilateral enlarged testes of heterogenous echotexture (c) Gross appearance of tumor, large grey white fleshy mass
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F1
General physical examination was unremarkable, with no palpable lymphadenopathy or hepatosplenomegaly except for visible bilateral testicular enlargement [Figure 1a]. Ultrasound of the scrotum showed bilaterally enlarged testes of heterogenous echotexture and bilateral hydrocoele with enhancement on computerized tomography (CT) scan [Figure 1b]. Grossly the testes weighed 220 g and measured 8 cm x 5 cm x 3 cm and 6 cm x 4 cm x 2 cm with a large, white, fleshy, soft, slightly tan mass replacing almost the entire cut surface with no evident necrosis or hemorrhage [Figure 1c].
(a) Cytological smear showing atypical lymphoid cells with plasmablastic differentiation (MGG, x400) (b) Microphotograph showing diffuse sheets of highly atypical cells having large round nuclei, coarse chromatin, and 1 or 2 prominent nucleoli (H and E, x400) (c) Tumor cells showing immunopositivity for CD38 and (d) CD138 (IHC, x400)
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F2
Fine-needle aspiration cytology of both the testes was done and cytological smears showed atypical large lymphoid cells showing plasmacytoid and immunoblastic differentiation, having basophilic cell cytoplasm, eccentric nuclei with 1-2 prominent nucleoli [Figure 2a]. Microscopic examination showed diffuse sheets of highly atypical cells having large round nuclei, coarse chromatin, and 1 or 2 prominent nucleoli [Figure 2b]. On immunohistochemistry, (IHC) tumor cells showed positivity for CD38 [Figure 2c], CD138 [Figure 2d], vimentin, and epithelial membrane antigen.