PMC5359450_01
Abdominal computerized tomography showing a large mass in the upper retroperitoneum compressing the vena cava. Thrombotic occlusion of vena cava with extension of intravascular clotting into both iliac veins.
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Further clinical evaluation revealed a right-sided testicular mass and a thrombosis of the vena cava with extension of the intravascular clotting into both iliac veins (Figure 1).
Histological section of the orchiectomy specimen showing pure seminoma. Haematoxylin-eosin stain, original x100.
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Histologic evaluation revealed pure testicular seminoma (Figure 2).
Abdominal CT scan showing a 5 x 6 cm mass with several calcifications between abdominal aorta and vena cava below the left renal vein: location is identical with metastatic site at first presentation.
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Abdominal CT revealed an oval mass sized 5 x 6 cm located in the retroperitoneum caudal to the left renal vein and between vena cava and abdominal aorta (Figure 3).
Cut section of the retroperitoneal mass after surgical excision: firm white-greyish mass and a clearly demarcated rim.
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Cut section of the specimen revealed a firm white-greyish mass with several bone-like appearing tiny spots and a clearly demarcated rim (Figure 4).
(a) Histological section of the resected abdominal mass: representative images of the tumour, composed of dispersed cells with no atypia, sometimes with a background of collagen fibers, resembling neurofibroma. Haematoxylin-eosin stain, original x50. (b) Histological section of the resected abdominal mass: More hypercellular areas with moderate nuclear atypia, resembling a malignant peripheral nerve sheath tumour (MPNST). Haematoxylin-eosin stain, original x50.
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Given the overall rather benign neurogenic differentiation with focal increased cellularity, nuclear atypia, and mitotic activity, the diagnosis of neurofibroma with transition into a low-grade malignant peripheral nerve sheath tumour (MPNST) was made (Figures 5(a) and 5(b)).
FISH analysis of resected abdominal mass: dual color probe (ZytoLight KRAS/CEN 12), demonstrating polysomy and isochromosome 12p (CEN 12: red; KRAS: green); magnification 1000x.
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Fluorescence in situ hybridization (FISH) examination revealed excess genetic material of chromosome 12p (isochromosome 12p) (Figure 6).