PMC5470564_01
- A and B - Ultrasonography of the left scrotal sac showing a heterogeneous mass with some scattered cystic areas (notedly in B).
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The tumor measured 11.6 x 9.5 x 6.8 cm (Figure 1).
- Gross view of the surgical specimen showing in: A - longitudinal section of left testicle and scrotal sac showing paratesticular tumor involving the testicle with fascicular areas, and in B - in detail, infiltration of testicular parenchyma in an area of discontinuity of the tunica albuginea.
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The epididymis was non-identified (Figure 2).
- Photomicrography of the surgical specimen (paratesticular tumor) showing: in A - stromal infiltration by solid tumor with epithelioid pattern (HE, 200X); B - infiltration by sarcomatoid spindle cells (HE,200X); C - immunohistochemical positive reaction for calretinin (400X); D - immunohistochemical positive reaction for WT-1 (400X).
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The morphological features (Figure 3), associated to the Immunohistochemical panel (Table 1) were compatible with the diagnosis of biphasic (epithelioid and sarcomatoid) malignant paratesticular mesothelioma with desmoplasic areas.
- Abdominal CT. A - Coronal reformation showing a heterogeneous mass involving the aorta and left iliac artery; B - Axial plane showing periaortic lymph nodes, delayed concentration/excretion of the contrast, and slight hydronephrosis; C - Axial plane showing lymph nodes conglomerate with signs of central necrosis along the left iliac artery; D - axial plane - multiple bilateral enlarged inguinal lymph nodes.
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An impairment of concentration and elimination of intravenous contrast by the left kidney accompanied by moderate hydronephrosis were found, as well as a few non-calcified pulmonary nodules scattered bilaterally with up to 1.1 cm in the superior segment of the right lower lobe (Figure 4).