PMC3350010_01
(a) Transabdominal ultrasound showing a heterogeneously hypoechoic mass (M) with internal septations (white arrows) and central necrosis (arrowhead). (b) Color and spectral Doppler images showing few internal vascular channels with arterial flow. (c) T1W axial image of the abdomen. The tumor is hypointense causing mass effect on to the adjacent structures. The right kidney is pushed more posteriorly. (d) T2W axial image showing the tubular gonadal structure in the region of right inguinal canal. (e) MR spectroscopy showing a high choline peak compatible with a tumor spectrum.
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fig1
Further assessment of mass by an ultrasound showed a large predominantly hypoechoic solid mass measuring 22 cm x 17 cm x 10.56 cm with minimal echogenic internal septations and central necrosis (Figure 1(a)). Few vascular channels were detected on colour Doppler (Figure 1(b)). T1 hypointense and T2 hyperintense (Figures 1(c) and 1(d)). Moderate contrast enhancement with central necrosis was identified on postcontrast administration. The right kidney was mildly compressed posteriorly and the aorta, IVC were slightly displaced towards left. A 17 mm long tubular structure with a 14 mm higher signal intensity nodule were detected extending from the right groin to the right inguinal region which were thought to represent a rudimentary gubernaculum of testis +/- undescended testis (Figure 1(d)). Further MR spectroscopy showed markedly raised choline peak suggestive of tumor spectrum (Figure 1(e)).
Histology of the left gonad (Lt). (a) classical seminoma, with tumor cells with nests, anastomosing cords, and sheets, ill-formed tubular growth pattern, accompanied by a heavy lymphocytic infiltrate, H&E x100. (b) Large polygonal tumor cells, with glycogen-rich clear cytoplasm, PAS x200. (c) Tumor cells are immunoreactive to both placental alkaline phosphatase and to C-Kit (d), both x100.
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fig2
Histopathology of the resected specimen revealed classical seminoma from the left gonad (Figure 2) while right gonad showed presence of inactive sertoli cell tubules with no evidence of malignancy (Figure 3).
Histology of the right gonad (Rt). (a) Atrophic gonadal composed mainly of tubules of sertoli cells, with absence of germ cells, and the presence of interstitial Leydig cells, H&E x100. (b) The Sertoli tubules show inactive epithelial cells, absence of germ cells or atypia, H&E x200. (c) Both Sertoli cells and Leydig cells are immunoreactive to inhibin x100, while only Leydig cells react to Neuron-Specific Enolase x100 (d).
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fig3
Histopathology of the resected specimen revealed classical seminoma from the left gonad (Figure 2) while right gonad showed presence of inactive sertoli cell tubules with no evidence of malignancy (Figure 3).