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Presented by Dr. Andres Matoso and prepared by Dr. Kevan Salimian
37 year old male with a testicular mass.
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1. Question
37 year old male with a testicular mass. Choose the correct diagnosis.
Correct
Answer: Nephroblastoma arising in teratoma
Histology: The tumor shows areas of primitive neural-type tubules lined by stratified epithelium and surrounded by poorly differentiated malignant cells.
Discussion: Somatic malignancies arising in teratomas with primitive appearing nests and tubules invites consideration of primitive neuroectodermal tumos (PNET) and nephroblastoma. PNET of the testis represent overgrowth of embryonic appearing neuroectodermal tissue. Some are pure but most have a small component of mixed germ cell tumor. Distinction with a teratoma with immature neural elements is based on the extent of the immature component (by consensus is >one 4x field or 5mm). Unlike peripheral PNETs, these tumors are not associated with chromosome 22 translocations. This case presented focal glomeruloid structures, diffuse cytokeratin stain and positive staining for WT1 which supports the diagnosis of neprhoblastoma.
References:
Am J Surg Pathol. 2014 Oct;38(10):1396-409.
Urology. 2007 Oct;70(4):812.e7-10.
J Urol. 1998 Jan;159(1):133-8.Incorrect
Answer: Nephroblastoma arising in teratoma
Histology: The tumor shows areas of primitive neural-type tubules lined by stratified epithelium and surrounded by poorly differentiated malignant cells.
Discussion: Somatic malignancies arising in teratomas with primitive appearing nests and tubules invites consideration of primitive neuroectodermal tumos (PNET) and nephroblastoma. PNET of the testis represent overgrowth of embryonic appearing neuroectodermal tissue. Some are pure but most have a small component of mixed germ cell tumor. Distinction with a teratoma with immature neural elements is based on the extent of the immature component (by consensus is >one 4x field or 5mm). Unlike peripheral PNETs, these tumors are not associated with chromosome 22 translocations. This case presented focal glomeruloid structures, diffuse cytokeratin stain and positive staining for WT1 which supports the diagnosis of neprhoblastoma.
References:
Am J Surg Pathol. 2014 Oct;38(10):1396-409.
Urology. 2007 Oct;70(4):812.e7-10.
J Urol. 1998 Jan;159(1):133-8.
