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Presented by Dr. Pedram Argani and prepared by Dr. Sintawat Wangsiricharoen.
This is a 45 year old male with a testicular mass.
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1. Question
This is a 45 year old male with a testicular mass.
Correct
Answer: B. Adenomatoid tumor
Histologic Description: This lesion is based in the tunica or capsule of the testis, not the seminiferous tubules though it does abut the latter. The lesional cells are cord like and cuboidal in their appearance, with frequent vacuoles that mimic signet ring cell morphology. There is no atypia or significant mitotic activity. The lesional cells are immunoreactive for calretinin and not for CEA, confirming their mesothelial derivation.
Differential Diagnosis: Metastatic signet ring cell carcinoma would have a more destructive growth pattern, would not label for mesothelial markers, and would contain intracellular mucin in most cases. Seminomas should be centered in the testes, and would typically have a solid pattern with lymphoid rich septa. Yolk sac tumors may have prominent vacuoles, but these would demonstrate more atypia and be centered within the testes. None of the entities in the differential diagnosis would label for the mesothelial marker calretinin.
Adenomatoid tumors are well known mimics of neoplasia around the testes that can be encountered on frozen section. Others include the oncocytic tumors of the andrenogenital syndrome that mimic Leydig cell tumor, testicular epidermoid cysts that can mimic a teratoma, and reactive mesothelial proliferations.
Incorrect
Answer: B. Adenomatoid tumor
Histologic Description: This lesion is based in the tunica or capsule of the testis, not the seminiferous tubules though it does abut the latter. The lesional cells are cord like and cuboidal in their appearance, with frequent vacuoles that mimic signet ring cell morphology. There is no atypia or significant mitotic activity. The lesional cells are immunoreactive for calretinin and not for CEA, confirming their mesothelial derivation.
Differential Diagnosis: Metastatic signet ring cell carcinoma would have a more destructive growth pattern, would not label for mesothelial markers, and would contain intracellular mucin in most cases. Seminomas should be centered in the testes, and would typically have a solid pattern with lymphoid rich septa. Yolk sac tumors may have prominent vacuoles, but these would demonstrate more atypia and be centered within the testes. None of the entities in the differential diagnosis would label for the mesothelial marker calretinin.
Adenomatoid tumors are well known mimics of neoplasia around the testes that can be encountered on frozen section. Others include the oncocytic tumors of the andrenogenital syndrome that mimic Leydig cell tumor, testicular epidermoid cysts that can mimic a teratoma, and reactive mesothelial proliferations.
