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Presented by Jonathan Epstein, M.D. and prepared by Orin Buetens, M.D.
Case 6: Epididymal lesion in an 88-year-old male.
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1. Question
Week 42: Case 6
Epididymal lesion in an 88-year-old male.images/7168a.jpg
images/7168b.jpg
images/7168c.jpgCorrect
Answer: Degenerative atypia
Histology: Within the epididymis there are scattered markedly enlarged nuclei. These nuclei are hyperchromatic yet have a smudged chromatin appearance without increased mitoses or prominent nucleoli. Some of the nuclei contain vacuoles.
Discussion: The histological findings in this case resemble the atypia seen within seminal vesicles. Nuclear atypia has been described to be focally present within the epididymis in approximately 14% of patients, and tends to occur in men of older age. In contrast to true neoplastic atypia, the cells have a degenerative appearance and are not accompanied by increased mitotic activity or prominent nucleoli. Seminomas may extend with a pagetoid spread into the rete testis. It is not common to see them extend into the epididymis. Furthermore, seminoma cells are characterized by large prominent nucleoli and pale to clear cytoplasm. When they spread in a pagetoid fashion, they tend to be situated within lacunae.
Incorrect
Answer: Degenerative atypia
Histology: Within the epididymis there are scattered markedly enlarged nuclei. These nuclei are hyperchromatic yet have a smudged chromatin appearance without increased mitoses or prominent nucleoli. Some of the nuclei contain vacuoles.
Discussion: The histological findings in this case resemble the atypia seen within seminal vesicles. Nuclear atypia has been described to be focally present within the epididymis in approximately 14% of patients, and tends to occur in men of older age. In contrast to true neoplastic atypia, the cells have a degenerative appearance and are not accompanied by increased mitotic activity or prominent nucleoli. Seminomas may extend with a pagetoid spread into the rete testis. It is not common to see them extend into the epididymis. Furthermore, seminoma cells are characterized by large prominent nucleoli and pale to clear cytoplasm. When they spread in a pagetoid fashion, they tend to be situated within lacunae.
