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Presented by Dr. Jonathan Epstein and prepared by Dr. J. Judd Fite.
Case 1. History: A 65 year old man presented with a testicular mass.
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Question 1 of 1
1. Question
Case 1. History: A 65 year old man presented with a testicular mass.
Correct
Answer: D. Metastatic Carcinoma
Histology: The tumor consists of nests of cell, individual glands, and focal cribriform glandular formation with dilatation of the rete testis. The nuclei are relatively uniform without marked pleomorphism and medium centrally located nucleoli.
Discussion: The tumor does not resemble any of the typical patterns or cytology seen in germ cell tumors or sex cord stromal tumors. It is not as pleomorphic as embryonal carcinoma which also does not make well-formed glands. Yolk sac tumor can have many architectural patterns, yet none consists of small nests of cells with glands and focal cribriform formation. The glands in yolk sac tumor resemble intestinal glands often with subnuclear vacuoles. Sertoli cell tumor typically has broad bands of dense pink collagen intersecting the tumor which is absent in the current case and cribriform formation is not seen in these tumors. The morphology of the tumor in the testis is consistent with metastatic prostate cancer. Metastatic prostate cancer is one of the most common tumors to spread to the testis. In the past before chemical castration when bilateral orchiectomy was the treatment for metastatic prostate cancer, it was not uncommon to see involvement of the testis. Typically, there will be a history of prostate cancer, as was present in this case. If the history is not present, immunohistochemistry for prostate specific markers can be performed to verify the diagnosis.
Incorrect
Answer: D. Metastatic Carcinoma
Histology: The tumor consists of nests of cell, individual glands, and focal cribriform glandular formation with dilatation of the rete testis. The nuclei are relatively uniform without marked pleomorphism and medium centrally located nucleoli.
Discussion: The tumor does not resemble any of the typical patterns or cytology seen in germ cell tumors or sex cord stromal tumors. It is not as pleomorphic as embryonal carcinoma which also does not make well-formed glands. Yolk sac tumor can have many architectural patterns, yet none consists of small nests of cells with glands and focal cribriform formation. The glands in yolk sac tumor resemble intestinal glands often with subnuclear vacuoles. Sertoli cell tumor typically has broad bands of dense pink collagen intersecting the tumor which is absent in the current case and cribriform formation is not seen in these tumors. The morphology of the tumor in the testis is consistent with metastatic prostate cancer. Metastatic prostate cancer is one of the most common tumors to spread to the testis. In the past before chemical castration when bilateral orchiectomy was the treatment for metastatic prostate cancer, it was not uncommon to see involvement of the testis. Typically, there will be a history of prostate cancer, as was present in this case. If the history is not present, immunohistochemistry for prostate specific markers can be performed to verify the diagnosis.
