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Presented by Dr. Jonathan Epstein and prepared by Dr. Katelynn Davis.
Case 2. A 35 year old man was noted to have a mass in testis and an orchiectomy was performed.
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1. Question
A 35 year old man was noted to have a mass in testis and an orchiectomy was performed.
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Answer: Scar resulting from regressed germ cell tumor
Histological Description: The testis had a fibrotic mass (2.9 cm) with ill-defined granulomatous reaction. Focally, there are seminiferous tubules surrounded by a lymphocytic infiltrate with isolated cells or a single row along a thickened basement membrane. The cells have clear cytoplasm, irregular nuclear contours, coarse chromatin, and enlarged single or multiple nucleoli. These seminiferous tubules lack active spermatogenesis and contain mostly Sertoli cells.
The background testicle have predominantly sclerotic seminiferous tubules, with <5% of seminiferous tubules showing spermatogenesis.Discussion: The findings in this case are classic for a regressed germ cell tumor. Whenever there is a dense scar in the testis, which has wiped out seminiferous tubules, one has to consider a regressed germ cell tumor. In contrast to trauma, there is typically not a lot of hemosiderin and the surrounding testis shows Sertoli only pattern in many tubules. If there is no germ cell neoplasia and no history of metastatic germ cell tumor, one can conclude that the findings are suspicious for a regressed germ cell tumor. However, finding germ cell neoplasia in situ in the setting of a testicular scar is diagnostic of a regressed germ cell tumor. One can see an associated granulomatous reaction to both invasive and germ cell neoplasia in situ. In this case, we verified the germ cell neoplasia in situ with positive staining for OCT3/4. Most frequently, patients present with distant metastases of germ cell tumor and are subsequently discovered to have sonographic signs of a regressed germ cell tumor. Regression does not affect prognosis with prognosis being stage dependent.
Incorrect
Answer: Scar resulting from regressed germ cell tumor
Histological Description: The testis had a fibrotic mass (2.9 cm) with ill-defined granulomatous reaction. Focally, there are seminiferous tubules surrounded by a lymphocytic infiltrate with isolated cells or a single row along a thickened basement membrane. The cells have clear cytoplasm, irregular nuclear contours, coarse chromatin, and enlarged single or multiple nucleoli. These seminiferous tubules lack active spermatogenesis and contain mostly Sertoli cells.
The background testicle have predominantly sclerotic seminiferous tubules, with <5% of seminiferous tubules showing spermatogenesis.Discussion: The findings in this case are classic for a regressed germ cell tumor. Whenever there is a dense scar in the testis, which has wiped out seminiferous tubules, one has to consider a regressed germ cell tumor. In contrast to trauma, there is typically not a lot of hemosiderin and the surrounding testis shows Sertoli only pattern in many tubules. If there is no germ cell neoplasia and no history of metastatic germ cell tumor, one can conclude that the findings are suspicious for a regressed germ cell tumor. However, finding germ cell neoplasia in situ in the setting of a testicular scar is diagnostic of a regressed germ cell tumor. One can see an associated granulomatous reaction to both invasive and germ cell neoplasia in situ. In this case, we verified the germ cell neoplasia in situ with positive staining for OCT3/4. Most frequently, patients present with distant metastases of germ cell tumor and are subsequently discovered to have sonographic signs of a regressed germ cell tumor. Regression does not affect prognosis with prognosis being stage dependent.
