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Presented by Dr. Jonathan Epstein and prepared by Dr. Sintawat Wangsiricharoen.
A 23 year old man underwent an orchiectomy for testicular pain.
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Question 1 of 1
1. Question
A 23 year old man underwent an orchiectomy for testicular pain.
Correct
Answer: C. Necrotic seminoma
Histology: A section of testis shows foci of cellular necrosis. Surrounding the necrosis there is prominent fibrosis with hemosiderin deposition and inflammation. Seminiferous tubules that are present appear atrophic with Sertoli only pattern and sclerosis.
Discussion: Occasional seminomas can undergo extensive necrosis, yet in the center of coagulative necrosis see ghosts of seminoma cells, as in this case. Even though the tumor is dead, one can make out ghosts of cells with vesicular nuclei with large central eosinophilic nucleoli, typical of seminoma. The adjacent testis with fibrosis, inflammation, and hemosiderin in this case likely represents a regressed tumor. In contrast with torsion, the necrosis involves the entire testis and it is coagulative necrosis where outlines of necrotic seminiferous tubules are visible. In an infarct, which is usually due to vasculitis, it is focal but also results in coagulative necrosis. In some cases adjacent to necrotic seminoma, atrophic seminiferous tubules containing germ cell neoplasia in-situ (GCNIS). Positive PLAP, CD117, and OCT4 may be maintained in necrotic seminoma, and these stains were focally faintly positive in this case. The stage can be variable and even entirely necrotic seminoma, some patients can present with metastatic disease.
Reference: Miller JS, Lee TL, Epstein JI, et al. The Utility of Microscopic Findings and Immunohistochemistry in the Classification of Necrotic Testicular Tumors: A Study of 11 Cases. Am J Surg Pathol 2009; 33: 1293-8.
Incorrect
Answer: C. Necrotic seminoma
Histology: A section of testis shows foci of cellular necrosis. Surrounding the necrosis there is prominent fibrosis with hemosiderin deposition and inflammation. Seminiferous tubules that are present appear atrophic with Sertoli only pattern and sclerosis.
Discussion: Occasional seminomas can undergo extensive necrosis, yet in the center of coagulative necrosis see ghosts of seminoma cells, as in this case. Even though the tumor is dead, one can make out ghosts of cells with vesicular nuclei with large central eosinophilic nucleoli, typical of seminoma. The adjacent testis with fibrosis, inflammation, and hemosiderin in this case likely represents a regressed tumor. In contrast with torsion, the necrosis involves the entire testis and it is coagulative necrosis where outlines of necrotic seminiferous tubules are visible. In an infarct, which is usually due to vasculitis, it is focal but also results in coagulative necrosis. In some cases adjacent to necrotic seminoma, atrophic seminiferous tubules containing germ cell neoplasia in-situ (GCNIS). Positive PLAP, CD117, and OCT4 may be maintained in necrotic seminoma, and these stains were focally faintly positive in this case. The stage can be variable and even entirely necrotic seminoma, some patients can present with metastatic disease.
Reference: Miller JS, Lee TL, Epstein JI, et al. The Utility of Microscopic Findings and Immunohistochemistry in the Classification of Necrotic Testicular Tumors: A Study of 11 Cases. Am J Surg Pathol 2009; 33: 1293-8.
