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Presented by Dr. Ashley Cimino-Mathews and prepared by Dr. Katherine Fomchenko
This case is a young adult male with a testis mass.
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1. Question
This case is a young adult male with a testis mass.
Correct
Answer: A. Seminoma
Histology: The lesion is composed of nests of loosely cohesive cells with round to cuboidal nuclei, coarse chromatin, conspicuous nucleoli, and background chronic inflammation. The lesion is unencapsulated but relatively well circumscribed.
Discussion: Seminomas are the most common malignant germ cell tumor of the testis and most frequently occur in young adult males, but they do have a bimodal age distribution. The neoplastic cells are often accompanied by a lymphoplasmacytic infiltrate, as well as non-necrotizing granulomas. By immunohistochemistry, the neoplastic seminoma cells label for OCT 3/4, and are negative for hematolymphoid markers and cytokeratins. Like seminoma, diffuse large B cell lymphoma cells are also loosely cohesive, but they are negative for OCT 3/4 and instead label for CD45 (pan-lymphoid) and CD20 (B-cell lineage). Embryonal carcinoma, another type of malignant germ cell tumor, is histologically high-grade and labels for cytokeratins and CD30. Finally, spermatocytic tumors (formerly, spermatocytic seminomas) are composed of three different cell types (small, intermediate, and giant cells) and have a benign clinical course.
Williamson SR, Delahunt B, Magi-Galluzzi C, Algaba F, Egevad L, Ulbright TM, Tickoo SK, Srigley JR, Epstein JI, Berney DM; Members of the ISUP Testicular Tumour Panel. The World Health Organization 2016 classification of testicular germ cell tumours: a review and update from the International Society of Urological Pathology Testis Consultation Panel. Histopathology. 2017 Feb;70(3):335-346. doi: 10.1111/his.13102. Epub 2016 Dec 14. PMID: 27747907.
Moch H, Cubilla AL, Humphrey PA, Reuter VE, Ulbright TM. The 2016 WHO Classification of Tumours of the Urinary System and Male Genital Organs-Part A: Renal, Penile, and Testicular Tumours. Eur Urol. 2016 Jul;70(1):93-105. doi: 10.1016/j.eururo.2016.02.029. Epub 2016 Feb 28. PMID: 26935559.
Incorrect
Answer: A. Seminoma
Histology: The lesion is composed of nests of loosely cohesive cells with round to cuboidal nuclei, coarse chromatin, conspicuous nucleoli, and background chronic inflammation. The lesion is unencapsulated but relatively well circumscribed.
Discussion: Seminomas are the most common malignant germ cell tumor of the testis and most frequently occur in young adult males, but they do have a bimodal age distribution. The neoplastic cells are often accompanied by a lymphoplasmacytic infiltrate, as well as non-necrotizing granulomas. By immunohistochemistry, the neoplastic seminoma cells label for OCT 3/4, and are negative for hematolymphoid markers and cytokeratins. Like seminoma, diffuse large B cell lymphoma cells are also loosely cohesive, but they are negative for OCT 3/4 and instead label for CD45 (pan-lymphoid) and CD20 (B-cell lineage). Embryonal carcinoma, another type of malignant germ cell tumor, is histologically high-grade and labels for cytokeratins and CD30. Finally, spermatocytic tumors (formerly, spermatocytic seminomas) are composed of three different cell types (small, intermediate, and giant cells) and have a benign clinical course.
Williamson SR, Delahunt B, Magi-Galluzzi C, Algaba F, Egevad L, Ulbright TM, Tickoo SK, Srigley JR, Epstein JI, Berney DM; Members of the ISUP Testicular Tumour Panel. The World Health Organization 2016 classification of testicular germ cell tumours: a review and update from the International Society of Urological Pathology Testis Consultation Panel. Histopathology. 2017 Feb;70(3):335-346. doi: 10.1111/his.13102. Epub 2016 Dec 14. PMID: 27747907.
Moch H, Cubilla AL, Humphrey PA, Reuter VE, Ulbright TM. The 2016 WHO Classification of Tumours of the Urinary System and Male Genital Organs-Part A: Renal, Penile, and Testicular Tumours. Eur Urol. 2016 Jul;70(1):93-105. doi: 10.1016/j.eururo.2016.02.029. Epub 2016 Feb 28. PMID: 26935559.
