Spermatocytic seminoma: A case report with literature review

Abstract

MA. Nazer, FA. Dayel, Tubular Seminoma: Case Report and Literature Review. 2001; 21(5-6): 334-336 Testicular neoplasms are classified into germ-cell and non-germ-cell neoplasms, with a predominance of the former, and a tendency to occur in young men. 1 Seminomas account for 40%-50% of all testicular germ-cell tumors, 2 and they have characteristic histological features, i.e., sheets of cells interrupted by fibrous septa containing lymphoplasmacytic infiltrate with occasional granuloma. When these classical features are not seen, diagnostic difficulties may arise. Tubular structures, a rarely encountered feature in seminoma, may lead to its confusion with other neoplasms, namely yolk sac tumors, embryonal carcinoma or Sertoli cell tumors. Tubular variant of testicular seminoma is a very rare entity with only eight cases reported in the English literature. We report here another case, emphasizing the diagnostic techniques utilized to differentiate it from other similar tumors. Case Report A 25-year-old Saudi male presented with left testicular swelling of a few months' duration which was confirmed by physical and ultrasound examination. The right testis was clinically normal apart from a small spermatocele. His serum βHCG level and alpha-fetoprotein (αFP) were not raised and his chest radiograph was free. Left inguinal exploration and frozen-section diagnosis of seminoma was followed by left radical orchidectomy with high ligation of the cord. Postoperative abdominal CT scan showed an enlarged para-aortic lymph node, putting the patient in stage IIa, for which he received radiotherapy and remained free from the disease over an 18-month follow-up period. Patient and Methods The patient was operated on in another hospital and a diagnosis of mixed germ-cell tumor (anaplastic seminoma and endodermal sinus tumor) was made for which he was referred to our hospital for further management. A review of the histological material and histopathology report was done. The orchidectomy specimen was formalin fixed and paraffin embedded, and 4-5 μm sections were obtained. Hematoxylin and eosin (H&E) and periodic acid-Schiff (PAS) staining were done. Immunohistochemical staining for vimentin, αFP, cytokeratin and placental alkaline phosphatase (PLAP) was performed on sections obtained from the available paraffin block. Gross Pathology The left orchidectomy specimen revealed a 5.5x5 cm testis with intact capsule harboring a homogenous fleshy, yellowish gray tumor replacing most of the testicular tissue. An attached 11 cm long unremarkable spermatic cord was identified. The tumor showed no extension to the surrounding structures. Microscopic Findings Most of the testis was replaced by malignant infiltrate with a few remaining seminiferous tubules that manifested intratubular germ-cell neoplasia. The tumor cells were arranged in sheets separated by connective tissue septa containing lymphocytic infiltrate in addition to areas of necrosis. This classic histologic architectural arrangement was seen in less than a third of the neoplasm. ...