GPR: 2019 - Week 18

From MGH Learn Pathology

Clinical history

27 M presenting with 3 weeks of left testicular pain; mass seen on ultrasound.


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Embryonal Carcinoma
  • 2nd most common pure germ cell neoplasm after seminoma (~ 10%)
  • ~ 80% seen as mixed with other germ cell tumor components
  • 15-35 yr (10 yr younger than patients with seminoma)
  • Does not occur in infants/children; rare after 50 yr
  • Often poorly circumscribed mass
  • Variegated cut surface with large areas of hemorrhage and necrosis
  • Mean tumor size: 2.5 cm
 

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Mixed Germ Cell Tumor

  • Most common nonseminomatous germ cell tumor (NSGCT) (30-40%)
  • 20-40 yr (10 years younger than seminoma)
  • Rarely seen in prepubertal children and > 50 years
  • Testicular mass or swelling ± pain
  • Variably large, bulky mass
  • Variegated cystic and solid mass with hemorrhage and necrosis
  • Teratomatous components with bone, cartilage, and skin elements
 

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Metastatic Carcinoma

  • Metastases are rarer in testis (< 1%) than in ovary
  • Majority > 50 yr
  • Nonsymptomatic or incidental finding during hormonal ablation orchiectomy or autopsy for metastatic prostate cancer
  • Symptomatic metastasis is rare, > 90% unilateral and solitary
  • Rare metastasis to primary testicular germ cell tumor
  • Localized mass, multiple nodules, or diffuse enlargement of testis with no grossly apparent mass
 

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Seminoma

  • Most common malignant testicular germ cell tumor (~ 50%)
  • 35-45 yr, uncommon > 50 yr, rare in children
  • 70% painless testicular mass, some with scrotal pain, asymptomatic, rarely gynecomastia and exophthalmos
  • Unilateral, 5 cm on average
  • Well circumscribed, homogeneous, often lobulated, tan, creamy, bulging mass without hemorrhage or necrosis
  • 90% confined to testis
 

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Diffuse Large B Cell Lymphoma

  • 2-5% of all testicular neoplasms (usually secondary)
  • Mean age: 56-60 yr; 50% tumors in patients over 60 yr are lymphomas
  • Testicular mass or enlargement
  • Systemic symptoms may occur such as fever, night sweats, weight loss
  • 20-38% are bilateral, though majority are metachronous
  • Replacement of testicular parenchyma by diffuse or lobulated, fleshy, cream-colored, tan, pale yellow, homogeneous mass
  • Focal hemorrhage and necrosis may be seen
 
  • Dr. Elena Maryamchik
  • Dr. Lisa Zhang
  • Jennifer Patel

This week's Gross Pathology Roundup was presented by [[| , ]] on Mon, Apr 29, 2019.