Case Study — February 2017
A 32 year old male, non-drinker and non-smoker, complains of heaviness in his lower abdominal region. This has been noted for two months and doesn't recall any trauma to the region. Upon examination, a 3-cm firm mass is found in the right scrotum. No lymphadenopathy is seen, and a scrotal ultrasound confirms the presence of a solid testicular mass. A radical orchiectomy is performed and histology is below: What is the diagnosis?
Tumor shows a diffuse pattern interrupted by fibrous septa with lymphocytic infiltrate. Seminiferous tubules are visible on the right.
At a higher magnification, tumor cells show clear cytoplasm with round polygonal nuclei and large nucleoli.
Neoplastic cells are negative for inhibin, but inhibin positivity are seen in Sertoli cells as well as in the leydig cells shown on the right.
Tumor cells show strong diffuse positivity for PLAP suggesting the neoplasm is of germ cell origin.
Tumor cells show strong diffuse nuclear positivity for SALL4 further confirming the neoplasm is of germ cell origin.
Neoplastic cell nuclei are negative for embryonal carcinoma marker SOX2.
The tumor cells do not express CD30, making embryonal carcinoma less likely.
Alpha-fetoprotein is not expressed in the tumor cells, reducing the likelihood of the tumor being a yolk sac tumor.
Neoplastic cells show strong diffuse nucelar positivity, suggesting possibly either a seminoma or a embryonal carcinoma.
Tumor cells are positive for CD117.
Neoplastic cells show strong diffuse nucelar positivity, further suggesting seminoma.