Deal collegues-pathologists.
I need your help with testicular cancer case.
Male, 34 y.o. Right testis mass.
Gross: testis 6x3x3 with solid-cystic mass 2,5x3,2cm.
Micro: mixed germ cell tumor: teratoma (70%) with classic seminoma (30%), with invasion t.albuginea, rete testis, without visible LVI. In teratomatous component one of the cyst 0,6x0.3cm is filled with aypical papillary structures. See attached pic.
Is it secondary somatic malignancy in teratoma? What tissue is this?
Diagnosis based only on H&E slides.
Thank You for your future answers.
Hi all!
I'm not pathologist, but we have had a similar rare case last year.
The patient P., 62 yo, was admitted with an intramesenterial mass ~130*150mm on CT-scan (biopsy - Adenocarcinoma), liver Mts 33mm and a "stone-like" mass ~1cm in left testis. There were no tumor in GI endoscopic exams etc,, the AFP was normal and BCG were a little elevated. Due to high risk and low possible success of intraabdominal surgery we decided to perform orchiectomy (Patho - Teratoma with adenocarcinoma G1 and high amount of ossificate). There were no difference of extragonadal teratoma with Mts into liver and testis or primary testicle tumor with Mts into liver and mesenterium. So, we started to treat using chemo - BEP. The 1 course was brilliant - the intraabdominal tumor had dissapeared!!! But due to neutropenia and general weakness the patient refused of the next course of chemo, so the second BEP we had started 5 weeks after the previous one. But during this month the intraabdominal tumor had growned to the previous size!!!! And remain resistant to the next BEP and VIP protocols of chemo. The patient became weak and was unable to continue chemo. So, we had to advise him the supportive care and symptomatic treatment.
I've found in Pub Med ~5 abstracts about the adenocarcinoma of testis.
P.S. Dear Bin Xu! Could you please review our case. I'll try to post our micro pictures in a few days.
P.S.S. Does anybody have the similar cases or could share any better treatment approach? Especially in my case?
Bohdan, hi.
You should send pathology slides for the second review. Non-germ cell carcinomas (like adenocarcninoma) will not give full clinical response on BEP. So we need second opinion :)
Teratoma often has areas of many tissues, and some can undergo malignant transformation
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