Testicular Mass in a 44 Year Old Man

Junqi Qian, M.D.

Specimen Type:

Testis

History:

A 44-year-old man underwent left orchiectomy owing to a mass in the left testis. The specimen consists of a 62-gram testicle having attached portions of the inguinal cord that measures up to 11.5 x 1.4 in great dimensions. The testicle measures 6.5 x 3.5 x3.2 cm. On sections there is a necrotic-appearing and hemorrhagic lesion measures up to 2.5 x 2.0 x 1.7 cm.

Pathologic Features:

The tumor cells are arranged in solid nests and acini in a fibrous to hyalinized stroma. The cells have eosinophilic, granular cytoplasm and round nuclei with a punctate or "salt and pepper" chromatin pattern, rare mitotic figures (Figures 1-6). The neoplastic cells exhibits positive immunohistochemical staining for, chromogranin A, synaptophysin, CD56 and AE1/AE3 (Figures 7-10). Immunostaining for PLAP, AFP, and inhibim are negative.

Differential Diagnosis:

  • Seminoma
  • Embryonal carcinoma
  • Yolk sac tumor
  • Teratoma
  • Sex cord-stromal tumors
  • Metastatic carcinoid tumor

Diagnosis:

Carcinoid Tumor

Key Features:

  • Grossly, usually a well circumscribed solid mass lesion.
  • Microscopically, the cells have eosinophilic, granular cytoplasm and round nuclei with a punctate or "salt and pepper" chromatin pattern.
  • Immunohistochemically, diffusely positive for chromogranin A; there are scattered positive cells for synaptophysin, CD56, and AE1/AE3.

Carcinoid tumor of the testis is considered a monodermal form of teratoma; and in support of this concept, about 15-25% of testicular carcinoid tumors are associated with other teratomatous elements. Primary carcinoid has a good prognosis. Large size (average diameter of metastasizing tumors = 7.3 cm vs. average diameter of non-metastasizing tumors = 2.9 cm) and the carcinoid syndrome were the strongest predictors of metastasis, whereas mitotic activity, vascular invasion, and tumor necrosis had no predictive value. Most cases are cured by orchiectomy. The course of patients with metastatic testicular carcinoid tumor is often indolent, and the utility of retroperitoneal lymph node dissection is unknown.

References:

  1. Zavala-Pompa A, Ro JY, el-Naggar A, et al.Primary carcinoid tumor of testis. Immunohistochemical, ultrastructural, and DNA flow cytometric study of three cases with a review of the literature.Cancer. 1993 1;72(5):1726-32.
  2. Abbosh PH, Zhang S, Maclennan GT, Montironi R, Lopez-Beltran A, Rank JP, Baldridge LA, Cheng L. Germ cell origin of testicular carcinoid tumors. Clin Cancer Res. 2008 Mar 1;14(5):1393-6.
  3. Stroosma OB, Delaere KP. Carcinoid tumours of the testis. BJU Int. 2008 May;101(9):1101-5.