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Spermatocytic tumour with intraductal growth pattern.


Piotr Sadowski1, Tadeusz Hessel2, Łukasz Curyło2, Piotr Chłosta2, Krzysztof Okoń1



Introduction

Spermatocytic tumour (ST) is a very uncommon testicular tumour, constituting less than 1% of germ cell tumours [1]. Although regarded as a germ cell tumour seen in elderly, it was shown to occur in a much broader age range, has broader morphologic variety and is distinct from germ cell tumours [2-4]. Authors of the 2016 WHO classification of testicular tumours decided to interrupt the long lasting relationship between spermatocytic tumours and other germ cell tumours, dropping the designation ‘seminoma’ [5]. In fact, ST differs in a number of features from the classic seminoma: occurs only in the male gonad, has no ovarian counterpart, is not associated with cryptorchidism, is not a component of mixed germ cell tumours and is not associated with intratubular germ cell neoplasia. Also, ST cells do not bear the isochromosome 12p and lack stem cell markers like OCT3/4 [3, 5]. The later feature may be used for differential diagnosis. From the clinical point of view it is important that ST has a very limited metastatic potential; few cases of malignant behaviour were described and what’s more, some of these cases were probably misdiagnosed [4]. Even less common than classic ST are its variants: ST with sarcomatoid transformation and recently identified anaplastic ST [4]; while most patients die of ST with sarcomatoid transformation, the anaplastic ST could have the same benign course as the standard variant.


Patient description

A 41-year-old male reported to Urology Department because of pain in the right inguinal area and sensation of enlarging testis for 2 previous weeks. The transscrotal ultrasound revealed two hypoechoic foci within the testis, sized 0.6×0.8cm and 0.3×0.4cm (Fig. 1). Right orchiectomy was performed and the specimen was sent for histopathologic examination.

The material consisted of the right testicle sized 6×4.3×3.4 cm, with the stump of the spermatic cord. Cut surface was tan, uniform, without visible tumour. The sections were taken by the standard procedure [6] and were processed in Shandon Excelsior processors (Thermo Fisher Scientific Inc., UK), embedded in paraffin, cut into 2 µm sections, stained and coverslipped in Tissue-Tec Prisma device (Sakura Finetek Europe B.V., Netherlands).

On histology, distended spermatic tubules filled with variously sized cells were seen (Fig. 2-3). Three different populations could be seen: lymphocyte-sized, medium-sized and giant cells (Fig. 4). Their nuclei were regular, with distinct granular to fibrillary chromatin. Only in some areas tumour cells formed solid nests (Fig. 3). The neoplastic cells expressed CD117 but not OCT3/4 (Fig. 5). Tumour stage was pT1 R0.


Images
figure1

Figure 1. Transscrotal ultrasound showing two hypoechoic lesions.
[please click on the image to enlarge]


figure2

Figure 2. The overall architecture of the testis is preserved, yet the tubules are filed with neoplastic cells. Haematoxylin & eosin 100×.
[please click on the image to enlarge]


figure3

Figure 3. Occasionally intertubular growth was seen; this may imitate a lymphoma. Haematoxylin & eosin 100×.
[please click on the image to enlarge]


figure4

Figure 4. On high magnification, the nuclear pleomorphism is striking. Haematoxylin & eosin 400×.
[please click on the image to enlarge]




























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figure5

Figure 5. The tumour cells show membranous reaction for CD117 (stem factor receptor). Immunohistochemistry 400×.
[please click on the image to enlarge]


figure6

Figure 6. Canine spermatocytic seminoma. Haematoxylin & eosin 100×.
[please click on the image to enlarge]


Conclusion

We presented a rare case of ST, with particularly prominent intratubular growth pattern. Also unusual was the lack of visible tumour on gross examination. Interestingly, the testicular “seminomas” occurring in animals [7-9] showing by rule the same growth pattern, are also thought to be of spermatocytic lineage (Fig. 6).


References

[1] Carriere P, Baade P, Fritschi L. Population based incidence and age distribution of spermatocytic seminoma. J Urol 2007; 178:125-8.
[2] Scully RE. Spermatocytic seminoma of testis - a report of 3 cases and review of literature. Cancer 1961; 14:788-94.
[3] Looijenga LHJ, Hersmus R, Gillis AJM, et al. Genomic and expression profiling of human spermatocytic seminomas: Primary spermatocyte as tumorigenic precursor and DMRT1 as candidate chromosome 9 gene. Cancer Res 2006; 66:290-302.
[4] Lombardi M, Valli M, Brisigotti M, et al. Spermatocytic seminoma: review of the literature and description of a new case of the anaplastic variant. Int J Surg Pathol 2011; 19:5-10.
[5] Moch H, Cubilla AL, Humphrey PA, et al. The 2016 WHO Classification of tumours of the urinary system and male genital organs-part A: Renal, penile, and testicular tumours. Eur Urol 2016; 70:93-105.
[6] Berney DM, Algaba F, Amin M, et al. Handling and reporting of orchidectomy specimens with testicular cancer: areas of consensus and variation among 25 experts and 225 European pathologists. Histopathology 2015; 67:313-24.
[7] Ishigami N, Shimouchi K. Intratubular spermatocytic seminomas in 2 Sprague-Dawley rats. J Toxicol Pathol 2014; 27:217-22.
[8] Bush JM, Gardiner DW, Palmer JS, et al. Testicular germ cell tumours in dogs are predominantly of spermatocytic seminoma type and are frequently associated with somatic cell tumours. Int J Androl 2011; 34:E288-95.
[9] Mizukami S, Murakami T, Tanaka T, et al. Spermatogonial nature of the germ cell component of canine testicular mixed germ cell-sex cord stromal tumours. J Comp Pathol 2016; 155:5-14.


Conflict of interest: none declared

Authors' affiliations:
1Department of Pathomorphology, Jagiellonian University Medical College, Cracow, Poland
2Department of Urology, Jagiellonian University Medical College, Cracow, Poland


Corresponding author:
Krzysztof Okoń
Katedra Patomorfologii UJCM
ul. Grzegórzecka 16, 31-531 Kraków
Poland
phone +4812 421 15 64
e-mail: k.okon@uj.edu.pl

To cite this article: Sadowski P, Hessel T, Curyło Ł, Chłosta P, Okoń K. Spermatocytic tumor with intraductal growth pattern. World J Med Images Videos Cases 2016; 2:e36-43.

Submitted for publication: 03 October 2016
Accepted for publication: 11 October 2016
Published on: 20 October 2016










































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