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Case 3
“Testicular neoplasia”
Sofia Manara – Multimedica - Milan
(Pictures by Dr. Manara)
Clinical history
42 y.o. man, painful nodule at right testicle after testicular self examination. Ultrasound: intra-parenchymal nodule of the right didymous. Normal lab exams (including alphaphetoprotein, beta-HCG, LDH).
Macroscopical description
Intra-parenchymal nodular lesion of the testicle, 0.4 cm in diameter, greyish-yellow, partly haemorrhagic, without evident connection to the tunica albuginea and testicles.
Microscopical description
Nodular proliferation defined by fibrous branches composed of epithelioid cells sometimes elongated, with eosinophilic cytoplasm and a round, nucleolated nucleus (Pict. 1 - Pict. 2 - Pict. 3 - Pict. 4 - Pict. 5 - Pict. 6 - Pict. 7).
Abundant intra and extracytoplasmatic hemosiderimic pigment (Pict. 8).
Numerous empty cytoplasmic inclusions negative for Alcian Blue and PAS (Pict. 9 - Pict. 10) push the nucleus to the periphery of the cell.
No mitoses or necroses were observed. Cells were strongly positive with immunohistochemical staining for Vimentin (Pict. 11), focally positive for MART-1 (Pict. 12) and negative for Cytokeratin AE1/AE3, MNF 116,r EMA, calretinin, PLAP, inhibin CD30, CD117, CD68, S100, HMB-45 and smooth muscle actin. MIB proliferation index: 1-2%.
Diagnosis
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