engleski

Unusual Mixed Germ Cell Tumor of the Testis Consisting of Rhabdomyosarcoma, Mature Teratoma and Yolk Sac Tumor: A Case Report

Testicular mixed germ cell tumors account for 32%-54% of all germ cell tumors. The various types of germ cell tumors can occur in any combination. The most common combination is teratoma and embryonal carcinoma, and also a variant of embryonal carcinoma, yolk sac tumor and syncytiotrophoblastic cells. Unusual cases of rhabdomyosarcoma arising in mature teratoma and rhabdomyosarcoma arising in mediastinal teratoma have been reported in the literature. We present an unusual case of testicular tumor in a 32-year- old man who complained of left testicular swelling and pain. Physical examination, ultrasonography and CT revealed a tumor in the left testis. Macroscopically, it was a grey, well circumscribed tumor measuring 4.5x7x6 cm in size, showing soft and yellow cut surface. There were white and firm areas, and parts of cartilage, with only marginally visible testicular tissue. Also, there was a nodule of 1.2 cm in size. Paraffin-embedded tissue specimens were routinely processed, cut and stained with hematoxylin and eosin. Additional methods performed on representative slides included desmin. Histopathologic examination revealed a yolk sac tumor and mature teratoma associated with embryonal rhabdomyosarcoma. The largest part of the tumor was yolk sac tumor (80%) with a mycrocystic pattern, and glandular structures lined by cells varying from cuboidal or polygonal cells inserted in mesenchymal stroma with perivascular Schiller-Duval bodies. The second part was mature teratoma (15%) consisting of well differentiated cartilage, and cystic formations lined by pseudostratified cuboidal or flattened epithelium surrounded with dense connective tissue stroma. The third part of the tumor was a sarcoma component of somatic type malignancy (5%), described macroscopically as a nodule. Microscopic examination showed aggregates of atypical small cells with hyperchromatism and marked cellular pleomorphism, and some of them were round or elongated with abundant eosinophilic cytoplasm like rhabdomyoblastic cells with numerous mitoses that showed positivity for desmin. Mixed germ cell tumor of the testis in this combination with sarcomatous component is uncommon. Recognition of this variant is important because it may mimic some other lesions, and the clinical outcome of some variants differs from the typical mixed germ cell tumor of the testis and may call for different therapeutic approach.

mixed germ cell tumor ; testis

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