Classical seminoma with associated sertou cell nodules and intratubuiar germ cell neopiasia. an unusual lesion mimicking gonadobiastoma

Abstract

A 32 year old man presented with a six week history of a solitary mass in the right testis. A radical orchidectomy was performed. On sectioning, a solitary pale grey, well demarcated tumour was present in the upper pole. The tumour was a classical seminoma comprised of sheets of tumour cells with a moderately dense lymphocytic infiltrate. In the adjacent testis intratubular germ cell neoplasia was localised to the tubules immediately adjacent to the tumour. The striking pathological feature was the presence of three Sertoli cell adenomas. In two of these, there were compactly arranged tubules filled with Sertoli cells, and showing focal calcification and Call-Exner like bodies. These two foci also showed scattered atypical germ cells resembling the cells in the neoplasm and elsewhere in the intratubular component of the neoplasm. The combination of gonadal stromal elements with calcification was highly reminiscent of gonodablastoma. A remaining third small focus of Sertoli cell nodule, remote from the tumour, lacked germ cell infiltration. The lesion appears to represent incidental Sertoli cell nodules infiltrated by the intratubular component of a seminoma. The lesion we describe may be termed intratubular germ cell neoplasia in Sertoli cell nodules and can be differentiated from gonadoblastoma clinically, genetically and by histopathology.