Germ Cell Tumors Of Testis Research Articles

A rare combination of double primary malignancies; mixed germ cell tumor of testis with papillary carcinoma of thyroid: a case report

Double malignancy occurring in multiple organs is relatively rare yet possible. The second primary lesion is identified either simultaneously with the primary lesion (synchronous) or after a while (metachronous). We report a case of synchronous double malignancy in a patient who had two separate carcinomas, a non-seminomatous germ cell tumor (NSGCT) and a papillary carcinoma of thyroid. These types of synchronous double malignancies can be dealt as independent carcinomas. This existence of two carcinomas at anatomically dissimilar sites with distinct histopathologies, being a rare combination, led us to report the case.

Expert consensus on specimen handling and pathological diagnosis of germ cell tumor of testis

睾丸生殖细胞肿瘤相对少见，但其具有明显的组织学和生物学行为异质性，准确的病理诊断和分期具有重要的临床意义。本共识在2018年美国癌症联合委员会第8版肿瘤淋巴结转移分期及2022年第5版WHO泌尿及男性生殖器官肿瘤分类的基础上，讨论了针对不同类型的睾丸生殖细胞肿瘤切除标本的规范化取材和病理诊断的要点，尤其是与分期密切相关的临床病理参数，并制订了相关的格式化病理诊断和报告的推荐模板，同时简要讨论了免疫组织化学染色和分子检测的实践应用，以期为睾丸生殖细胞肿瘤的精准诊断和治疗提供理论和实践依据。.

S1737 Germ Cell Tumor of Testis With Metastasis to the Common Bile Duct: A Rare Case Report

S1737 Germ Cell Tumor of Testis With Metastasis to the Common Bile Duct: A Rare Case Report

CYTOLOGICAL EVALUATION OF NECK LYMPH NODES FOR METASTATIC DISEASE

Background: Fine needle aspiration cytology (FNAC) is a simple, rapid and cost effective procedure with minimal complications for evaluating enlarged neck nodes, but also gives clue. Neck lymph nodes are a common site of metastasis for various carcinomas, usually from the upper aerodigestive tract and salivary gland or carcinoma of unknown primary. Objectives: To study different cytomorphological patterns of metastatic neck nodes. To evaluate the diagnostic utility of FNAC in diagnosis of metastatic lesions of lymph node. Methods: It is a one year prospective study comprised of all aspirates 139 lymphnodes of 968 patients. FNACs conducted in the Department of Pathology, Vydehi Institute of Medical Sciences, Bangalore, between January 2019 to December 2019. A total of 70 out of 139 peripheral neck nodes in patients diagnosed with metastatic neck lymph node on FNAC were included in the study. Results: Out of 70 cases included in our study, metastasis to the neck lymph nodes were most common in the age group 51 to 60 years (38.6%) followed by 61 to 70 years (28.6%). Male preponderance was noted with male to female ratio of 1.7:1. On cytological examination, squamous cell carcinoma was found to be the most common tumor metastasizing to the neck nodes, accounting for 37 (52.9%) cases followed by each 10 (14.3%) cases each of undifferentiated carcinoma and thyroid carcinoma, 9 (12.9%) cases of adenocarcinoma, 3 (4.3%) cases of parotid gland carcinoma and 1 (1.4%) case of germ cell tumor of testis. Conclusion: FNAC is an early and reliable tool for the diagnosis of metastatic neck nodes. Any enlarged neck node should be investigated to rule out metastasis.

RARE CASES OF MIXED GERM CELL TUMOUR OF TESTIS- A REPORT OF TWO CASES WITH UNCOMMON COMBINATIONS AND REVIEW OF LITERATURE.

Mixed germ cell tumours of testis represent a comparatively rare category of testicular tumour where different types of both seminomatous and non-seminomatous tumours can be present in varied proportions. We report two cases of mixed germ cell tumours, one consisting of seminoma, embryonal carcinoma and post-pubertal teratoma in the testis of a 22-year-old male and second consisting of a yolk sac tumour and immature teratoma in the testis of a 19-year-old male. We report theses case due to the rare combination and for documentation

Histomorphological Spectrum of Gonadal and Extragonadal Germ Cell Tumours at a Tertiary Cancer Centre in Southern Rajasthan, India

Introduction: Germ Cell Tumours (GCT) are heterogenous tumours believed to arise from primordial germ cells. The GCT predominantly affects gonads (testis and ovary) and also involves extragonadal sites, characteristically locations along midline of the body. The GCT of testis, ovary and extragonadal sites show peculiar histomorphological features and types subject to the age and site of patient. Definite histopathological typing of GCT is of vital importance to decide the further treatment. Till now, very few studies have been conducted in India on GCT of gonads and extragonadal sites. Aim: To study the pathologic findings of GCT including macroscopic and microscopic features and to classify the tumours according to latest World Health Organisation (WHO) classification of GCT for designated site of origin. Materials and Methods: Retrospective analysis was conducted including 141 cases of GCT of all sites, diagnosed at a tertiary cancer centre in Udaipur, Rajasthan, India between January 2016 to April 2021. Data were collected regarding demographic, clinical, gross and histopathological details. Results were analysed using Statistical Package of Social Sciences (SPSS) software Version 21.0. method. Results: Germinal cell tumours shows various age ranges for different site of origin. Ovarian GCT age varies from seven years to 65 years. Age group of testicular GCT varies from 1-55 years. Extragonadal GCT (EG GCT) was seen as early as in four-day-old newborn. Out of 141 cases, 103 were ovarian, 21 were testicular and 17 were EG GCT cases. Most common ovarian GCT is Mature Teratoma (MT) (85 cases, 82.53%) and most common malignant ovarian GCT is dysgerminoma (9 cases, 8.74%). Most common testicular GCT type is Malignant Mixed GCT (MM GCT) (9 cases, 42.86%) followed by seminoma (5 cases, 23.81%) and Yolk Sac Tumours (YST) (3 cases, 14.29%). EG GCT involves retroperitoneum (5 cases, 29.41%), anterior mediastinum (4 cases, 23.53%), Sacrococcyx (3 cases, 17.65%) and Central Nervous System (CNS) (2 cases, 11.76%) with most common EG GCT is teratoma (9 cases, 52.94%) Conclusion: Gonadal and extragonadal GCT share many common tumours, albeit, distinctive site-specific histopathological findings also present. These features often complicate the definitive diagnosis of GCT for pathologists, specifically in cases of MM GCT.

208P Prognostic factors and outcomes of non-seminomatous germ cell tumours of testis: Experience from a tertiary cancer centre in India

208P Prognostic factors and outcomes of non-seminomatous germ cell tumours of testis: Experience from a tertiary cancer centre in India

Senescence and adiponectin signaling — Studies in canine testis

BackgroundThe meaning of senescence for tissue physiological and pathological conditions is poorly known. Based on initial reports especially proteins and mechanisms that regulate this process are necessary to be determinate. MethodsThe main aim of the study was to investigate the presence of senescent cells in canine testicular tissue (mixed breed testes; n = 60) in relation to adiponectin signaling. In detail, new information on the senescence cell number, as well as senescence and adiponectin signaling mechanisms in cryptorchid and germ cell tumor testes were provided with the use of immunohistochemical and colorimetric analyses. ResultsComparison of immunohistochemical results, in cryptorchid and tumor testes revealed increased number of senescent cells (p16 and γH2AX markers). Increased expression of adiponectin and adiponectin receptor 1, as well as extracellular signal-activated kinase (ERK1/2) in pathological testes were detected. In addition, decreased cholesterol and increased testosterone levels in tumor testis were found. ConclusionThe present study is the first to demonstrate the presence as well as the differences that exist in senecent cell number in mixed breed dog testes with cryptorchidism and germ cell tumor. Altered expression of adiponectin signaling and ERK1/2 signaling pathways together with altered cholesterol and testosterone levels reflect important senescence role in disturbed functions of canine testis. Moreover, the application of studied here senescence regulating molecules for detection and prevention against pathologies of the male gonad should be furtherly considered.

The Study of the Expression of CGB1 and CGB2 in Human Cancer Tissues.

Human chorionic gonadotropin (hCG) is a well-known hormone produced by the trophoblast during pregnancy as well as by both trophoblastic and non-trophoblastic tumors. hCG is built from two subunits: α (hCGα) and β (hCGβ). The hormone-specific β subunit is encoded by six allelic genes: CGB3, CGB5, CGB6, CGB7, CGB8, and CGB9, mapped to the 19q13.32 locus. This gene cluster also encompasses the CGB1 and CGB2 genes, which were originally considered to be pseudogenes, but as documented by several studies are transcriptionally active. Even though the protein products of these genes have not yet been identified, based on The Cancer Genome Atlas (TCGA) database analysis we showed that the mutual presence of CGB1 and CGB2 transcripts is a characteristic feature of cancers of different origin, including bladder urothelial carcinoma, cervical squamous cell carcinoma, esophageal carcinoma, head and neck squamous cell carcinoma, ovarian serous cystadenocarcinoma, lung squamous cell carcinoma, pancreatic adenocarcinoma, rectum adenocacinoma, testis germ cell tumors, thymoma, uterine corpus endometrial carcinoma and uterine carcinosarcoma.

Non Seminomatous Mixed Germ Cell Tumor of Testis with a Large Abdominal and Retroperitoneal Extension: A Case Report

Primary testicular germ cell tumors (PGCT) can be classified as seminomatous and non-seminomatous germ-cell tumor (NSGCT) types. Mixed germ cell tumors (MGCT), a subtype of NSGCT, contain more than one germ cell components. Here, we present a rare case of a MGCT composed of yolk sack tumor and teratoma which had a continuous large abdominal and retroperitoneal extension. A 43 years old male presented with complaints of discomfort and swelling over the right inguinoscrotal region. Ultrasonography (USG) showed a large ill-defined heteroechoic mass in the right inguinoscrotal region with vascularity and without separate visualization of right testis. Subsequent contrast enhanced Computed Tomography (CT) showed large enhancing mass in the right scrotal sac which was continuous with large abdominopelvic and retroperitoneal mass through the right inguinal canal. Tru-Cut biopsy of the scrotal mass showed MGCT with yolk sac and teratoma component. Patient underwent 6 cycles of chemotherapy followed by Right Radical Inguinal Orchidectomy.

NAD(P)H: Quinone oxidoreductase (NQO1) and catalase expression in nonseminomatous germ cell tumors.

413 Background: NAD(P)H:quinone oxidoreductase 1 (NQO1) is an enzyme which detoxifies quinones and reduces oxidative stress. NQO1 is expressed in multiple tumor types at levels up to 200-fold above normal tissue, including in breast, pancreatic, and non-small cell lung cancers. NQO1 bioactivatable drugs have the potential to deliver tumor-selective DNA damage and cell death by exploiting the elevation of NQO1. Alterations in catalase expression can cause marked cytoprotection. The ratio of NQO1:catalase activities is presumed to be a predictive marker for therapeutic activity of NQO1 bioactivatable drugs. There is no data available on NQO1 and catalase expression in germ cell tumors. Methods: Patients with germ cell tumor who underwent orchiectomy/tumor resection between January 2016 and December 2018 were identified from the Indiana University Melvin and Bren Simon Cancer Center database. Patients with non-seminomatous germ cell tumor of testis or primary mediastinal non-seminomatous germ cell tumor were selected. Immunohistochemistry staining for NQO1 and catalase was performed on tumor tissue. Results: NQO1 and catalase expression were assessed in 16 patients. Fifteen of 16 tumors stained positive for NQO1, 13 of which were moderately to strongly positive. Conversely, the majority of tumors were catalase deficient or only mildly positive for catalase. The details of the Immunostaining is summarized in the table below. Conclusions: Non-seminomatous germ cell tumors appear to have overexpression of NQO1 and deficiency of catalase. NQO1 bioactivatable agents could be beneficial in treating patients with refractory non-seminomatous germ cell tumors.[Table: see text]

Origin of somatic transformation in germ cell tumor of testis (TGCT): Role of differentiation versus dedifferentiation in a mature teratoma.

410 Background: TGCT is a prototype stem-cell malignancy recapitulating the ontogeny of solid tumors. We studied the roles of differentiation versus dedifferentiation in a bona fide well-differentiated tumor, namely mature teratomas, associated with or without somatic transformation. Methods: Between 2001 and 2013, we identified 7 out of 13 cases in which teratoma and somatic transformation were present within the same residual tumor after chemotherapy and resected at our institution with sufficient quantity and quality for DNA and RNA analysis. We performed primary cell culture, flow cytometry, and xenografts to evaluate stem-ness biomarkers and tumor phenotypes of freshly resected mature teratomas. Results: We detected very few mutations within a preselected gene pool (T200) in all tumor samples. The "within patient mutation agreement" from a mutation matrix of 57 genes, in which at least one mutation occurred between teratoma and somatic transformation, was 86.2 to 94.8%. There was disparity in gene expression, including miR7-3HG, ARHGEF35, and DLX6, between the 7 matched tumor pairs (log2 fold change of about 2). Prospective primary cell culture studies using cell surface stem-ness markers (SSEA3, TRA1-60, Cripto-1, CD90, CD133, CD44) indicate presence of stem cells embedded within residual mature teratomas (n = 3) after chemotherapy. Conclusions: Molecular profiling confirms a common clonal origin between teratoma and somatic transformation but refutes the idea of dedifferentiation of teratoma to somatic transformation. Presence of stem cells embedded within mature teratomas and capable of differentiation into separate ontogenetic lineages could account for the origin of somatic transformation in TGCT.[Table: see text]

A Huge Intraabdominal Lump in a Male Patient of 32 Year with Congenital Absence of Left Testis - A Case Report

Undescended testis is a common risk factor for the testicular neoplasm. The risk of malignancy in an undescended testis is highest when the testis lies in the abdomen. It usually presents with a painless intraabdominal lump. Seminoma is the most common adult germ cell tumour of testis whereas Yolk sac tumour in seen in the pediatric age group. Pure yolk sac testicular tumor in an adult is extremely uncommon. Here we present a case where an adult male presented to us with a painless left sided intraabdominal lump with undescended testis on the same side was previously diagnosed as metastatic adenocarcinoma of unknown primary. In a private hospital he received three cycles of chemotherapy; but the lump did not reduce in size and he was reffered to our care for better management. The lump was excised and histopathological report revealed yolk sac tumour of left testis which is a rare presentation in adult.
 J Shaheed Suhrawardy Med Coll, December 2018, Vol.10(2); 115-117

Post-chemotherapy robot-assisted retroperitoneal lymph node dissection in non-seminomatous germ cell tumor of testis: Feasibility and outcomes of initial cases.

To report our initial experience and short-term results in post-chemotherapy robot-assisted retroperitoneal lymph node dissection (RA-RPLND) for advanced testicular cancer. We analyzed prospectively collected data of 5 patients who underwent post-chemotherapy RA-RPLND between August 2017 and May 2018. All patients had a diagnosis of non-seminomatous germ cell tumor (NSGCT) of testis and received three or four cycles of BEP chemotherapy for their clinical stage IIC disease before the surgery. Perioperative parameters (operation time, estimated blood loss and intraoperative complications) and postoperative findings (change in hematocrit, duration of hospitalization and postoperative complications) were noted. Pathological outcomes and postoperative radiological imaging in the 3rd month were investigated. RA-RPLND was completed successfully in all patients, and none of them required conversion to open surgery or early intervention. The median operation time was 309 minutes (range, 275-360), and median estimated blood loss was 180 mL (range, 150-210). One patient required postoperative transfusion of 1U red blood cells. The histologic examination of the specimens revealed necrosis in 3, and mature teratoma in 2 patients. The median hospitalization time after surgery was 2 days. During a median follow-up of 10 months (range 7-12), there were no retroperitoneal recurrences or distant metastasis in radiological imaging. No major complication (Clavien ≥3) or death occurred. The only minor complication was transfusion of red blood cells in one patient (Clavien 2) and the overall complication rate was 20 percent. Post-chemotherapy RA-RPLND appears to be a feasible and oncologically safe procedure with acceptable operative morbidity. However, this technique should be applied in centers highly experienced in robotic surgery, considering that RPLND is a surgery with fatal complications.

MIXED GERM CELL TERATOMATOUS TUMOUR OF TESTIS IN ADULTS: DIAGNOSTIC CHALLENGES FOR A HISTOPATHOLOGIST (case report)

Background. Testicular tumours account for approximately 1-2 % of the total cancer cases in the male population globally and show higher incidence in the younger male age group of up to 15 years. The majority (~98 %) of testicular tumours are observed to be of the germ-cell origin which can either be of seminomatous type or non-seminomatous type. The non-seminomatous germ cell neoplasm may be pure or of mixed subtype. Objective was to emphasize the rare case of mixed germ cell teratomatous tumour of testis in adult man.Methods. A mixed germ cell teratomatous tumour of testis comprising of yolk sac tumour and embryonal carcinoma in an adult Indian male is reported in the research.Results. A 45 year-old Indian male presented with enlargement of right testis which was found to be an encapsulated right testicular tumour on exploratory surgery which was followed by radical orchiectomy. Serum AFP and β-hCG levels were elevated to 380 ng/ml and 590 mg/ml respectively. Histopathology revealed a mixed germ cell teratomatous tumour of testis comprising of yolk sac tumour and embryonal carcinoma.Conclusions. In adults teratomas occur usually as a component of mixed germ cell tumours. However in the present case teratomatous embryoid yolk sac germ cell tumour of testis was observed in an Indian adult male. The prognosis of embryoid germ cell tumours of testis is generally poor. The possibility of this condition should always be considered in all cases that present with a testicular lump.

Radiological nodule behavior: A critical parameter in the surgical management of pediatric pulmonary metastases.

Divarcı E, Arslan S, Dökümcü Z, Kantar M, Demirağ B, Öniz H, Ertan Y, Alper H, Erdener A, Özcan C. Radiological nodule behavior: A critical parameter in the surgical management of pediatric pulmonary metastases. Turk J Pediatr 2018; 60: 372-379. Radiological nodule behavior (RNB) means the course of nodule appearance on consecutive CT scans. In this study, we aimed to discuss the effects of RNB on prognosis of patients with pulmonary metastasis. Retrospective analysis of patients who underwent pulmonary metastasectomy (PM) between 2005-2015 was performed. RNBs were grouped as stable, enlarging or new rising nodules. The effects of RNBs were analyzed on recurrence, 1- and 3-year event free survival (EFS) and mortality. Twenty-seven patients (18 male) underwent PM with a median age of 15 years (3-18 years). The diagnoses were listed as osteosarcoma (13), Wilms` tumor (7), Ewing`s sarcoma (3), synovial sarcoma (2), rabdomyosarcoma (1) and mixed germ cell tumor of testis (1). RNBs were new rising in 15 patients (55%), enlarging in seven patients (26%) and stable in five patients (19%). Vital tumor metastasis was detected in all of the patients with enlarging nodules (100%); in 10 of the 15 patients with new rising nodules (66%) and none of the patients with stable nodules. None of the patients with stable nodules developed recurrence or died after PM (p˂0.05). In patients with enlarging nodules, metastases recurred and they died in the postoperative period. These findings were similar in different types of tumors. RNB could be used as a critical parameter in deciding surgical management strategies of pulmonary metastases. Stabile nodules should be observed by close follow-up with serial CT scans without surgery. All of the suspected new rising nodules should undergo surgical sampling to avoid unnecessary chemotherapy. Nodule progression under chemotherapy is a poor prognostic criteria for overall survival.

An Unusual Presentation of Testicular Metastasis in a Patient With Esophageal Adenocarcinoma

Esophageal adenocarcinoma is the eighth most common cancer and sixth leading cause of cancer mortality worldwide. Incidence of Esophageal adenocarcinoma (EAC) is dramatically increasing over the past few decades and is now the most common form of esophageal cancer in United States. 54 year old male with no significant medical history presented to primary care clinic with complaints of poor appetite, early satiety, heartburn and 40lb weight loss. He denied any Alcohol and Smoking use. Physical examination and basic labs were unremarkable. Upper GI series showed irregular marginated mass with narrowing and ulceration of distal esophagus. Follow up EGD and Endoscopic ultrasound showed mass extending from 36 cm to 42 cm with portion of tumor invading pericardium. TNM staging was determined as T4aN0Mx. Biopsies obtained from esophageal mass was consistent with invasive poorly differentiated adenocarcinoma. Decision was made to start neoadjuvant chemotherapy with carboplatin and paclitaxel followed by esophagectomy. Interval follow up PET scan after chemotherapy showed improvement in diffuse circumferential mural thickening of esophagus showing favorable response to therapy. Later, he presented to oncology clinic as he started to experience testicular pain and was noted to have right testicular mass and also left sided skull mass. CT head showed 2.9 x3.2 cm mass in the left parietal skull area and Right scrotal ultrasound showed 1.5x1.6x1.8 cm mass in right testicle. The patient underwent craniotomy resection followed by right radical orchiectomy. Biopsies of skull mass and right testicle showed metastatic poorly differentiated esophageal adenocarcinoma positive for CK7, CAM 5.2, MOC 31 and EMA. All markers for mesothelioma of tunica vaginalis, germ cell tumor of testes, adenocarcinoma of rete testis, prostate adenocarcinoma were negative and they were excluded. Pathologist coreviewed the esophageal mass biopsy along with skull mass and testicular mass and it was found that they had many features in common confirming our diagnosis of Testicular metastasis. Testicular cancer most commonly metastasizes to liver, lungs, bone, and adrenal glands via hematogenous route. Only one case of testicular metastasis from esophageal cancer has been reported so far. The exact pathogenesis of metastatic spread to testes remains unknown. High degree of suspicion is indicated when the patient presents with testicular mass in the setting of esophageal cancer.

Pulmonary resection for isolated pulmonary metastasis: patterns of disease

Background: Pulmonary metastasectomy dates back to 1880s, sub lobar resections, lobectomy and pneumonectomy, described in the setting of metastatic sarcoma, renal cell cancer, testicular NSGCT. Extremity sarcoma is the most common primary site for metastasis to lung. Almost 20 % of patients with extremity sarcoma, give rise to isolated pulmonary metastasis at some point in the course of the disease. Though pulmonary metastasis commonly arises from primary tumors in extremities, they may arise from any histologic variant. Despite progresses in multimodality treatment, there are significant deaths, after metastasis from soft tissue malignancies. There is evidence that surgical resection is the treatment of choice for isolated pulmonary metastasis from extremity sarcoma. Chemotherapy has proved to be ineffective to increase survival in such cases. Keeping this in mind we report an analysis of 11 such cases in terms of patterns of disease, for Isolated pulmonary metastasis originating from various histologic variants.Methods: This is a retrospective study from July 2006 to September 2016, carried out at NKP Salve Institute of Medical Sciences. During this period, total 13 patients were admitted with Isolated pulmonary metastasis. Out of 13 patients 2 patients were later on proved to have metastasis in the liver and so excluded from study. Of 11 patients, metastasis from soft tissue sarcoma of extremity were (5), cancer of uterine cervix (3), non seminomatous germ cell tumor of testis (3). All 11 patients were treated with pulmonary resectional surgery. Patterns of disease in terms of specific survival from various histological variants.Results: The median survival for soft tissue sarcoma from the diagnosis of pulmonary metastasis for all 5 patients was 18 to 26 months. Reports suggest, with non-operative therapy for soft tissue sarcoma, the median survival was 11 months. After pulmonary mastectomy, three-year survival for these patients was around 23%. For world wide data suggest the prevalence of pulmonary metastasectomy was 3.6% in cancer cervix. In the present study, the mean disease-free duration for cancer cervix after pulmonary resection was more than 60 months. In the present study, all 3 patients are still alive even after 5 years with no recurring disease. Reports published in 2016 surgical clinics show 5-year survival in 80%. Patients with NSGCT showed persistent rising levels of (ß HCG, æ fetoprotein, LDH) and CT evidence of active pulmonary metastasis, with 4 or less nodules were subjected for surgery, with outcome of 2 patients had recurrent disease died at the end of 27th month. 1 patient is still alive after 11 years. Patients with complete resection of all metastatic disease was the important prognostic factor for survival.Conclusions: Isolated pulmonary metastasis is not a very common disease in this part of the world. Complete surgical resection of metastasis is the single most important factor which determines outcome in these patients. Disease free interval (DFI), number of metastatic nodules, are important factors in surgical decision making. Long term survival is possible in selected patients, even when recurrent disease is resected.

Primary Germ Cell Tumour of Testis with Sarcomatous Changes: A Unique Case Report

Primary Germ Cell Tumour of Testis with Sarcomatous Changes: A Unique Case Report

Primary Germ Cell Tumor of Testes with Extensive Lymph Nodal and Splenic Metastases Masquerading Lymphoma on 18-F-FDG PET/CT.

Germ cell tumors (GCT) account for the 95% of the malignancies associated with testes. They are the most common solid malignancies affecting the males in the age group of 15–35 years. It is known to be bilateral in 3% of cases. We herein present FDG PET-CT findings of a case with biopsy proven GCT with multiple lymph nodal and splenic metastases mimicking lymphomatous neoplasm.