case_images: PMC5671707_01
case_images: Coronal CT showing mass discreet from undescended left testicle.
case_images: CRIU2017-4529853.001.jpg
case_images: PMC5671707_01_CRIU2017-4529853.001.jpg
case_images: fig1
case_images: A CT scan obtained at the OSH revealed a 14 x 18 x 20 cm abdominopelvic mass causing ureteral obstruction and bilateral hydronephrosis, with no retroperitoneal lymphadenopathy (Figure 1).
case_images: Ultrasound of normal right testicle.
case_images: CRIU2017-4529853.002.jpg
case_images: PMC5671707_01_CRIU2017-4529853.002.jpg
case_images: fig2
case_images: Ultrasound of the right testis revealed no lesions (Figure 2).
case_images: FNA smears and core biopsy of abdominal mass. Malignant cells with high nuclear to cytoplasmic ratio, pleomorphic nuclei, and macronucleoli, singly and in loose clusters, in a background of small lymphocytes (Papanicolaou stain, x400) (a); core biopsy section shows similar tumor cells (H&E stain, x400) (b); tumor cells show immunoreactivity to Oct-3/4 (c) and c-kit (d).
case_images: CRIU2017-4529853.003.jpg
case_images: PMC5671707_01_CRIU2017-4529853.003.jpg
case_images: fig3
case_images: The percutaneous biopsy returned positive for metastatic seminoma (Figure 3).
case_images: Left testicle, orchiectomy. Atrophic seminiferous tubules with small diameters, absence of spermatogenesis, increased numbers of Sertoli cells, and thickened basement membranes (hematoxylin-eosin stain, x200).
case_images: CRIU2017-4529853.004.jpg
case_images: PMC5671707_01_CRIU2017-4529853.004.jpg
case_images: fig4
case_images: The left radical orchiectomy specimen contained no tumor (Figure 4).
case_images: Retroperitoneal mass, excision. Nonviable tumor with extensive hyalinization and xanthogranulomatous reaction, and epididymis (a) (H&E, x40); testicular parenchyma with extensive tubular atrophy, Sertoli cell hyperplasia, and clusters of small seminiferous tubules with pseudostratified Sertoli cells. Some tubules show Sertoli cell-produced basement membrane-like material inside the hypoplastic tubules (b) (H&E, x200); colonic wall adjacent to nonviable tumor showing xanthogranulomatous reaction (c); colonic mucosa with no pathologic changes (d) (c and d: H&E, x40). Immunoperoxidase stain with antibody against OCT 3/4 shows absence of germ cell neoplasia in situ in atrophic tubules (e) (DAB and hematoxylin counterstain, x200).
case_images: CRIU2017-4529853.005.jpg
case_images: PMC5671707_01_CRIU2017-4529853.005.jpg
case_images: fig5
case_images: PET imaging demonstrated pet avidity in the region of the residual mass, so the patient was taken back to the operating room, 5 months after completion of chemotherapy. Pathology from this specimen showed no viable tumor (Figures 5 and 6) but did contain testicular parenchymal tissue.
case_images: Gross photograph of retroperitoneal mass. A 4.3 cm lobulated solid white-yellowish mass with fibrous bands and extensive necrosis is seen adjacent to the undescended testis and a segment of colon.
case_images: CRIU2017-4529853.006.jpg
case_images: PMC5671707_01_CRIU2017-4529853.006.jpg
case_images: fig6
case_images: PET imaging demonstrated pet avidity in the region of the residual mass, so the patient was taken back to the operating room, 5 months after completion of chemotherapy. Pathology from this specimen showed no viable tumor (Figures 5 and 6) but did contain testicular parenchymal tissue.