case_images: PMC3804809_01
case_images: A) Ultrasonography showing testicular SOL with diffusely heterogeneous echo-texture and fluid in the scrotal sac; B) cellular smear showing cluster of bland spindle cells (May-Grunwald-Giemsa, x400); C) cut section of enlarged testis showing grey-white, mostly solid and a few cystic areas. Tunical sac is partially attached to the testis; D) tunical sac is showing multiple well circumscribed nodules of varying sizes. Thin rim of normal appearing testicular tissue is present.
case_images: rt-2013-3-e34-g001.jpg
case_images: PMC3804809_01_rt-2013-3-e34-g001.jpg
case_images: fig001
case_images: The ultrasonogram (Figure 1A) showed grossly enlarged left testis measuring 7.6x4.5 cm with diffusely heterogeneous echo-texture. A review of slides revealed cellular smear with 3-dimensional clusters and groups composed of bland looking spindle cells (Figure 1B). The cut surface of the testis was gray-white, mostly solid, with few cystic areas (Figure 1C). A thin rim of normal appearing testicular tissue was present (Figure 1D).
case_images: Sections show bundles of bland spindle shaped cells separated by fibrocollagenous stroma and a few tubules (arrow). A) Haematoxylin and Eosin, x40; B) Haematoxylin and Eosin, x100; C) Periodic Acid Schiff, x100; D) Periodic Acid Schiff, x400.
case_images: rt-2013-3-e34-g002.jpg
case_images: PMC3804809_01_rt-2013-3-e34-g002.jpg
case_images: fig002
case_images: Microscopically, sections from the testis and the tunical sac nodules showed nests of spindle cells arranged in bundles separated by variable amounts of collagen (Figure 2A). The nuclei were fairly uniform with evenly dispersed chromatin and mitotic figures of up to 2 MF/10 high power fields were present. Occasional foci showed tubules which were lined by cuboidal cells and contained central hyaline materials (Figure 2B).
case_images: A) and B) cluster of tubules which are lined by inhibin positive cuboidal cells (x100 and x400 respectively). B) Spindle cells showing diffuse strong cytoplasmic positivity for vimentin (x200). D) The Ki-67 proliferative index was 2% (x400).
case_images: rt-2013-3-e34-g003.jpg
case_images: PMC3804809_01_rt-2013-3-e34-g003.jpg
case_images: fig003
case_images: On immunohistochemical examination, the tumor cells showed strong immunoreactivity for vimentin (Figure 3A) and were immunonegative for calretinin, WT-1, inhibin, pancytokeratin, cytokeratin 5/6, smooth muscle actin, CD 34 and S 100 protein. The ki 67 proliferative index was 2% (Figure 3B). Lining cells of the tubule were immunoreactive for inhibin (Figure 3C).