case_images: PMC11047120_01
case_images: (A) Ga68 DOTATATE PET-CT showing a mass in the right scrotum, with a SUVmax value of 26.7 and a size of 38 x 47 mm. The DOTATATE uptake of the mass is significantly increased. (B) Scrotum ultrasound confirming a mass in the right tunica vaginalis cavity (C) with abundant blood flow signals. (D) Testicular CT demonstrating a low-density mass in the right scrotum. (E) The mass is obviously enhanced in contrast-enhanced imaging. (F) MRI revealing the low T1-weighted signal of the lesion. (G) Sagittal plane and (H) transverse section MRI images showing the high T2-weighted signal of the lesion. (I) Lesion presenting as hyperintense on diffusion-weighted imaging.
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case_images: PMC11047120_01_fonc-14-1373727-g001.jpg
case_images: f1
case_images: NE 2,405.4  pg/mL (reference range: 19-121 pg/mL), urine free NE 1,003.13  ug/24 h (reference range: 7-65 ug/24 h), urine free E 28.04  ug/24 h (reference range: 0-22 ug/24 h), and urine free DA 445.45  ug/24 h (reference range: 75-440 ug/24 h), suggesting a possible PGL. Next, systemic Ga68 DOTATATE positron emission tomography-computed tomography (PET-CT) scan was performed, and it revealed a soft tissue mass in the right scrotum measuring approximately 38x47 mm, with a SUVmax value of 26.7, and the SUVmax ratio of this mass to the liver was 3.42 ( Figure 1A ). In addition, the scrotum ultrasound showed a 42.0 x 22.5 x 39.0-mm solid mass in the right tunica vaginalis cavity, with abundant blood flow signals ( Figures 1B, C ). Testicular enhanced computed tomography (CT) confirmed a low-density focus of 4.5 x 3.4 cm in the right scrotum ( Figure 1D ), and no significantly enlarged lymph nodes were seen in the bilateral groin or pelvis. After enhancement, the focus was obviously enhanced, and the blood supply was very abundant ( Figure 1E ). The lesion had a low T1-weighted (T1w) signal and a high T2-weighted (T2w) signal, and it was hyperintense on diffusion-weighted imaging and exhibited a reduced signal on the apparent diffusion coefficient map ( Figures 1F-I ). Upon pelvic enhanced CT re-examination, no evidence of local recurrence or distant metastasis at 4 and 8 months after the operation was shown ( Supplementary Figure S1 ).
case_images: (A) Right spermatic cord, testis, epididymis, and tumor. The tumor is closely related to the spermatic cord, and its section is grayish yellow, solid, and with moderate hardness. A negative resection margin was obtained. (B) H&E staining (x4) of the tumor. Immunohistochemical staining (x200) of the tumor showing the (C) CgA positive, (D) SDHB positive, and (E) CD34 positive in intravascular tumor thrombus.
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case_images: f2
case_images: The section is grayish yellow, solid, and with moderate hardness; a negative resection margin was obtained ( Figure 2A ). In hematoxylin-eosin (HE,  Figure 2B ) staining, the tumor cells were arranged in a pattern of nests with nuclear atypia. Immunohistochemical (IHC) staining depicted positive staining of chromogranin A (CgA,  Figure 2C ), succinate dehydrogenase (SDH) complex iron sulfur subunit B (SDHB,  Figure 2D ), CD34 (positive in blood vessels,  Figure 2E ), synaptophysin, S-100 (positive in sertoli cells), GATA binding protein 3 (GATA3), CD56 and Ki67 (5%).
case_images: Timeline with relevant data from the episode of care.
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case_images: PMC11047120_01_fonc-14-1373727-g003.jpg
case_images: f3
case_images: Table S1 ), we identified the c.C1334>T (p.Ser445Leu) succinate dehydrogenase complex flavoprotein subunit A (SDHA) missense mutation, with a mutation abundance of 0.773. The timeline with relevant data of this case is shown in  Figure 3 .