case_images: PMC8263218_01
case_images: (a) Conglomerating bilateral paraaortic nodal mass circumferentially encases without narrowing the aorta. (b) The large left-side mass measures 9.5 x 7.5 x 10.5 cm containing a large internal necrosis. It is inseparable from the left gonadal vessels (arrow), superiorly extends to the renal vein level (arrowhead), and laterally it displaced the kidney and renal pelvis (*) causing mild hydronephrosis. The 3.5 x 5.5 x 4.5 cm right-side mass indents the inferior vena cava.
case_images: CRIPA2021-9992978.001.jpg
case_images: PMC8263218_01_CRIPA2021-9992978.001.jpg
case_images: fig1
case_images: CT showed a 12.1 x 10.8 x 8.6 cm mass encasing the aorta circumferentially in the retroperitoneum (Figure 1). Containing considerable internal necrosis, the 9.5 x 7.5 x 10.5 cm left-side mass displaced the left kidney and renal pelvis, which caused mild left hydronephrosis.
case_images: (a) Low power view infiltrative tumor cells mixed with lymphocytes. (b) High power view showing the infiltrating tumor cells with a sheet-like growth pattern with medium to large size, pale to clear cytoplasm, and polyclonal nuclei. (c) The tumor cells were positive for pan-cytokeratin. (d) The tumor cells are positive for MOC31. (e) The tumor cells were diffusely and strongly positive for Oct-3/4. (f) The tumor cells were diffusely and strongly positive for CD117.
case_images: CRIPA2021-9992978.002.jpg
case_images: PMC8263218_01_CRIPA2021-9992978.002.jpg
case_images: fig2
case_images: Microscopic examination revealed that the lesion was comprised of infiltrative malignant cells mixed with lymphocytes (Figure 2(a)). Some of them were undergoing mitosis (Figure 2(b)). TTF-1, CK7, CK20, CDX2, synaptophysin, chromogranin, and NKX3.1. The malignant tumor showed positive for pan-cytokeratin (Figure 2(c)) and MOC31 (Figure 2(d)). In comparison, the cells were diffusely and strongly positive for OCT-3/4 (Figure 2(e)) and CD117 (Figure 2(f)) which are the markers of germ cells.
case_images: (a, b) US demonstrate a 2.4 x 1.6 x 3.7 cm left intratesticular heterogenous hypoechoic mass ((a) sagittal view; (b) transverse view). (c) Color Doppler transverse view demonstrates asymmetrical enlargement of the left testicle (right side) containing a heterogeneous mass, compare to the right testicle (right side). (d) Mild internal vascularity of the mass in the left testicle.
case_images: CRIPA2021-9992978.003.jpg
case_images: PMC8263218_01_CRIPA2021-9992978.003.jpg
case_images: fig3
case_images: Testicular ultrasound revealed a 2.4 x 3.7 x 1.6 cm heterogeneous hypoechoic mass in the left testicle (Figures 3(a) and 3(b)). The Color Doppler showed asymmetrical enlargement of the left testicle containing a hypervascular tissue mass compared to the right testicle (Figures 3(c) and 3(d)).