The utility of microscopic findings and immunohistochemistry in the classification of necrotic testicular tumors: A study of 11 cases

Jeremy S. Miller, Thomas K. Lee, Jonathan Ira Epstein, Thomas M. Ulbright

Research output: Contribution to journalArticle

Abstract

Necrotic testicular tumors are relatively frequent and can present a significant diagnostic challenge. Because of differing treatments for seminomas versus nonseminomas, accurate diagnosis is critical. Eleven totally (n=9) or almost totally (n=2) necrotic testicular tumors were retrieved from our consult files. The submitting pathologists favored benign processes in 4 cases, Leydig cell tumor in 1, and lymphoma in 1. The cases were evaluated for histologic features and, when material was available, by immunostaining with 7 antibodies: keratin (AE1/AE3), OCT4, placental alkaline phosphatase, α-fetoprotein (AFP), CD117, CD30, and S100. Only distinct reactivity in a cellular distribution in the necrotic zone was considered positive; nuclear reactivity alone was scored for OCT4 and membrane reactivity for CD117 and CD30. Mean patient age was 35 years (range 16-63). Mean tumor size was 19?-mm (range 7-53). All patients presented with unilateral testicular masses (6 right, 5 left); 2 also had acute pain. The combination of histologic features, immunostains and, in 1 case, serum AFP permitted classification of 8 tumors (4 seminomas, 3 embryonal carcinomas, 1 yolk sac tumor). Three were not classifiable. The necrotic seminomas lacked associated coarse intratubular calcifications and were positive for OCT4 (4/4) and CD117 (3/3) but negative for keratin (0/4) and CD30 (0/4). The necrotic embryonal carcinomas had associated coarse intratubular calcifications and were positive for keratin (2/3), OCT4 (2/2), and CD30 (3/3). OCT4 stained 1 unclassifiable tumor, which lacked other specific markers. We did not find placental alkaline phosphatase, AFP, and S100 stains useful, although S100 did highlight tumor "ghost" cells in 1 case. Other features in most cases included intratubular germ cell neoplasia (6/11), tubular atrophy/hyalinization (10/11), tumor "ghost" cells (10/11), scar (9/11), and inflammation (10/11). Of the 5 patients with available follow-up, 3 were free of disease at 1, 5, and 8 years after orchiectomy (2 necrotic seminomas and 1 germ cell tumor, unclassified). One patient with yolk sac tumor (age 63?-y) developed widespread metastases after 15 months and died of disease. The final case was initially misinterpreted as "testicular infarction, no malignancy" and 16 months later the patient developed a large retroperitoneal seminoma. Most totally necrotic testicular tumors can be placed into clinically important groups by assessment for coarse intratubular calcifications and staining reactions for keratin, OCT4, CD117, and CD30.

Original languageEnglish (US)
Pages (from-to)1293-1298
Number of pages6
JournalAmerican Journal of Surgical Pathology
Volume33
Issue number9
DOIs
StatePublished - Sep 2009

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Testicular Neoplasms
Seminoma
Immunohistochemistry
Fetal Proteins
Neoplasms
Embryonal Carcinoma
Endodermal Sinus Tumor
Alkaline Phosphatase
Keratin-4
Keratin-2
Keratin-3
Leydig Cell Tumor
Keratin-7
Orchiectomy
Germ Cell and Embryonal Neoplasms
Acute Pain
Keratins
Germ Cells
Infarction
Atrophy

Keywords

  • Germ cell tumor
  • Necrotic
  • Regressed
  • Testis

ASJC Scopus subject areas

  • Anatomy
  • Pathology and Forensic Medicine
  • Surgery

Cite this

The utility of microscopic findings and immunohistochemistry in the classification of necrotic testicular tumors : A study of 11 cases. / Miller, Jeremy S.; Lee, Thomas K.; Epstein, Jonathan Ira; Ulbright, Thomas M.

In: American Journal of Surgical Pathology, Vol. 33, No. 9, 09.2009, p. 1293-1298.

Research output: Contribution to journalArticle

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