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Classic seminoma with necrosis

Posted Wed, 08/19/2009 - 05:18 by Norman Loberant

Images

Figure 1

Figure 2

Figure 3

Clinical History:

38-year-old man presented to the emergency department with acute left scrotal pain.
Clinical diagnosis on admission: Suspected torsion.

Findings:

Fig.1 Ultrasound imaging: Large heterogeneous mass of the left testis with extensive hypoechoic area in center of the mass, there was only minimal remaining testicular parenchyma (arrow).

Fig.2 Color Doppler US showed increased vascularity mostly around hypoechoic area.

Fig.3 Histological examination shows preserved tumor cells (arrows) and extensive necrotic areas (original magnification x100, hematoxylin-eosin stain).

Diagnosis:

Classical Seminoma

Discussion:

We present a case of seminoma with unusual clinical presentation and atypical sonographic appearance, pathologically proved as classical seminoma with large areas of necrosis.

Seminoma is the most common type of testicular tumor in adults and accounts for about 40 - 50 % of germ cell tumors.
Classic clinical presentation of seminoma is painless scrotal mass; however testicular pain may be a presenting symptom and may be due to infarction or bleeding.
On ultrasound examination seminomas range in size from a small well-defined lesion to large masses that totally replace the testis.
Seminomas are generally uniformly homogeneous hypoechoic masses (1, 2), and necrotic changes are not frequent in this tumor. It is more typical for nonseminomatous tumor to have inhomogeneus echotexture (2) and necrosis (3, 4).

References / Suggested Reading:

1. Howlett DC, Marchbank ND, Sallomi DF. Ultrasound of the testis. Clin Radiol 2000; 55:595–601.

2. Dogra VS, Gottlieb RH et al. Sonography of the scrotum. Radiology 2003; 227:18-36

3. Ueno T, Tanaka YO, Nagata M et al. Spectrum of germ cell tumors: from head to toe. RadioGraphics 2004; 24:387–404.

4. Woodward PJ, Sohaey R, O’Donoghue MJ, Green DE. Tumors and tumorlike lesions of the testis: radiologic-pathologic correlation. RadioGraphics 2002; 22:189–216

Author

Chernihovski A (1), Samovsky M (1), Loberant N (1), Cohen HI (2)

Departments of Radiology (1) and Pathology (2)

Western Galilee Hospital, Nahariya, Israel