Department of Pathology, University of Oklahoma Health Sciences Center
A 22 year-old man with metastatic mature testicular teratoma in lymph node.
Clinical information:
A 22 year old man presented to the hospital with abdominal pain, nausea and vomiting. Physical examination disclosed right supraclavicular adenopathy and a left testicular mass. His beta-HCG in serum was 394,000 mIU/ml and alpha-fetoprotein in serum was 2,100 ng/dL. A CT scan disclosed multiple complex heterogeneous masses involving the mediastinum, chest, retroperitoneum, lesser sac and mesentery of the abdomen, and possible pelvic lymph nodes. An inguinal radical orchiectomy was performed and pathologic examination revealed a mixed germ cell tumor of the testis that was composed of 70% teratoma and 30% seminoma. He was treated with chemotherapy consisting of BEP (bleomycin, etoposide and cisplatin).
His tumor markers normalized five months after treatment.. Multiple large masses in the mediastinum, retroperitoneum, and abdomen, however, could still be demonstrated by CT scan. Biopsy material of a supraclavicular lymph node revealed only mature teratomatous elements. He was treated with chemotherapy consisting of VIP (vinblastine, ifosfamide and cisplatin). Although there was a brief period of elevated beta-HCG level in serum before the chemotherapy, his beta-HCG and alpha-fetoprotein levels were within normal limits 10 months after orchiectomy and chemotherapy.
An extensive lymphadenectomy was performed and the followings are representative photomicrographs:
Click thumbnails
to see pictures.
What is your diagnosis? What other test would you perform to confirm your diagnosis? Discussion
Cases of the Month Evaluation Coordinator: KarMing-Fung@ouhsc.edu