Testicular Fibroma of Gonadal Stromal Origin with Minor Sex Cord Elements, Presenting with Hydrocele
A 40-year old male presented with painless scrotal swelling that had gradually increased in size for two years. He had no hormonal symptoms. On examination, enlarged firm left testis and hydrocele with positive translucency test was detected. The ultrasonogram () showed grossly enlarged left testis measuring 7.6×4.5 cm with diffusely heterogeneous echo-texture. There were multiple well-defined nodular and heterogeneously echoic lesions found within the left scrotum adherent to the wall. A large amount of free fluid was seen in the left scrotal sac. The right testis and epididymis were unremarkable. The patient had undergone testicular FNAC one year before and mesenchymal tumor had been diagnosed. A review of slides revealed cellular smear with 3-dimensional clusters and groups composed of bland looking spindle cells ().\nThe patient underwent left high inguinal orchidectomy and the specimen was sent for histopathological examination. The testis was firm, measuring 7.5×7×6.5 cm, and had a partially attached tunical sac which contained multiple well-defined nodules on its inner surface. The cut surface of the testis was gray-white, mostly solid, with few cystic areas (). A thin rim of normal appearing testicular tissue was present (). Microscopically, sections from the testis and the tunical sac nodules showed nests of spindle cells arranged in bundles separated by variable amounts of collagen (). The nuclei were fairly uniform with evenly dispersed chromatin and mitotic figures of up to 2 MF/10 high power fields were present. Occasional foci showed tubules which were lined by cuboidal cells and contained central hyaline materials (). On immunohistochemical examination, the tumor cells showed strong immunoreactivity for vimentin () and were immunonegative for calretinin, WT-1, inhibin, pancytokeratin, cytokeratin 5/6, smooth muscle actin, CD 34 and S 100 protein. The ki 67 proliferative index was 2% (). Lining cells of the tubule were immunoreactive for inhibin (). The post-operative period was uneventful and there was no evidence of disease after a follow-up period of six months.