Spermatocytic Seminoma With Sarcoma: An Indication for Adjuvant Chemotherapy in Localized Disease
A 29-year-old male of Syrian origin presented with a painless right-sided testicular swelling of 12 months' duration. Clinical examination revealed a nontender enlarged right testis. The tumor markers alpha-fetoprotein (α-FP) and beta human chorionic gonadotropin (β-HCG) were negative. An ultrasound scan of the scrotum revealed a 7-cm hypoechoic, hypervascular and cystic mass replacing the right testis (). The patient underwent a right radical inguinal orchidectomy. A staging computed tomography scan was negative for lymphatic or metastatic disease.\nMacroscopically, a lobulated, circumscribed, focally necrotic, soft tumor (60 mm×55 mm×50 mm) was found replacing most of the right testis. The tumor appeared to be confined within the testis. The majority of the tumor was polymorphous and was composed of small, intermediate, and large epithelioid cells arranged in sheets with broad areas of necrosis. Microscopic features of these cells were consistent with SCS. Additionally, there were ill-defined areas of undifferentiated sarcoma (, ) that were composed of highly pleomorphic, epithelioid, and spindle-shaped cells with high mitotic activity invested in fibrous and fibromyxoid stroma. The tumor did not extend beyond the tunica albuginea. The spermatic cord and epididymis were uninvolved. No lymphovascular invasion was identified. Immunohistochemical analysis revealed focal staining of a small proportion of the SCS cells with antibody to CD117 (c-KIT). Immunohistochemical stains of antibodies to PLAP, HCG, AFP, CD30, and CD68 and the myeloid markers CD34 and CD117 were all negative. The histological diagnosis was SCS with undifferentiated sarcoma confined to the testis. Further oncological treatment with adjuvant chemotherapy was strongly advised but the patient refused and moved to a different locality.