Indian Journal of Pathology and Microbiology

CASE REPORT
Year
: 2011  |  Volume : 54  |  Issue : 1  |  Page : 138--140

Spermatocytic seminoma associated with undifferentiated sarcoma: A rare case report


Priti Trivedi, Sunil Pasricha, Anuja Gupta 
 Department of Pathology, The Gujarat Cancer and Research Institute, Asarwa, Ahmedabad - 380 016, Gujarat, India

Correspondence Address:
Priti Trivedi
Room # 412, Department of Pathology, The Gujarat Cancer and Research Institute NCH Campus, Asarwa, Ahmedabad - 380 016, Gujarat
India

Abstract

The presence of sarcomatous element transforms the usually innocuous spermatocytic seminoma into a highly aggressive neoplasm. We report a case of spermatocytic seminoma with undifferentiated sarcomatous component in a 43-year-old male, presented with testicular mass since two and a half years. Orchidectomy was performed and after 9 months, the patient presented with recurrent scrotal mass with bilateral pulmonary metastases.



How to cite this article:
Trivedi P, Pasricha S, Gupta A. Spermatocytic seminoma associated with undifferentiated sarcoma: A rare case report.Indian J Pathol Microbiol 2011;54:138-140


How to cite this URL:
Trivedi P, Pasricha S, Gupta A. Spermatocytic seminoma associated with undifferentiated sarcoma: A rare case report. Indian J Pathol Microbiol [serial online] 2011 [cited 2020 Jul 11 ];54:138-140
Available from: http://www.ijpmonline.org/text.asp?2011/54/1/138/77369


Full Text

 Introduction



Spermatocytic seminoma is a rare but distinctive germ cell tumor (GCT) first described by Masson. [1] It occurs only in adults and constitutes about 4%-7% of seminomas. Spermatocytic seminoma is not associated with another GCT component and is characterized by a favorable prognosis. However, discovery of a sarcomatous contingent markedly worsens the prognosis. [1],[2],[3] We report a case of a spermatocytic seminoma associated with undifferentiated sarcoma. To the best of our knowledge, this is the second reported case from India and 16th in the literature. [2],[3],[4],[5]

 Case Report



A 43-year-old male patient presented with left testicular mass since two and a half years with recent rapid increase in size for 2 months. Clinical examination revealed a huge well-defined left testicular mass, which was hard and adherent to the scrotal skin. Inguinal lymph nodes were not palpable. Ultrasonography of scrotum, pelvis, and abdomen revealed a well-defined left testicular mass measuring 17 × 10 × 9 cm. Right testis was unremarkable. No paraaortic or abdominal lymph nodes were evident. Serum tumor markers were normal except for elevated serum lactate dehydrogenase levels (647.4 IU/L). The patient underwent left orchidectomy. Grossly, the tumor weighed 900 g and measured 18 × 10 × 10 cm. The cut surface was gray white with areas of hemorrhage and necrosis. The tumor was adherent to the overlying scrotal skin. Microscopically, the tumor comprised two distinct histologic entities-spermatocytic seminoma and high-grade spindle cell sarcoma. Spermatocytic seminoma was composed of proliferation of tumor cells in nests separated by fibrous septae without lymphocytes. Three different populations of tumor cells were recognized-small, medium, and large-with predominant population of medium-sized cells [Figure 1]. The chromatin was dense in small cells and filamentous in medium and large ones. Occasional giant cells were also seen. The cytoplasm was eosinophilic in the tumor cells. Immunohistochemically, the tumor cells were negative for CD 30, c-kit, placental-like alkaline phosphatase, and alpha fetoprotein. The second component had a sarcomatous appearance comprising spindle cell population arranged in haphazard fascicles. The tumor cells were pleomorphic having a hyperchromatic nucleus with frequent mitotic figures. A few tumor giant cells were also seen [Figure 2]. Strap-like cells or cross-striations were not evident. Hemorrhage and necrosis was evident. The tumor was infiltrating the tunica albuginea and involving the dermis. Immunohistochemically, sarcomatous area showed strong positivity for vimentin [Figure 3], whereas actin, desmin, cytokeratin, CD 34, S-100, and myoglobin were negative. A final diagnosis of spermatocytic seminoma with undifferentiated sarcoma was established. Adjuvant chemotherapy was advised but the patient refused for the same. The patient came back after 9 months with recurrent left scrotal mass and difficulty in breathing. Computed tomography (CT) of the pelvis revealed a well-defined mass in the left scrotal sac measuring 10 × 8 × 6 cm in size. CT thorax revealed bilateral multiple pulmonary metastases, largest measuring 81 × 97 mm on the right side with minimal bilateral pleural effusion. The above findings led to multiagent chemotherapy (cisplatin, bleomycin, and etoposide). The patient had taken the first cycle of chemotherapy and died after 1 month.{Figure 1}{Figure 2}{Figure 3}

 Discussion



Spermatocytic seminoma is a rare testicular GCT with distinct histopathologic features. It is uncommon in subjects younger than 40 years and is not associated with other germ cell elements and intratubular germ cell neoplasm unclassified. [2],[6],[7] Spermatocytic seminoma is characterized by slow painless testicular enlargement for several years, followed by a sudden rapid increase in size. [6] In the present case, the patient had a gradual testicular enlargement for two and a half years followed by rapid increase in size for 2 months. Among the previously reported cases, histologic details of 12 cases are available. Undifferentiated spindle cell sarcoma was found in 5 cases, whereas 7 cases showed evidence of rhabdomyosarcoma. One case had associated elements of chondrosarcoma. [2] There were no significant prognostic differences in these histologic types. No teratomatous component was identified in any of the cases. In the present case, the sarcomatous component was an undifferentiated spindle cell, high-grade sarcoma. Spermatocytic seminoma is an indolent neoplasm and is associated with an excellent prognosis; however, the presence of the sarcomatous element transforms this innocuous neoplasm into an aggressive neoplasm, with most of the patients dying early due to widespread metastases. [1],[2],[5] Histogenesis of sarcomatous elements and their relationship to spermatocytic seminoma has been a matter of debate. The currently held view is that sarcomatous component arises by anaplastic transformation or dedifferentiation of spermatocytic seminoma. [1] The treatment of choice in spermatocytic seminoma is orchidectomy. However, in the presence of sarcomatous component, adjuvant chemotherapy and radiotherapy may be beneficial, but in majority of the cases prognosis is dismal despite these aggressive interventions. [4],[5],[6]

In summary, spermatocytic seminoma with sarcomatous transformation although rare, are aggressive tumors associated with early metastases and poor prognosis, and due to limited number of cases the precise treatment modalities are yet to be established.

 Acknowledgments



The authors wish to express their thanks to Dr. P.M. Shah, Honorary Director, Dr. K.M. Patel, Dr. S.N. Shukla Deputy Directors, and Dr. M.J. Shah, Head of department of pathology of The Gujarat Cancer & Research Institute for allowing us to publish this case report.

References

1True LD, Otis CN, Delprado W, Scully RE, Rosai J. Spermatocytic seminoma of the testis with sarcomatous transformation, a report of five cases. Am J Surg Pathol 1988;12:75-82.
2Eble JN. Spermatocytic seminoma. Hum Pathol 1994;25:1035-42.
3Chelly I, Mekni A, Gargouri MM, Bellil K, Zitouna M, Horchani A, et al. Spermatocytic seminoma with rhabdomyosarcomatous contingent. Prog Urol 2006;16:218-20.
4Robinson A, Bainbridge T, Kollmannsberger C. A spermatocytic seminoma with rhabdomyosarcoma transformation and extensive metastasis. Am J Clin Oncol 2007;30:440-1.
5Menon S, Karpate A, Desai S. Spermatocytic seminoma with rhabdomyosarcomatous differentiation. A case report with a review of the literature. J Can Res Ther 2009;5:213-5.
6Matoska J, Talerman A. Spermatocytic seminoma associated with rhabdomyosarcoma. Am J Clin Pathol 1990;94:89-95.
7Floyd C, Ayala AG, Logothetis CJ, Silva EG. Spermatocytic seminoma with associated sarcoma of testis. Cancer 1988;61:409-14.