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Year : 2008  |  Volume : 51  |  Issue : 3  |  Page : 405-406
Testicular granulosa cell tumor, adult type


Department of Pathology, Pt. BD Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India

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   Abstract 

Granulosa cell tumor (GCT) of the adult type is a rare and slow-growing neoplasm in the testis. This tumor may be associated with endocrine manifestations and resemble classic GCT of the ovary morphologically. It has a potential for distant metastasis or recurrence late in the clinical course. We report a case of granulose cell tumor of the testis, adult type.

Keywords: Adult, granulosa cell tumor, testis

How to cite this article:
Gupta A, Mathur S K, Reddy CP, Arora B. Testicular granulosa cell tumor, adult type. Indian J Pathol Microbiol 2008;51:405-6

How to cite this URL:
Gupta A, Mathur S K, Reddy CP, Arora B. Testicular granulosa cell tumor, adult type. Indian J Pathol Microbiol [serial online] 2008 [cited 2021 Oct 19];51:405-6. Available from: https://www.ijpmonline.org/text.asp?2008/51/3/405/42536



   Introduction Top


Sex cord stromal tumors of the testis are uncommon and granulosa cell variants are considered rare.

Two types of testicular granulosa cell tumors (GCTs) have been described: the adult type (rare) and the juvenile type (more frequent). Adult type of GCT is found in the testes of both young and older males and may produce estrogen. The incidence is low as compared to GCT in the ovary. The prognosis of adult type is better in the testis than in the ovary where there are less chances of malignancy. [1]


   Case history Top


A 12-year-old male presented with a painless left scrotal swelling that had been growing slowly for up to 5 years. The patient had no endocrine-related symptoms. On physical examination, a large left testicular mass was noted and transillumination test was found to be positive. Ultrasonogram revealed a well-defined hypoechoic mass in the left scrotum along with secondary hydrocele. CT scan showed mildly enhancing heterogeneous soft tissue mass of 10 × 8 cm involving the left testis. Endocrine evaluation of β-hCG and α-fetoprotein were within normal limits. FNAC was inconclusive. The patient underwent orchidectomy and the specimen was sent for histopathological examination. The postoperative period was uneventful. The patient is still healthy after 1 year of surgery, with no recurrence or metastases.

Pathological findings

Gross appearance:
The specimen was a solid tumor measuring 8 × 5 × 3 cm with a smooth external surface and weighing 200 g. It was well circumscribed. The cut surface was gray white, lobulated and predominantly solid along with few cysts, ranging in size from 0.1 to 0.3 cm diameter [Figure 1].

Microscopic features: The tumor had a pseudocapsule of compressed fibrous tissue and showed various typical patterns of classic GCT of the ovary, such as microfollicular, solid, trabecular, cystic and insular. In our cases, microfollicular pattern was the most prominent. Call-Exner bodies were present. The tumor cells were fairly uniform having scanty cytoplasm and ovoid-to-elongated nuclei with distinct longitudinal nuclear grooves. No other recognizable sex cord tumor component was identified. Few mitotic figures were seen [Figure 2]. There was no evidence of vascular and capsular invasion.

However, immunostaining for vimentin was positive in the tumor cells, but no reaction was seen for keratin or epithelial membrane antigen. Hence, a diagnosis of adult GCT was made. The patient was kept on follow-up.


   Discussion Top


Granulosa cell tumors are rare and occur in the testis in two forms: adult and juvenile GCTs. [2] Juvenile GCT occurs in infants less than 6 months of age and may be associated with abnormal chromosomes and ambiguous genitalia. [3] Adult GCT is the rarest tumor, less common than juvenile GCT. [4] In 1952, Laskowski reported the first case of adult GCT in a 20-year-old male. [5] Less than 20 cases have been reported yet. Guzzo et al . observed GCT of the contralateral testis in a man with cryptorchism. [6] A case of adult GCT was also reported by Al-Bozom. [4]

Most of these tumors are benign, non-functioning and present as painless testicular enlargement or may be detected incidentally at autopsy. Endocrine (estrogenic) manifestations such as gynecomastia and impaired libido are also seen in some cases by Matoska et al . [7] These tumors can be associated with multiple congenital abnormalities and urinary bladder carcinoma. [8] The age of occurrence varies from 21 to 73 years (average 42.5). Grossly, the tumor is well circumscribed. Our case is a 12-year-old male with painless enlargement of the left testis that was diagnosed as adult GCT on gross and histological features, further confirmed by immunohistochemical staining. GCTs express vimentin, but do not express keratin and other intermediate filaments. [1],[8] Vimentin was positive in our case too. Al-Bozom also demonstrated MIC-2 Ab positivity. [4]

Granulosa cell tumors are benign tumors, but Talerman [9] considered them as low-grade malignant tumors as they grow slowly and metastasize. Histological features that predict metastasis include tumor size (>7 cm), vascular and capsular invasion, necrosis and hemorrhage. [8] These features were absent in our case except large size (8 cm).

In conclusion, this case of adult GCT of testis is documented for its rarity. It is slow growing and has the potential to cause distant metastasis. Hence, long-term follow-up of adult patients with GCT of the testis is warranted.

 
   References Top

1.Nistal M, Lazaro R, Gracia J, Paniagua R. Testicular granulosa cell tumor of the adult type. Arch Pathol Lab Med 1992;116:284-7.  Back to cited text no. 1    
2.Damjanov I. Male reproductive system: Testis, epididymis and penis. In : Damjanov J, Linder J, editors. Anderson's pathology. 10 th ed. Philadelphia: Mosby Company; 1996. p. 2166-96.  Back to cited text no. 2    
3.Young RH, Lawrence WD, Scully RE. Juvenile granulosa cell tumor, another neoplasm associated with abnormal chromosomes and ambiguous genitalia: A report of three cases. Am J Surg Pathol 1985;9:737-43.  Back to cited text no. 3  [PUBMED]  
4.Al-Bozom IA, El-Faqih SR, Hassan SH, El-Tiraifi AE, Talic RF. Granulosa cell tumor of the adult type: A case report and review of the literature of a very rare testicular tumor. Arch Pathol Lab Med 2000;124:1525-8.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]
5.Laskowski J. Feminizing tumors of the testis: General review with case report of granulosa cell tumor of testis. Endokrynol Pol 1952;3:337-43.  Back to cited text no. 5    
6.Guzzo T, Gerstein M, Mydlo JH. Granulosa cell tumor of the contralateral testis in a man with a history of cryptorchism. Uro Int 2004;72:85-7.  Back to cited text no. 6    
7.Matoska J, Ondrus D, Talerman A. Malignant granulosa cell tumor of the testis associated with gynaecomastia and long survival. Cancer 1992;69:1769-72.  Back to cited text no. 7  [PUBMED]  
8.Jimenez-Quintero LP, Ro JY, Zavala-Pompa A, Amin MB, Tetu B, Ordoρez NG, et al . Granulosa cell tumor of the adult testis: A clinicopathologic study of seven cases and a review of literature. Hum Pathol 1993;24:1120-6.  Back to cited text no. 8    
9.Talerman A. Pure granulosa cell tumor of testis: Report of a case and review of the literature. Appl Pathol 1985;3:117-22.  Back to cited text no. 9  [PUBMED]  

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Correspondence Address:
Anshu Gupta
1403/18, Opposite Model School's Gate No. 2, Civil Road, Rohtak - 124 001, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.42536

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    Figures

  [Figure 1], [Figure 2]

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