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  Table of Contents    
CASE REPORT  
Year : 2020  |  Volume : 63  |  Issue : 4  |  Page : 618-619
Borderline serous papillary tumor of the testis


1 Department of Laboratory Medicine, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
2 Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India

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Date of Submission25-Oct-2019
Date of Decision25-Dec-2019
Date of Acceptance20-Jan-2020
Date of Web Publication28-Oct-2020
 

   Abstract 


Ovarian epithelial type tumor of the testis is a rare entity. Herein, we report borderline serous papillary tumor of the testis in a 37-year-old male, which was clinically suspected to be a testicular malignancy.

Keywords: Ovarian epithelial, serous papillary tumor, testis

How to cite this article:
Fonseca D, Manasa P L, Sharma R, Giridhar A. Borderline serous papillary tumor of the testis. Indian J Pathol Microbiol 2020;63:618-9

How to cite this URL:
Fonseca D, Manasa P L, Sharma R, Giridhar A. Borderline serous papillary tumor of the testis. Indian J Pathol Microbiol [serial online] 2020 [cited 2020 Nov 25];63:618-9. Available from: https://www.ijpmonline.org/text.asp?2020/63/4/618/299328





   Introduction Top


Ovarian epithelial type tumor of the testis is a rare entity with an incidence of 5.4 cases per 100000 men based on the US database. It resembles its ovarian counterpart and occurs in the age range of 14–68 years. To date, around 52 cases of serous type tumors of testis are documented in the world literature.[1],[2] There are no consensus guidelines on the recommended treatment of these tumors. Therefore, we report borderline serous papillary tumor of the testis in a 37-year-old male, which was clinically suspected to be a testicular malignancy.


   Case Report Top


A 37-year-old male presented with scrotal swelling. On examination, testicular enlargement was noted. His general condition was good. He was evaluated with a clinical suspicion of carcinoma. Ultrasound of scrotum/testis revealed an enlarged right testis 27 × 48 × 41 mm with well-defined hypoechoic lesions having multiple tiny foci of microcalcifications. Imageology of the abdomen did not yield any contributory findings. Laboratory investigations including serum human chorionic gonadotropin (HCG) and alpha feto protein (AFP) were within normal limits.

An inguinal orchidectomy was performed. Gross examination of testis showed a uniloculated cyst with papillary excrescences, measuring 4.8 × 3 cm, well-demarcated from the testicular parenchyma. Tunica vaginalis and spermatic cord were unremarkable. Histologically, the cyst wall showed ovarian type stroma with papillary tufts protruding into the lumen of cyst. These papillae were lined by cuboidal to columnar ciliated epithelium resembling that of the fallopian tube. There was focal stratification and pleomorphism of the nuclei. The nuclei were vesicular with inconspicuous nucleoli. The uninvolved testicular parenchyma was within normal limits. No stromal invasion was seen. Immunohistochemistry (IHC) was positive for [Figure 1] PAX8, EMA, WT1 and ER, and negative for SALL4. Ki67 was 10–12%. A diagnosis of a serous borderline tumor of ovarian epithelial type was given.
Figure 1: (a) Gross specimen of orchidectomy showing uniloculated cyst wall demarcated from testicular parenchyma, (b) Hand E: Papillae lined by ciliated columnar epithelium. Inset shows cyst wall with ovarian type stroma. (c) PAX8 positive ×400, (d) EMA positive ×100, (e) WT1 positive ×400, (f) ER-positive ×100

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   Discussion Top


Cystic neoplasms of the testis are rare. Serous borderline tumors comprise the vast majority of ovarian epithelial type tumors occurring in the testis. They may present as unilocular or multilocular cystic masses which have intracystic rounded branching papillae with fibrovascular core and lined by cuboidal to columnar epithelium exhibiting nuclear atypia and occasional mitoses.[1],[2] Our patient presented with unilocular cyst with papillary excrescences.

IHC can be used as an adjunct to exclude histological differential diagnoses. Positive staining for PAX8 and ER excludes the possibility of adenocarcinoma of rete testis and mesothelioma since WT1 and EMA could be positive in either of these entities. Absence of stromal invasion excluded the possibility of low-grade serous carcinoma.[1],[3],[4],[5],[6]

Several hypotheses exist regarding the histogenesis of epithelial tumors in testicular tissue. Some authors suggest that tumors may arise from the remnants of Mullerian ducts that form male appendix, testis, epididymis, and connective tissue between testis and epididymis and spermatic cord. The other postulated hypothesis is Mullerian metaplasia of the surface lining mesothelium and metaplasia of mesothelium within testicular parenchyma are the sources of origin.[4],[5] A thorough sampling of borderline tumors is essential as the presence of invasion increases chances of recurrence and metastases. Mutually exclusive mutations in either BRAF or KRAS are known to occur in serous borderline tumors of the ovary.[1] However, our patient was not tested for these mutations.

Owing to its rarity clinicians and pathologists need to be aware of this entity in the differential diagnosis of uncommon testicular tumors. There is also a need to highlight the best approach for the management of these cases since the data is relatively insufficient. The prognosis of patients with complete excision of borderline tumors is excellent; however, follow-up is advised. Our patient has been managed with orchidectomy and is asymptomatic on 24 weeks of follow-up.


   Conclusion Top


Ovarian type epithelial tumor of the testis is rare and should be considered in the differential diagnosis of cystic lesions of the testis. A thorough sampling of the cyst wall and application of IHC aid in the diagnosis and differential diagnosis.

Acknowledgments

U T Ravinder, Hussain M.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Bürger T, Schildhaus HU, Inniger R, Hansen J, Mayer P, Scheweyer S, et al. Ovarian-type epithelial tumours of the testis: Immunohistochemical and molecular analysis of two serous borderline tumours of the testis. Diagn Pathol 2015;10:118.  Back to cited text no. 1
    
2.
Moch H, Humphrey PA, Ulbright TM, Reuter VE, editor. WHO Classification of Tumors of Urinary System and Male Genital Organs. 4th ed. IARC: Lyon. 2016. p. 238.  Back to cited text no. 2
    
3.
Wilkerson ML, Lin F, Liu H, Cheng L. The application of immunohistochemical biomarkers in urological surgical pathology. Arch Pathol Lab Med 2014;138:1643-65.  Back to cited text no. 3
    
4.
Huang PW, Chang KM. Adenocarcinoma of the rete testis with prominent papillary structure and clear neoplastic cells: Morphologic and immunohistochemical findings and differential diagnosis. Indian J Pathol Microbiol 2015;58:232-4.  Back to cited text no. 4
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5.
Ibrahim AS, Li Cheng, Jafari MS. Borderline serous papillary tumor of the testis: A case report and review of literature. Anticancer Res 2012;32:5011-14.  Back to cited text no. 5
    
6.
Almarzooqi S, Awwad A, Suhaila A, Albawardi A. PAX8 expression in non epithelial and germ cell gynaecological tumors. Int J cancer Res Mol Mech 2017;3. doi: http://dx.doi.org/10.16966/2381-3318.131.  Back to cited text no. 6
    

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Correspondence Address:
Daphne Fonseca
Department of Lab Medicine, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad - 500 034, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJPM.IJPM_837_19

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