Indian Journal of Pathology and Microbiology

CASE REPORT
Year
: 2020  |  Volume : 63  |  Issue : 3  |  Page : 470--471

Malignant granulosa cell tumor of testis with metastasis to liver: Case report and review of literature


Sandhya Bordiya, Kumari Priyanka, Dharmendra Garg 
 Department of Pathology, RNT Medical College, Udaipur, Rajasthan, India

Correspondence Address:
Kumari Priyanka
Flat No. A-508, Miraj Malhar Apartment, New Bhupalpura, Udaipur - 313 001, Rajasthan
India

Abstract

We report a case of testicular granulosa cell tumor of adult type in a 65-year-old male patient who has presented with hepatic metastasis. Although, this type of sex cord stromal tumor is relatively common in the ovaries, it is extremely unusual in the testis, and it probably represents the rarest type of testicular sex cord stromal tumor.



How to cite this article:
Bordiya S, Priyanka K, Garg D. Malignant granulosa cell tumor of testis with metastasis to liver: Case report and review of literature.Indian J Pathol Microbiol 2020;63:470-471


How to cite this URL:
Bordiya S, Priyanka K, Garg D. Malignant granulosa cell tumor of testis with metastasis to liver: Case report and review of literature. Indian J Pathol Microbiol [serial online] 2020 [cited 2020 Oct 24 ];63:470-471
Available from: https://www.ijpmonline.org/text.asp?2020/63/3/470/291671


Full Text



 Introduction



Testicular neoplasms are diseases that can arise from germ cells, sex cord or stroma. Granulosa cell tumor of the adult testis is extremely rare, and its biological behavior is unclear.[1],[2],[3] This is described for the first time in 1952,[4] granulosa cell tumors are originated from epithelial elements of the sex cord, and they can be divided in juvenile or adult types.[3],[4],[5] granulosa cell tumors comprise less than 5% of ovarian tumors in women, and are much rarer in men only 45 cases have been previously reported.[1] As compared with their ovarian counterparts, these tumors may follow a more aggressive course.[3] Ultrasonography guided fine needle aspiration cytology (FNAC) is currently the most favored and increasingly used pre-operative diagnostic procedure in various deep seated neoplastic and non-neoplastic mass lesions, and it provides a good diagnostic yield for intra-abdominal masses.

 Case Report



A 65-year-old man, referred to us with a 2-year history of a mass in abdomen and pain abdomen without past history of trauma, infection, gastrointestinal or lower urinary tract symptoms. Physical examination revealed intra-abdominal mass in right hypochondrium region. Ultrasonography of abdomen showed multiple echogenic mass in liver, largest being 12 × 12 cm in size.

Under aseptic precautions, ultrasonography guided fine needle aspiration cytology (US-FNAC) was performed using 22 gauge, 90 mm spinal needle attached to a 10 ml disposable syringe. The prepared smears were stained with MGG stain.

Cytological examination showed hypercellular smears with both large and small overlapping cell clusters. Tumor cells were round to oval, with hyperchromatic nuclei containing granular chromatin, micronucleoli, and focal nuclear grooves. Microfollicular structures with central amorphous material seen – Call-Exener bodies [Figure 1] and [Figure 2].{Figure 1}{Figure 2}

 Discussion



Sex cord-stromal tumors of the gonads are numerous including thecomas, fibromas, Sertoli cell, Leydig cell, Sertoli-Leydig cell, and granulosa cell tumours (GCTs). GCT of testis is extremely rare and GCTs are divided into two different types: juvenile and adult type.[6],[7],[8] The juvenile type commonly occurs in the first 6 months of life. The adult type is very rare and can occur at any time after puberty. Adult granulosa cell testicular tumors (AGCTT) affect mainly in white males usually as a painless enlargement over a variable period of time in >50% of cases.[9] The mean (range) age at diagnosis is 47 (12–77) years. Erectile dysfunction, gynaecomastia, and decreased libido may also be present. Gynaecomastia is present in 25% of cases due to hormonal abnormalities such as estrogen hypersecretion, or chromosomal abnormalities.[5],[8],[9]

Some AGCTTs have the potential for distant metastases and thus poor outcomes, but otherwise they are non-functioning, slow growing, and most often benign. A relatively long survival period was found in patients with metastases to regional lymph nodes; however, deaths occurring at few months to a few years after metastases have occurred in patients that have distant metastasis and who exhibited rapid disease progression.[10] The retroperitoneal lymph nodes are the most common metastatic region, but lung, liver, and bone metastases have also been reported.[3],[10] More extensive follow-up may be warranted with larger tumors or tumors deemed to be aggressive. A follow-up protocol suggested is an abdominal and testicular sonography along with chest X-ray, with a CT of the abdomen and pelvis every 6 months. The duration of follow-up is not well-defined; however, long term follow-up is mandatory because metastasis has been found after 10 years of treatment.

 Conclusion



In summary, granulosa cell tumors with metastasis to live in an adult male is a rare disease, and precise pathological diagnosis is important for guiding treatment decisions.

Financial support and sponsorship

Nil.

Conflicts of interest

There is no conflicts of interest.

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