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LETTER TO EDITOR
Year : 2020  |  Volume : 9  |  Issue : 6  |  Page : 271-272

Spermatocytic tumor in a young patient-not so rare


Department of Pathology, University College of Medical Sciences and GTB Hospital, Delhi, India

Date of Submission15-Jun-2020
Date of Decision25-Sep-2020
Date of Acceptance14-Oct-2020
Date of Web Publication28-Nov-2020

Correspondence Address:
Nadeem Tanveer
Department of Pathology, University College of Medical Sciences and GTB Hospital, Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ccij.ccij_88_20

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How to cite this article:
Sarkar B, Tanveer N, Verma A. Spermatocytic tumor in a young patient-not so rare. Clin Cancer Investig J 2020;9:271-2

How to cite this URL:
Sarkar B, Tanveer N, Verma A. Spermatocytic tumor in a young patient-not so rare. Clin Cancer Investig J [serial online] 2020 [cited 2021 Jan 27];9:271-2. Available from: https://www.ccij-online.org/text.asp?2020/9/6/272/301733



Sir,

Spermatocytic seminoma has been renamed spermatocytic tumor by the 2016 edition of the World Health Organization classification of testicular tumors. It is not derived from testicular germ cell neoplasia in situ (GCNIS). Germ cell tumors derived from GCNIS have increased in incidence during the twentieth century, have been linked to the Western lifestyle, are more prone to occur in dysgenetic testes, and usually develop in young men. The incidence of Germ cell tumors unrelated to GCNIS on the other hand, has remained stable throughout the twentieth century. These tumors have not been linked to the Western lifestyle, sedentary habits, or obesity.[1]

A population-based estimate of spermatocytic tumors found 58 cases out of 9658 cases of testicular seminoma. The mean age at diagnosis was 53.5 years with a range of 19–92 years.[2] It is different from classic seminoma since it occurs only in testis, does not occur in combination with other forms of germ cell tumors, and has a favorable prognosis in most of the cases.

A 30-year-old male presented with a slowly enlarging left scrotal swelling for 2 years. Ultrasound revealed 7 cm × 5.8 cm × 5 cm left testicular multinodular mass. Tumor markers serum alpha fetoprotein, lactate dehydrogenase, and beta-human chorionic gonadotrophin levels were not elevated. A left-side high inguinal orchidectomy was done. On the cut section, the tumor measured 7 cm × 5 cm × 5 cm and was multinodular, gray white with few areas of mucoid/gelatinous change. However, no areas of hemorrhage or necrosis were seen.

On microscopy, the tumor was multinodular with edema filled spaces giving it a pseudoalveolar appearance [Figure 1]a. Three types of tumor cells were noted: (a) small cells with a narrow rim of cytoplasm resembling lymphocytes (b) intermediate cells with granular chromatin and eosinophilic cytoplasm (c) large cells with “spireme” chromatin [Figure 1]b. An intratubular growth pattern was prominent in some areas. No intratubular germ cell neoplasia or other germ cell tumor was seen. No fibrovascular septa, granuloma, or lymphocytic infiltrate was seen [Figure 2]a and [Figure 2]b. No sarcomatous or anaplastic component was seen. On immunohistochemistry, the tumor was immunopositive for CD117 and negative for leukocyte common antigen [Figure 2]c and [Figure 2]d. Based on these features, final histopathologic diagnosis of spermatocytic tumor was made. Postoperative computed tomography scan abdomen did not show any retroperitoneal lymph node deposits. The patient did not show any evidence of tumor recurrence or metastasis at 6 months follow-up.
Figure 1:(a) H and E (×100) - the characteristic edema fluid giving the tumor pseudoalveolar appearance (upper and lower inset - gross appearance of the orchidectomy specimen with cut section showing mucoid areas due to the edema fluid). (b) H and E - characteristic tripartite appearance of tumor cells - small lymphocyte like cell (red arrow), an intermediate-sized cell with granular chromatin and moderate amount of cytoplasm (blue arrow) and large cells with spireme chromatin (black arrow)

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Figure 2:(a and b) H and E (×100) - no fibrovascular septa and no lymphocytic infiltration. (c) The tumor is immunopositive for CD117 (c, ×100) and negative for leucocyte common antigen (d, × 100)

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In a recent review, the most consistent histologic finding in cases of spermatocytic tumor was tripartite cellular population (100% cases) followed by edema fluid (87% of cases). An intratubular tumor spread was seen in 64% of the cases.[3] Rarely sarcomatous transformation occurs in spermatocytic tumors making the prognosis poor.[4]

A recent systematic review of treatment outcomes of 146 patients (99% of which were treated by radical orchidectomy) concluded that the published literature does not support testis sparing surgery or adjuvant therapy. Patients who develop metastasis have a poor prognosis as spermatocytic tumor does not respond well to chemotherapy.[5]

To conclude, spermatocytic tumor should be kept in the differential diagnosis of testicular tumors even in the younger age group.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patients understand that their name 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.
Ulbright TM. Recently described and clinically important entities in testis tumors: A selective review of changes incorporated into the 2016 classification of the World Health Organization. Arch Pathol Lab Med 2019;143:711-21.  Back to cited text no. 1
    
2.
Carrière P, Baade P, Fritschi L. Population based incidence and age distribution of spermatocytic seminoma. J Urol 2007;178:125-8.  Back to cited text no. 2
    
3.
Hu R, Ulbright TM, Young RH. Spermatocytic seminoma: A report of 85 cases emphasizing its morphologic spectrum including some aspects not widely known. Am J Surg Pathol 2019;43:1-1.  Back to cited text no. 3
    
4.
Pandey V, Khatib Y, Khade AL, Pandey R, Khare MS. Spermatocytic seminoma with rhabdomyoblastic differentiation: Case report and review of literature. Indian J Pathol Microbiol 2018;61:437-9.  Back to cited text no. 4
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5.
Grogg JB, Schneider K, Bode PK, Wettstein MS, Kranzbühler B, Eberli D, et al. A systematic review of treatment outcomes in localised and metastatic spermatocytic tumors of the testis. J Cancer Res Clin Oncol 2019;145:3037-45.  Back to cited text no. 5
    


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