Case 1057 - 9-year-old Boy with "Unusual Left Testicular Tumor"

Contributed by Claudia Maria Salgado MD, PhD and Miguel Reyes-Múgica MD


CLINICAL HISTORY

Nine year-old-boy presenting with left testicular swelling noticed 2-3 months prior to physician visit.

ULTRASOUND

"hypervascular, hypoechoic lesion with irregular contour in the left testis upper pole measuring 0.8 x 0.7 x 0.9 cm with estimated volume of 0.26 mL which has not significantly changed in size…" (compared to the US two months before).

GROSS FINDINGS

MICROSCOPIC EVALUATION

Histologic sections show prepubertal testicular parenchyma largely replaced by a lymphoid proliferation which in areas adopts a follicular arrangement. The follicles show similar sizes. In adjacent areas, the neoplastic cells infiltrate between seminiferous cords which show no lumina, spermatogenesis or Leydig cells. The lymphoid cells also infiltrate the tunica albuginea, rete testis and epididymis. In some areas a more diffuse infiltrative pattern is noted. Mitotic figures are easily seen in the proliferating lymphocytes. The cells in the small lymphoid follicles are positive for CD20, Bcl6, CD10 and negative for Bcl2 (figure 2). TdT shows occasional scattered positive cells outside of the follicles. EBER ISH is negative.

DIAGNOSIS and DISCUSSION


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