Synchronous bilateral testis tumor: mixed germ cell and theca cell tumors

[Sex cord gonadal stromal tumors]

According to the World Health Organization (WHO) classification from 2004, sex cord gonadal stromal tumors are divided into Leydig cell tumors, Sertoli cell tumors, granulosa cell tumors, tumors of the thecoma-fibroma group, incompletely differentiated sex cord gonadal stromal tumors, mixed forms of sex cord gonadal stromal tumors and tumors containing both germ cell and sex cord gonadal stromal elements. These tumors can appear sporadically or in combination with hereditary syndromes. To diagnose these rare tumors the combination of characteristic morphological aspects and various immunohistochemical markers is useful. Latest investigations demonstrate the potential role of mutation analyses in the diagnosis of this heterogeneous group of tumors.

Testicular fibroma of gonadal stromal origin with minor sex cord elements, presenting with hydrocele

Testicular fibroma of gonadal stromal origin is a rare benign tumor of testis which usually presents as a slow growing testicular mass. Only 25 cases of testicular fibroma have been reported in the literature. Presence of minor sex cord elements in this tumor is even rarer. We report a case of testicular fibroma with minor sex cord elements that involved almost the entire testis and tunica vaginalis. The patient presented with hydrocele, a rare presentation for this entity. The rarity of the diagnosis and the clinical presentation prompted this case report.

A 17 year old male with a testicular fibrothecoma: a case report

We herein report the case of a right-sided testicular fibrothecoma in a 17 year old male and review the pertinent literature relatable to this rare, benign lesion.

Testicular thecoma in an 11-year-old boy with nevoid basal-cell carcinoma syndrome (Gorlin syndrome)

We report a case of testicular thecoma in an 11-year-old Japanese boy with nevoid basal-cell carcinoma syndrome (Gorlin syndrome). He presented with left testicular swelling and underwent a radical orchiectomy on suspicion of a malignant paratesticular tumor. The tumor arose from the testis exophytically and was diagnosed as a thecoma histopathologically. Ovarian thecoma-fibroma group tumors are closely associated with Gorlin syndrome or with abnormalities in PTCH, a candidate gene for the syndrome. The occurrence of an extremely rare testicular thecoma in this case (the second in the literature) suggests that such an etiological association may also exist in the pathogenesis of testicular tumors.

Testicular (gonadal stromal) fibroma: case report and review of the literature

A 25-year-old man presented with complaint of a painless enlargement in his left testis. The solid, encapsulated, circumscribed and grayish-white testicular mass displayed the characteristics of testicular fibroma histologically. It was composed of acellular collagenized plaques and hypercellular areas of fibroblastic spindle cells. Immunohistochemically, the neoplastic cells were positive for vimentin and smooth muscle actin, but not for cytokeratin, S-100 protein, desmin, CD99/MIC2 (a protein expressed by Sertoli cells and granulosa cells) and CD34. Only 18 cases of testicular (gonadal stromal) fibroma composed exclusively of spindle cells have been reported to date. An additional case of fibroma, which lacks definite neoplastic sex cord elements, and its differential diagnosis from other mesenchymal lesions of testis are discussed here, together with other cases in the literature.

Synchronous bilateral testicular tumour: nonseminomatous germ cell tumours and contralateral benign tumours

Synchronous bilateral testicular germ cell tumours (TGCT) of different origin are very rare; the simultaneous appearance of a TGCT with a contralateral benign non-germ cell tumour represents an even more seldom event. We report on three patients with nonseminomatous TGCT and a contralateral benign testis tumour being Leydig cell tumour, leiomyoma and epidermopid cyst, respectively. Patients were treated by radical orchiectomy in one case and by enucleation resection of the tumour in two cases. After follow-up of more than 5 years all patients are NED; no local recurrence occurred in the patients treated by tumour enucleation with their endogenous testosterone production being maintained. Although very rare the simultaneous appearance of a malignant TGCT and a contralateral benign intratesticular mass should be considered with bilateral tumours. Frozen section examination of the tumours might enable an organ sparing approach in benign testis tumours thereby maintaining endogenous testosterone production and fertility.