Fine needle aspiration (FNA) of testicular germ cell tumours; a 10-year experience in a community hospital

Diagnostic yield and safety of ultrasound-guided percutaneous testicular biopsies in children

BACKGROUND

Traditionally, testicular biopsy is performed using an open surgical approach. Ultrasound-guided percutaneous biopsy is a less invasive alternative and can be performed in children.

OBJECTIVE

The aim of this study is to report our technique and to assess the diagnostic accuracy and safety of ultrasound-guided percutaneous biopsy of testicular masses in children.

MATERIALS AND METHODS

This is a 16-year retrospective review of ultrasound-guided percutaneous testicular biopsies at a single pediatric hospital.

RESULTS

We performed nine ultrasound-guided testicular biopsies in 9 patients (median age: 3 years, range: 4 months-11 years; median weight: 20.9 kg, range: 8.4-35 kg; median volume of testicular lesion biopsied: 4.4 mL, range: 1.2-17 mL). A percutaneous co-axial technique was used for 5/9 biopsies with absorbable gelatin sponge tract embolization performed in 4 of those biopsies. A non-co-axial technique was used in 4/9 biopsies. A median of three cores, range 2-6, were obtained. The diagnostic yield was 89% with one biopsy yielding material suggestive of, but insufficient for, a definitive diagnosis. The most common histological diagnosis was leukemic infiltration, occurring in 6/9 biopsies. Of the remaining three biopsies, one biopsy was suggestive of, but not confirmatory for, juvenile granulosa cell tumor and two biopsies confirmed normal testicular tissue; the long-term follow-up of which demonstrated normal growth and no lasting damage. There was one (clinically insignificant) complication out of nine biopsies (11%, 95% confidence interval 0-44%): a mild, self-resolving scrotal hematoma.

CONCLUSION

Ultrasound-guided testicular biopsy can be performed safely in children as an alternative to open surgical biopsy, with a high diagnostic yield and low complication rate.

A comprehensive review of the "tigroid" background cytological concept: what, when, where and why?

The concept of “tigroid” background is used in cytology to describe a peculiar smear background characterized by the presence of a relatively granular, reticulated material that was described as “foamy, lazy, tiger-striped or astrakhan”. It was used to describe the background seen in smears obtained from seminoma. In addition to seminoma, we now know that it can be present in different tumours, mostly carcinomas and round cell sarcomas. These share with seminoma a cytoplasm with high glycogen content and many times clear cell morphology. The “tigroid” background is seen when smears are air-dried and Romanowsky-based stains are used (May-Grunwald-Giemsa and Diff-Quik stains). It is only seen in fine needle aspiration or intraoperative squashing or scrapping samples, but not in specimens obtained from effusions or liquid-based cytology. Wet-fixed cytologic samples with alcohol or with formaldehyde tend to dissolve the background so it is not usually present in Papanicolaou stained smears. In this review, we discuss tumours in which the “tigroid” background is observed and its potential diagnostic utility and aetiology. It is interesting to remark that except for parathyroid adenoma and adenomatoid tumour all the neoplasms in which this background has been observed are malignant.

Educational Case: Testicular Germ Cell Tumor: Clinical Presentation, Pathogenesis, and Diagnostic and Therapeutic Modalities

The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, seehttp://journals.sagepub.com/doi/10.1177/2374289517715040.¹

Current status of percutaneous testicular biopsy for focal lesions

OBJECTIVE

The purpose of this review is to evaluate the current role of percutaneous testicular biopsy in the diagnosis of focal testicular lesions.

CONCLUSION

Percutaneous testicular biopsy can be either fine needle aspiration biopsy or trucut core needle biopsy. It is a well-tolerated and effective procedure useful in small testicular lesions, multifocal lesions, hematological malignancies, and focal lesions in single testis.

Cytologic diagnosis of metastatic seminoma to the prostate and urinary bladder: a case report

A 42-year-old man presented with severe abdominal pain, constipation, and hematuria. The patient had a history of seminoma treated by chemotherapy followed by bilateral orchiectomy and retroperitoneal lymph node dissection 16 years earlier. A computed tomography (CT) scan showed a 8.0 x 6.0 x 5.0 cm mass in the retrovesical space, encompassing the left side of his proximal bladder, the prostate, and the rectum. A urine cytologic specimen showed loosely cohesive cell clusters composed of highly atypical large cells and occasional large, single cells with macronucleoli present in a background of mainly lymphocytes and histiocytes was diagnosed as recurrent seminoma. Prostate biopsies showed extensively necrotic seminoma with accompanying granulomatous reaction. The tumor cells were immunoreactive for c-kit (CD117), placental-like alkaline phosphatase (PLAP), D2-40, and OCT4. To our knowledge, this is the second report on urine cytology of metastatic seminoma.

Diagnostic limitations in testicular cytopathology: To what extent is fine-needle aspiration reliable for the diagnosis of epidermoid cyst of the testis?

This article describes the cytologic and histologic findings of a epidermoid cyst of the testis diagnosed by means of fine-needle aspiration (FNA) cytology. The gross and cytologic features are creamy aspirate, squamous cells, squamae, and fragments of granulomatous tissue. The cytologic features are fairly typical and similar to those observed in cutaneous epidermoid cysts; however, in this setting, the differential diagnosis should be carried out mainly with teratoma and dermoid cysts. The patient's age and precise location of the mass are paramount in the differential diagnosis. We believe that FNA is a reliable tool for the diagnosis of testicular epidermoid cysts, but the differential diagnosis with dermoid cysts should be based on histology.

Fine-needle aspiration biopsy of the retroperitoneum: a series of 111 cases not including specific organs

We report on our experience in fine-needle aspiration (FNA) biopsy of the retroperitoneum: 111 FNA biopsies performed on 99 patients. Cytologic diagnoses were divided into four groups: nondiagnostic (unsatisfactory samples because of a low cellularity and/or improperly prepared smears) aspirates (20%), benign (16%), suspicious for malignancy (13%), and malignant (50%). There were no known false-positive samples. We had two false-negative diagnoses due to sampling errors. Among diagnostic smears, the procedure showed a sensitivity of 97% and a specificity of 100%. The predictive value of a positive result was 100% and the predictive value of a negative result was 90%. The overall accuracy was 98%. Metastatic carcinomas accounted for the largest number of lesions in the group of malignant tumors. A primary tumor site was known for the majority of the cases before the aspiration was performed. In the remaining cases we were unable to suggest an origin. It is therefore important to emphasize the role of ancillary studies in patients that are at the first assessment of the disease or when a second intercurrent malignancy is suspected. In our limited experience, a suggestion of the correct subtype of retroperitoneal sarcoma was not possible. As in the rest of cytopathology, a multidisciplinary approach is mandatory in this setting to improve patient management.

Diagnosis of malignant mesothelioma of the tunica vaginalis testis by ultrasound-guided fine-needle aspiration

Malignant mesothelioma of the tunica vaginalis testis is a very rare tumor that is not usually diagnosed until surgery is undertaken. In only a few cases has the correct diagnosis been obtained preoperatively by cytologic examination of fluid from the hydrocele. We describe a case of mesothelioma of the tunica vaginalis testis that was suspected on sonography because of the presence of a hydrocele and focal nodularities. The diagnosis was confirmed preoperatively by ultrasound-guided fine-needle aspiration cytology aimed at 1 of the focal nodularities. Our patient was an 85-year-old man with concomitant cancer of the sigmoid colon; because of his age and the spread of his colon cancer, we did not remove the scrotal lesion. We recommend consideration of ultrasound-guided fine-needle aspiration cytology of the solid masses instead of the fluid from the hydrocele in cases of suspected malignant mesothelioma of the tunica vaginalis testis.