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Diagnosis 2 and
DiscussionDiagnoses: Testicular
mixed germ cell tumor, predominantly yolk sac type (images 1-3) with
small foci of embryonal carcinoma (image 4) and mature teratoma
(image 5). The tumor invaded lymphatics and blood vessels of the
spermatic cord but did not invade the tunica albuginea (capsule of
testis). Pelvic metastasis with focal destruction of the left pelvis
and femoral head. Metastases to L4, T12, the proximal right humerus,
retroperitoneal lymph nodes, and
lung.
Clinical history
completed: The neurologic symptoms and signs
were attributed to a pelvic plexopathy, and spinal cord compression
was excluded. After the orchiectomy, he was begun on the first of 4
cycles of cisplatin, etoposide, and bleomycin. He also received
radiation to the left leg. He was discharged on crutches and
non-weight-bearing on the left leg.
Tumor disappeared except for residual, non-enlarging nodules in the lung, and the patient appeared well and without neurologic deficit. A routine chest CT scan performed in 10/96 showed bilateral lung nodules that did not appear to have increased in size and a subcarinal node with central low attenuation, which had increased from 2 to 3.2 cm. Resection of one lung nodule and the subcarinal lymph node was performed in 1/97.
Gross features: The subcarinal mass, 4.5 x 3.5 x 3 cm contained multiple cysts with smooth, thin, white walls and clear, serous or thick, yellow fluid. The wedge of lung contained a firm, white nodule, 1.7 x 1.4 x 1.2 cm. Section showed a biloculated cyst with serous fluid.
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Diagnosis 2 and
Discussion