~!ALE GENITAL TUHORS

Tumor Pathology Loan Collect ion

Kansas University Medical Center

Kansas City, Kansas

This case material constitutes t he fifth in a series of Tumor Loan collections prepared and distributed by the Department of Pathology and Oncology of t he University of Kansas l<!edical School aided by a Cancer Control Grant (CS-9209) from the National Cancer Institute of the National Ins~itutes of Health, United States Department of Health, Education and !·lelfare. This material is furnished on a permanent "loan" basis.

:!se 1 ~no~a of Testi s

University of Kansas Medical Center Kansas City, Kansas Surgical Pathology No . : 883- 52

:fistor.v: This 39- year- old white male was admit ted to t he hospi t al with t he compl aint

f a mass i n t he l eft test:ls vthich had been pr esent for about three year s and a mass

:n the left side of the abdomen >~hich had been present for only a short time . The

~tient gave a history of mumps four years befor e admissi on and shortly thereafter ,

t':e left testis began to enlarge and became very tender. Ther e was an associ ated

wight loss of about eight pounds . Befor e admission he had been suffering f rom con-

;IJ.pation and had vomit ed several times .

The examiner f ound the left testis to be enlarged to abou t 25 em. in cir cumfer-

~ce . There was a mass in the left para- umbilical region about 4 to 5 em . in diameter

11tich was moderately tender on deep palpation. The Friedman test was negative , X- ray

~Mrination of the chest, gastro- intesti nal tract , ' and urinart tra ct showed no e\~dence

of metastases .

A left orchiectomy and resection of the cord were performed . Postoperative

~diotherapy was administered and consisted of a total depth dose of 2358 r . through

,.= ports to the pelvis and 2113 r . through two ports to the preaortic chain .

One year lat er the patient was admitted f or i ncisi on and drainage of a peri-

~~pendiceal abscess . At this time several l ymph nodes a l ong t he preaor t ic chain v:ere

•o>ected, and no evidence of tumor was f ound in any of them . T-vro years after or ch-

•. ct.wy the patient was well with no evidence of recurrence .

~ Pathololl:iC Findings : . The specimen consisted of the left testis which was reni-

i~J;.T. in shape and measured 7 by 8 by 6 em . It '~<'eighed 220 gr ams . The capsule was

.'ink, smooth, glis t ening, and semi -transpar ent revealing the under l ying vascul a r ity .

"h& cut surface was composed of firm, gray, protruding smooth tissue . The entire

=ection ~'liS homogeneouslY gray •'i th an i rregular oosaic of >:hi te and yeUo~o~ spongy

tissue . The gray tissue exuded a white lililky secretion.

Diagnosis: Seminoma of the left testis .

i:ase 1 - Page 2

~ormnent~ This tumor has the best prognosis of any of the testicular tumors of germinal • It is t he one t umor of the testis which is radiosensitive and may be cured by

-ray therapy even in the presence of metastases in the r etroperitoneal lymph nodes,

"he usual lreatment consists of orchiectomy ~th post operative radiation to retro-

,~ritoneal lymph nodes. The one precaution which should be mentioned is that one

::ust be certain that only seminoma is present in the tumor, otherwise surgical resec-

tion of the retroperitoneal lymph nodes is necessary to eradicate the tumor . I n

c>ses of doubt the latter treatment is the one of choice ,

There is a more benign variant of this tumor sometimes called atypical seminoma,

•adult" seminoma or more properly spermatocytoma . They differ in shelling better

~fferentiation of the cel ls such that they resemble secondary spermatocytes , They

seem to be less cohesive and are often rounded and the stromal component of the tumor

is minimal.

'.e references: 1, 2, and 3.

:ase 2 :lbryonal Car cinoma of Testis

University of Kansas Medical Center Kansas City, Kansas Outside Aut opsy No.: 39- 247

;;istor:v: A 38- year-old ~1hite man "'as admitted to the hospital with t he complaint of

:~ere pain in the right testis of three months• duration . One month before admission

had developed a persistent cough with slight hemoptysis; he also developed a diffuse

hGadache at about the same time.

Upon physi cal examination a rather indef il".ite mass ~1as felt in the right testis ,

a nodular, poorly defined mass ~·as found in the lower lllid- abdanen . The Babinski

•· n~x was present bilaterally . X-ray examination of the chest sho~·ed numerous "snow-

tall-like" shado>~s throughou t the lungs .

The patient became progressively ~:orse a."ld died about a month and a hail l at er.

}r.8S Pathologic Findi~s: Itt autopsy the right testis ~·as considerably enlarged.

•• .he inferior pole in the region of the rete testis, the parenchyma was replaced by

·ray cellular t i ssue which was homogeneous and moderately firm, blending "'ith the

:urrounding testicular subst~~ce. This mass measured 2 em . in its greates t diameter.

The periaortic lymph nodes 1-•ere greatly enlarged and measured up to 4 em. in

:liaJTeter . Hany of the lymph nodes were closely matted toge ther . On ::section they

~resented a firm, gray, translucent appear ance 1-tith considerable t endency t o necrosis

-~r.d hemorrhage in the central region .

The right lung ~·eighed 989 grams and the left •·eighed 950 grams . Scattered

•hroughout both lungs were firm nodules, 1 to J em. in diameter, ~1hich on cut section

I 1d a cystic and hemorr hagic a l)pearance . They 1··ere ~rell demarcated from the surround-

, •;cry congest.ed lung tissue .

The spleen weighed 245 grams. The pulp was firm and the Malpighian ccr?uscles

md trabeculae were quite distinct . There ~1as a firm, dark red nodule at the hilum

wr.:ch measured 4 em. in diameter . The cut surface of this nodule revealed tumor tissue

h necrosis, secondary cystic change, and considerable hemorrhage .

~;ase 2 - Page 2

The brain \1eighed 1240 g r ams . "l'her e v•as some diffuse hemorrhage beneath t he

rachnoid on the right side in the frontal pole . Just benea th the surface in this

~.non, there was a cystic, h"emorrhagic metastatic nodule about 3 em . in diameter .

~l~r encapsulated nodlles of the same size were seen in the right cer ebella r hemi­

'~here on the posterior inferior surface.

D!al!llosis: &.lbryonal carcinoma vii th seminoma of the right testis, >1 th choriocarcin­

·atous metastases to retroperitoneal lymph nodes, lungs, brain, and spleen .

Coll!lllent: It seems apparent from a number of careful studies of large series of

e~ses that embryonal carcinoma represents a primitive tumor \•li th potentialitie$ to

nfferentiaLe either into somatic teratomatous structures or into chorioepithelioma­

".LS formations resembling placenta or both. In this case the metastases either by

·etastasis of sel ective cells 0':' by differentiation at the sites manifest a chorio-

carcinOlllatous type of differentia Lion . Their functional activi ty is reflected in the

fSLis by hyperplasia of the interstitial cells despite Lhe lack of a Friedman test .

No mention was mlde of gynecomastia wbich is sometimes found in such cases . The

Nsence of the semi nomatous areas are probably coincidental although some bave t hought

•j could represent the more natural somati c line of differentiation which can take

bet in these tumors . Their presence does not change the othen•ise poor prognosis.

In some of the sections there is a small teratomatous area adjacent to the

cryonal carcinoma which >tould change the diagnosis t.o teratocarcinoma .

references: l, 4, and 5 .

of Infantile Testis University of Kansas Medical Cent er Kansas City, Kansas Surgical Pathology No .: V-515

A seven-month-old boy ~·as admitted to the hospital ·.dth t he complaint of an

·hrged right testis which had been pr esent since bi rth . This t umor had been growing

~ ra?idly in the three months just before admission . The infant had had a normal,

1l1 term deli very and had \·ll~ighed 7 pounds, 6 ounces at birth. There was a history

:~&)llent upper respire tory infections.

?hysical exami.nation shov•ed no·thi ng of importance other than a l arge mass in the

•· .. n~ ~estis about 4 c:n . in diameter which •as finn and slightly irregular in outline;

phimosi s of the penis .

7he right testis was removed surgically, and the patient ~ade an uneventful

~he subsequent course of this patient is unknown .

Pathologi c Find;ne:s : The specimen consisted of a testis measuring 5 .5 by 3 . 7

7 }.5 em. in size and ~teighing 34 grams . It ~·as gray-pink and soft . 'l'he external

urface ••as covered by a thin fibrous capsule •~hich l·t as smooth, moist, and glistening .

. con section the substance of the testis ~·as translucent, gray-~·hi te, soft, and

Ther e were numerous scattered cystic spaces varying from 1 to 10 mm. in

often filled ~~th a gr~y , stringy, mucinous material . There were also nlli~-

-us scattered areas of hemorrhage on the cut surface .

Adenocarcinoma of the infantile testis, probably originating from the rete

'i'here a r e four such cases in the files of the Kansas Univer sity Hedical

· ~r. All are morphologically similar and occurred in infants f r om 7 to 18 months

Two of the four cases aro kno~'ll dead; one died of pneumonia follo~·ing chicken

' J months .after a course of post-operative inadiation to chest and abdomen which

• suf fidien t t o cause nausea , vomiting and leukopenia . The second case died ~d th

Case 3 - P~ge 2

rlhat v1ere interpreted .a s pulinonary me t astases; unfol't una t ely, no post mortem examina­

~ion ~1as done . The third case Kas reoperated with a retroperitoneal lymph node

:resection several months after or chiectomy, No evidence of metastati c tumor 11as

found and the boy is living and •··el l some 2 years postoperativel y .

These cases are i dentical to ~hose ·described by Magner and Bryant (see r efer ence

6) as aoenocarci noma of the testis in inf ants . It vtas t he opi nion of these authors

that they repr esent tumors of lot·· malignancy aris ing from t he rete blast.ema . v,re are

i.n.clined t o agree t~i th these interpretations but more cases need to be· follOt·:ed before

final conclusions can be reached concerning their prognosis .

~ase 4 -era&ocarcinoma of Testi s

University of Kansas Medical Center Kansas City, Kansas Surgical Pathology No . : 10-3610-44

-.istory: A 46-year-old >'hite man "'as admitted to the hospital ><ith the complain& of

:nlargement of the left testis of abou t six weeks duration. · ·hen first discovered,

tnis mass had been about 3 by 5 em. It g r adually enlarged until admission when it

w~s 11 by 6 . 5 em. It vras painless w1til a d\tll aching sensation developed at the base

>f the scrotum a fe•• days before admission .

Physical examination shmved a large, firm left testis of t he stated size. There

~ several small shotty lymph nodes in the left inguinal region . Exa~nation of

~e l:aart revealed an occasional premature systole . X- ray exaoination of the chest

'mwed no evidence of pulmonary metastases .

A left orchiectomy was performed and the patient was dismissed . Subsequent

J',llo1~-ups on this man revealed no evidence of t umor with nega t ive chesL x-rays

1 1/2 years later and now, el-even years after his operation he is h v'.ng and well .

Gross i'at .. ologic Findings: The specimen consisted o:f a t estis and a i)Ortion of t he

c·rd n:easuring about. 15 em . in length . The surface of the tunica albuginea was

~ .• ~th, LranslucenL, and glistening . The cut surface of the testis r evealed a firm

·r~slucent tumor replacing the usual testicular architecture . I t was gray- white,

:-oUlad 1•1 th frequent hemorrhagic a reas and it contained numerous r ather ~sell demarc-

ated cystic a1•eas . The general texture of the lesion was moderately softJ but there

;•e-re a fev• r egitms Vthich v:ere much softer than othe r s . The r e ~1as a l arge amount of

fat and fib rolls tissue scaLtered throughout Lhe specimen .

~a;nosis: Teratocarcinoma composed chiefly of immature ter atoma .

=ent: According to present concepts t.his represents a highly malignant tumor. Even

· 't radical orchiectomy and retroperitoneal lymph node dissection, the prcgnosis

· ~ruy slightly better th~~ in cases of embryonal carcinoma because of the somatic

"fierentiation .

• reference 1 .

Case 5 Adult Teratoma of Testis

Uni versity of Kansas Hedical Center Kansas City, Kansas Surgical r a thology No . : 4-1204-44

"isi:>ry: A 28- year-old single ~·hite man ••as admitted to the hospi tal wi th a mass in

;e chest, a mass in the left lo~·er ouadrant, and an enlargen:ent of the left testia .

··inc mont.hs before admission a mass was removed from the left supraclavicular area

oy Dr. N.C. l!orro» of Parsons, Kansas . Dr . Norro>' stated that grossly the mass con-

scsted of a multilocular cyst. and the pathological diagnosis >~as teratoma . Nine

ooths before he came to the hospital, he had noticed that his left testis was larger

tr.an the right . Physical exa:nination at that time revealed a growing mass in the

left lo~•er quadrant . Fiv.e months before admission x- ray examinati on of the chest

sho>•ed a large mass in the anterior mediastinum . The pati ent complained of f r eq-

uency of urination and dysuria . He had had poliomyelitis a t the age of 12 . He had

had a 2+ I ·asserman and had recetved 50 inj ections of Bis muth.

At ~he -~tme of admission the exami ner f ound a ha rd, i'reel y movabl e mass , s urr-

ounded by a hydr ocele, i n the scr otum on the left sid e . There was a hard mass in

tne left lo~·er quadrant , measuring 8 em . in diameter, which di d not move with r es-

pi ra;:,ion . The l i ver ••as palpable t•·o fingers belo~· the costal margin . There was an

"~.lsrged submaxillary lymph node and a supraclavicular scar on the left . There was

e bilateral indirecl inguinal hernia . There »as soToe post- poliomyelitis atro~hy of

the left leg . The Friedman test \\'as negative . The' assennan and Kahn tests •·ere 4+ .

---ray examination sho•·ed a huge, lobulated mass in the anterior mediastinum . The

~ss in the left lo•·er quadrant of the abdomen displaced the descending colon upward

~i to the right.

A left orchiectomy was performeo and the pati ent was dismissed for extensive

•adiothera,>y. This consisted of 992 r . through tvro ports to the superior mediastinum,

11<88 r . through tv•o ports to the abdomen, 285 r . to the left anteri or a bdomen and

left hi p, 708 r . to the right lateral pelvis, and 560 r . to the left supraclavicular

ragion . 'C-ray examination follo1··ing t his therapy r eveal ed no appreci abl e decrease in

:ase 5 - Page 2

t.he &ize of the tumor masses . The patient died si x months lat er and no autopsy was

lil-rformed.

}ro$s P-athologic Find ings : The specimen consisted of an irregularl y shaped piece

:u' tissue , measuring 1.0 by 5 by 5 em . Part of i t ;·•as covered by a smooth, s hiny

.A~ous membrane . The tissue Has firm and nodular. Upon section, some normal test -

icul ar t issue '"as seen, but most ~·as replaced by gray t issue v1hich showed variat ions

b structure, •t:ith marry- areas of cystic degener ation and necrosis . Some of the

;hin-1·•alled cysts v1ere filled with a watery f luid . In par ts of the tumor there was

marked induration v·i th calcif'ication . An attached piece of tissue, con t aining the

spe:rmati'c cord and vessels, v•a s covered by a smooth, shiny se rosa i n 'o"hich 1··a,s f ound

a hard, flat nodule mea.s uring 2 em. in diameter .

Diagnosis: Adult teratoma repl acing most of the l.e:flt te·stis .

Gvmment : Although t.hese tumors have a distinctly better prognosis than other more

llllllBt\lr e gt'ov>ths , the v•el.l differ entiated benign a1)pearance of t he t issue comp~·isiqg

he tUinor i n t he testis is deceiving . 1-;etastases of mere undifferentiated embryonal

cells may take place before t he d~fferentiation occurs, and t hereby bring about a

f, L-al outcome . ~Jote : A tiny separate focus of seminoma i.Jl f ibrous tissue oan be seen in t he remain-

· ng testicular t issue of most of the sections .

'e reference 1.

·ase 6 ::coma of Testis

University of Kansas Hedical Center Kansas City, Kansas Surgical Pathology No . : 4-1652-47

' .4ry: A 65-year- old colored man ~·as admitted t o the hospital r:ith the complaint

: a ?ainless enlargement of the left testis of ap~roximately one year•s durat i on .

·- nad r,ro1·n rapidly for the last six months .

?he examiner found the left side of the scrotum to be filled with a hard, slightly

~~~gular mass about 10 em. in diameter. It seemed to be continuous ~~th the testis

a:J!i i~ could not. be transilluminated . The f riedman test was negative .

A left orchiectomy ~·as performed. The patient fell out of bed on the first post-

operat ive day, injuring the operat ive site and causing a large hematoma to develop

l'!!ic~ subsided slo~rly . He was dismissed and had had no recurrence six years later.

Gross Pathologic Findin,~~:s: Tho speci.rnen consisted of a roughly spher ical mass ~reighing

'130 grams and meagur ing 11 em. in diameter . At one pole a struct ure resembl ing sper-

12tic cord and its vessels was attuched; it. •·as t raced to a " hilum" marked by a

moderate amount of loose areolar connective tissue . The enti r e mass was 1-rell encapsul-

eied in a firm fibrous sheat,h. At the point ,.·here the spermatic cord was adhere~t to

~ne :1;~ss there was a cleft-like space lined by smooth, shining membrane resembling the

u:.'lica anti extending for a fe1·• centimeters over the surface bet"·een the outer capsul e

a:.ll the mass . Section sho~·ed the mass to be com,x>sed of dense material ~·hich closely

-e~e::bled a fibroid tumor throughout ;>ractically its entire e=ent. Ho•:ever, there

N several areas marked by some softening and hernorrhage in Yhicb the tumor aptJeared

!'>:!translucent and cellular . Near the "hilum" some soft yello•·- bro>'ll tissue was

f.!!r.d vhich appeared to be compressed testicular tissue 'r.i. th att ached rete .

~ enosis: Leic~yofibrosarcoma of the left testis .

This might be regarded by some observers as a one-sided. development of a

tP.sticular teratoma but, >rithout other ~issue elements , such a diagnosis i s hardly

the lesion is probably liLtle different from similar tumors elsewhere

Case 7 Interstitial Cell Tumor of Tes tis

Contr ibuted by Dr . David Gibson St . Luke's Rospital Kansas Ci t y , l1i s s ouri Surgical Pathol ogy No.: 54-E-269

Jtistory: This patient is a 45-year- old man who in 1951 had the skin of t he entir e.

penis and scr otum avulsed ih a, combine accident , At t hat time skih Has graf ted on the

penis and the testi cles were implanted subcut aneously in the t highs . Af ter a pproxi-

mately S months t he patient was able to have an erecti on and had intercourse in normal

lilalli\er . Hm~ever, i n the past year and a hal f the desire for inter cour se has com-

pletel y di sappeared and he has had no more erect ions . Also, since the acc i dent the

patient ' s voice has become very high pitched and he has gained considerable tYeight ;

the fat deposition is f emal e in type 1dth preponderance in the buttocks and abdomen .

1/o hai r has ever r et urned to the genital regions follm1ing his operation. There has

been no evi dence of gynecomastia .

FolloHing oper ation he continued to have discolili'or t ~1ith ·~he right testicle and

11as for ced to 1•Jal k 1~ith a very a~VkHard gait to be f r ee of pai n . This cons·ti tuted the

indication for r emoval of the r i ght testicle ,

~l'Oc~s l'athologic Fi ndi ngs : The specimen consisted of a piece of tissLte S x 3 x 1.5 em,

It 1~as completel y covered ~:ith a tan fibrou~ capsule and on sect ion showed a soft

mott l ed yello1~ and broNn parenchyma ~~i·~h part of the nor mal appear i ng epididymis

attached . (No non nal testicular t issue apparent)

D~agnosis : Interstitial cell twnor of' the testis ,

CO!imlent : This t ype of tumor sometimes i s func·~ional, secreti ng an excessive amount

of androgenic hormone which can be detected by elevated 17-ketosteroid in t he urine.,

Jhen such a f unctional t umor occurs in young boys it produces prec.oci ous puber ty.

lUter puber ty par adoxicall y it ma.1· produce gynecomastia i n an othen:ise muscul ar al')d

Virile man. Pr esumably this is due to testost erone o·ver lappi ng the actions of estro-

gen and proF,esterone as noted by Selye in his Textbook of Endocrinol ogy_ An androgen

producing tcmor of adr enal cor tical origin may resul t in a similar picture clinically

JSe 7 - Page 2

and histologically . Such tumors of the adrenal cortex never contain crystalloids of

IGinke Hilich may occur in i nterst itial or Leydi g cell ~umors .

<- references 7 and 8.

Case 0 IQ'l'lphoma of Testis

University of Kansas ~!edical Center Kansas City, Kansas Surgical Pathology No . : 2540-55

History: A 15-year- old 1~hite high school boy ~1as admitted to the hospital 1~ith a

c\ief complaint of lumps on his body and i~ his left testicle for at least 5 month~ .

lhe patient had been kicked in the scrotum during a football game 9 months before

.edrnission. About 2 months later he noticed a firm non-tender mass in the left scruc.L'l

unich has r emained unchanged since that time . Multiple nodules developed over the

entire body, including the left eye lid, right ear lobe, and the r i ght arm. Three

11eeks prior to admission the patient had some low back pain. The pain persisted and

tn the last few days prior to admission the pain radiated t o the left groin. There

.laS been no weight loss and the patient has been active throughout his i.llness,

Physical examination Has negative except for the presence of a firm non-t ende1·

nodule L~ tte left upper eye lid causing ptosis,~ a firm 1 em. nodule in the tragus

of tile right ear and numerous small hard nodules in the left abdomen and left in··

~inal region. The left testicle ~1as enlarged measuring approximately 10 em. by 1~

.n. It was f irm and did not transilluminate. A .2 by 2 em. hard nodule in the i.mt.

,j~Ct of t~e right arm and a l em. nodule behind the lateral malleolus on the right

~ide 1:1ere noted.

Routine laboratory work ;1as Hithin normal limits . l"o-~o Friednan tests ~<ere

·arried out and reported as doubtful.

~ross Pathologjc Findings : The specimen consisted of the left testicle and cord.

The ;1eight l<as JJJ! gm . The testicle measured 11 x 6 x 6 em. The cord measured

10 x 3 x 3 em. and was enlarged . Cut secti on revea:Jed the t esticle to be replaced

by soft, lobulated homogeneous pinkish 1-1hite glistening tumor tissue , ~•ith a some­

"hat hemorrhagi c appearance . The cord was filled Nit.h the same grayish ~Illite to pinJ.;

tumor tissu~ up to the proxiMal line of excision.

Diagnosis: Lymphosarcoma of left testis and the spermatic cord .

Cw.ment: This is the most cor:mon "seconda_ry" tumor of the testis . Although it may

ase 8 - Page 2

;;e the presenting finding, it is probabl y alHays associated with systemic rr.alignant

mphorna . Dermal manifestations also are a cOIIUTion accompaniment i n these cases .

-~references 9, 10, and 11 .

c~se 9 Aaenomatoid Tumor of Epididymis

Contributed oy )r . C. J . i-leber Asbury Hospital Salina, Kansas Surgi cal Patholo~ No .: 11-2759-54

History: A 49-year- old whHe man sought medical advice because of pain t·Jhich recently

aeveloped in the scrotum. He ~~as found to have a fim nass at the lo~Jc.r pole of one

testis and was admitted to the hospital. Tho testis and epi didymis were re~oved .

ill" patient ' s postoper ative course was uneventful and he is well.

Gross Pathologi c Findings : The specimen consists of a t-esti cle measuring 4 . 5 x 3 x 3

ems . HHh the attached epididymis and a 4 cn1. segment of the spermatic cord . I n the

tail of the epididymis there is firm tumor· mass measuring 2 .$ x 1.5 x 2 .0 em. which

is confined to the epididymis and does not extend to involve the adjacent testis .

~ cut section (see gros~ picture) the ~Ass is composed of solid gray-white, semi-

O[>aQUe tissue 1·1ith fine in·terlacing of ''lhite fibers . It is rather Nell-defined and

circumscribed but not encapsulated . The testls and spermati c cord aprx;ar normal.

~ia~noois: Adenornatoid twnor of the epididymis .

See references 4 and 12 .

Case 10 3arcoma of Spermatic Cord

Contributed by Dr. Jack Hill Trinity Lutheran Hospital Kansas City, Missouri Surgical Pathology No . : 48-1278

History: This 18-year-old white man was admitted with a lump in his left testicle,

which he said had been present for 18 to 2lf months. The lump '"as about 1 em. in size

t•hen he first noticed it. It was non-painful and non-tender and located at the upper

}ole of the testis. One year before admission he had played football without diffi-

~ty. Six months before admission the nodule began to ache. At that time it was

estimated to be 10 to 15 em . in diameter. ~'hen he rode on a tractor it was painful

and required tl•o or three athletic supporters. One month before admission he began

to note lov• back pain, and he finally consulted a doctor one '~eek before admission.

Upon admission the tumor was excised vdth high ligation of the spermatic cord and

resection of the testicle and c-ord.

Subsequent follovt-up revealed the patient died 6 months later . Unfortunately no

autopsy v•as performed.

~ Pa tholosical Findings : The specimen ~!hen received .. -eighed 420 gn~. and measured

12 x 8 . 5 x 7 em. It consisted of a large tumor compressing and displacing the testis

and e~ididymus, but ~thout distinct gross invasion of these structures. There was

no evidence of a hydrocele . The tunica was smooth and glistening, and the spermatic

cord ~ras attached to the tumor at one end. Hembranes of the cord partially covered

the exterior of the mass. The testis was displaced to one side, and measured 4 . 5 x

J x 2.5 em. It appeared normal. The epididymis was not remarkable. The tumor had a

,lseudo- capsule, and on cut section it was lobulated and composed of pale, grayish-t:hite

croist tissue. In some areas there were indistinct bundles of t!hi te fibrillar tissue

~prising the tumor. There ~ere only a few small areas of hemorrhage and softening,

ruagnosis~ Rhabdomyosarcoma of the spermatic cord.

Case 11 Carcinoma in situ of Penis

Contribu~ed by Dr . Lauren Ackerman Barnes Hospi tal St . Louis, ~fissouri Surgical Pathol ogy No . : 5l- 2288

Hi story : The pat ient was a 46-,year- old Negro admit ted to Barnes Hospital Hay 4 ,

1951~ because of a "sore on penis" of 7 months' duration . The sore began as a t iny

red pimple near the meatus of the urethra . I t gradually grew larger vrithcut asscc-

iated bl eeding or 11eeping . The patient had noted no enlar gement of l ymph nodes .

'Burning on urination had been presrmb for 8 v1e.eks . He d enied having had ·syphilis

or gonorrhea but s t ated he had had bilateral "blue balls " at age 19 .

Phys ical examination reveal ed the patient had not been circumcised. He had a

reddened, macular, granular, v1eeping l esion of the glans, surrou nding t he meatus .

It cover ed most of ~ he glans . The urethra \1as slightl y stenot i c . Ther e was one

sQft 2 em. lymph node palpate~ in t he l e f t i nguinal region.

laboratory examination ·r evealed a negative Karm ' and normal blood count and

urinary findi ngs . An intravenous urogram 1vas normal and a serie.s of x - rays search-

ihg for pos·sible rnetast atic l esion s were negative ..

A partial amputati on of the penis '"'as done on Hay 11, 1951. The pat ient "as

last seen on June 10, 1954, and there ~1as no evidence of . any recurrence noted .

Dia.c;nosis : Carcinoma-in-sit u of the glans penis .

C0mment : This lesion has been previously described as Erythroplasia of Queyrat,

8o11en ' s disease or Paget • s. di sease but present terminology would place it in the

category of carcinoma-in-situ . This is a section .from the case illus trated i n

Figur e 574 of Dr, Ackerman's book, see reference 13 ..

;ase 12 Sertoli Cell Tu'llor of Testis

Case of Dr. Alan McEwan of Washington, D. C. Contributed by Dr . i'"illard H. Eyestone Laboratory of Pathology National Cancer Insti tute Bethesda 14, Maryland Accession Nc .: G 55920

'iistor.v: This dog was a U-year-old male Pomerani an who had become completely hairless

and ~·as attracted by other male dogs like a female in heat . One testis was enlarged

~il!l\ and nodular . It ~·as removed and submitted for diagnosis . No ment ion is made

cf any breast changes .

"'est-operatively the ~·ound did net heal and there appeared to be ra.Jid regrc~lth

lUring the remaining 2 1/2 ~-eeks follot·'ing the operation. The dog was given a lethal

se of gas and no autopsy was penni tted .

Crass 'athologic Findings: The specimen consisted of a testis measuring 4 x J .5 x ~

2 em. There '''ere three slightly raised nodules visible on the surface . On cut sec-

.ion each of the nodules measured approxi.mately 1 x 1. 5 x 2 em. and almost the ·"

<atire testis was replaced by the tUillOr .

Dl al(noais: Sertoli cell t.umor of the testis.

Goment: Thi s is the typical picture of this twnor and histo1,ogically in fat stains

th~re are many scattered discrete spherical globules of fat in the islands of tumor.

:s tumor is often benign in dogs and it is so rare in man that few have had the

;x>rtuni ty to study such a case . In dogs the tumors contain and secrete estrogen

"nducing feminization ~·hich has been reproduced by administration of estrogen .

See references 11, , 15, and 16 .

~ase 13 '~ryptorchidism

Contributed by Dr . G. L. Ashley Neosho Memorial Hospital Chanute, Kansas Surgical No .: B-1621-52

~istory : An undescended tes tis r emoved from a 25-ye?I' - Ol d Hhi te man.

Gross Pathologic Findings : The specimen consists of a tr.i n cloak of fil:>roadipos e

t issue surrounding a ·~esticle and epididymis lying in a caVity l i ned by smooth

glistening ~unica . The test is measur es J . 5 x 2 . 2 x 2 . 0 crlt. and on cut section

con·~ains the usual soft tan t issue . No nodular areas can be palpated .

Di agnos i s : Undescended testicle .

Comm<Jnt: Undescended testicles almost al1-1ays contain f ocal areas of imn~ature tubules

'Atd.ch ~/hen they ar e lar ge enough are termed "Pic!<' s adenomas" . These pr esumably

represent . an anomaly raiher than nooplasm and t hey are di agnostic of undescended

testis .

Case 14 .. ~rophy of Testes .• ben·ant adrenocortical tissues of spermat ic cord

Cont r ibuted by Dr. Hilliard Cohen l~et•orah l'iedical Center Kansas City, l•lissouri Surgical Patholoey l~o . :1890- 1951

Historv: This 51-year- old man had an undescended testis lying in the inguinal canal.

He was operated upon and Lhe test.is , epididymis and spermatic cord ~1ere removed .

Gross l?athological Findil'lRS : 1'he testis me~sured 4 . 5 .x 2 . 5 x 1.0 em. and the

epididymis, 8 .0 x 0 . 6 em . ln the i'at of the !:!pe.rmatic co,rd there v1as a J ,O x J .O

Im~., v1ell-defined nodule t11r1t had a distinct yellow outer layer and brown inner

layer, grossly typi cal of adrenal cortical tissue .

Diagnosis : .~trophy of testis . .31nall nodule of aberrant adrenal cortical tissue

in spcrrr.at.ic cord.

Comment : In the inner zono or t he nodule there a~::,e a f~t~ laminated, basophilic

bodies that have the appearance of psammoma bodies . The presence of these rests

probably account s f or the rare tumors of adrenal cortical cells Hhich have arisen

.:. the region of tohe testis . S:imi:.ar rests are abo souet.i.mes four.d in the region

vf the ovary. Rests of this sort are possible because both the adrenal cortex and

the tiOnad originate embryologically from the urogeni tal ridge .

See reference 17 .

Case 15 "arcoma of Penis

Contributed by Dr . David Gibson St . Luke ' s Hospital Kansas Ci ty> Hi ssouri Surgical Pat hology No. :50-C-438

50-C-446 52-C-40

History: The patient was an 82-year- old man 1;ho had had a fungating lesion of the

glans penis which had gradually increased in size since i~s a ppearance 6 months

previously. Biopsy ~1as performed on Qlovember 5, 1950 and t>to small pieces of tissue

wcre removed ..,hich on histologic hxantirull.ion proved to be a sarcoma of the glans

pe.'lis . A partial amputation of the penis 1·1as performed 4 days later .

The patient was admitted again to the hospital on .ianuary ::n, 1952 1;ith com-

plaim,s of difficult urirot.ivn . At this t ime the patient v1as poorly nourished and

uppeared chronically ill. li:x.a111inat.ion revealed a palpable supraclavicular l,ymph

!lOde 2 ern . in r.liamcLc.r and tvro Jrnall fir111 subcutaneous nodules situated near the

111~bllicus . The prostate v1a:; benign to pal pation .!_dth ;2-pl us enlargement 1 and the

tlood Kline Ha:J negative . TllC3 tNO small fir ••• :;ubcutaneous nodules near· tile umbilicus

.• ,ere removed f.or biopsy, and t he tisoue.~ r eceived by the laboratory consisted of t Ho

irregular pieces of Ussu~ partially surrounded by fat and measuring up to 12 ll'Jll. i n

diocne<;er . 3ection revealed portions of lymph nodes s helling considerable replacement

vi tl: adi pose tissue and areas of metastatic tumor . Hicroscopically they ~;ere inter-

preted as lymph nodes containing maligront hemangioendothelioma . The patient was

:her, treated ldth ind!ielline urethral catheter and his course continued slowly down-

·< ·.1 with tenrinal r.J.assive hemorrhage from t.he urin:try bladder and congestive heart

.:ailure prior ;,o his death on February 13 , 1955 . Ho autopsy ~<as obtained .

Gross Pathologic Findings : t:x&nination of the anJputated penis revealed approximately

5 c.T •• of the ten.tin:\l portion . On the t.;l.lns there v;as a nodule ~•hich ueasured 10 x

8 x L. r.m . The nodule appeared to ho.ve u rist:ll from the right side of t he meatus .

3ect-ion ~hrough t his nodule revealed firul tissue ell.bending approximately 4 f11Jl . into

~r.e unc;l,erlying Lis sue .

Diagnosi$ : Sarcoma o f ~he penis> pr-obably hemangioe ndotheliomatous in origin .

Tumor Pathology Loan Collection J.!ale Geni tal Tumors

References

l. Dixon, F. J . and l·!oore, R. A. Testicular Tumors: A Clinicopathological. Study. Cancer 6: 427- 454, 1953 .

2. LEMi.s, Lloyd G. Testis Tumors: Repor t of 250 Cases . J. Urol. 59 : 763-7'12, 1948.

3 . Stofer, Bert E. Carcinoma Derived from Adult Seminiferous Epithelium. Arch . Path . 40 : 68-71, 1945 .

4. Dixon, F . J . and l.foore, R. A. Atlas of Tumor Pathology. Tumors of the ~lale Sex Organs . Armed Forces Institute of Pathology, Nashington, D. C. 1952 .

5. Noon, H. D. and Hullinghorst, R. L. Basic Patterns in Teratoid Tumors of the Testis . Am . J. Path. 24 : 1067-1081, 1948.

6 . Hagner, D. and Bryant, A. J . S . Adenocarcinoma of the Testis Occurring in Infants . Arch . , Path . 51: 82-89, 1951 .

7. Hertz, R., Cohen, i'f. I ., Lewis, L . G. and Fi:nninger, H. I. Sexual Precoci t y in a 5-Year-Old Boy with Interstitial Cell Tumor of the Testis. J . Clin . Endocrinol. and Netab . 8: 1248-1253, 1953 .

8 . Hostofi, F. K, (to be published soon, probably in the Journal of Urology. )

9. 1-lath~, C. P .. Lymphosarcoma of the Testicle; Report of a Case . J , Ur ol. 55: 5.30-541, 1946 .

10. Dockerty, J.! . B. and Priestley, J . T. Lymphosarcoma of the Testis : Report of Four Ne1·1 Cases . J . Urol. 48: 51.4-523, 1942.

ll . Gandin, ~J . J.l . and Kno>lal er, B. E. Lymphosarcoma of the Testicle . Ann. l!est . Ned. and Sur g. 5: 55- 58, 1951.

12. Golden, A. and Ash, J . E . Adenomatoid Tumors of the Genital Tract . Am. J . Pat h . 21: 63-79, 1945 .

13 . Ackerman, L. V. Surgical. Pathology, P. 504 . C. V. Kosby Co . St. Louis, 1953 .

1.4. Huggins, C. and Moulder, ? . V. Est rogen Production by Sertoli Cell Tumors of the Testis . Cancer Res . 5: . 510-514, 1945 .

15. ~iulligan, R. H. Feminization in Hale Dogs : A Syndrome Associated t-li th Carcinoma of the Testis and l:.imicked by the Administrati on of Estrogens . Am . J . Path . 20: 865-893, 1944 .

2

16 . Teilum, G. Homologous Ovarian and Testicular Tumors : III. Estrogen­Producing Sertoli Cell Tumors (i.ndroblastoma Tubular Lipoides) of the Human Testis and Ovary. J . Clin . Endocrinol. 9: 301-318, 1949 .

17. Gardner, L. I ., Sniffen, R. C. , Zy~untowicz, A. S . and Talbot , N. B. Follo1·r-Up Studies in Boy 1·rith Mixed Adrenal Cortical Disease . Pediatrics 5: 808-823, 1950 .