Characterizing high-grade serous papillary carcinoma of tunica vaginalis

Abstract

Serous carcinomas of the testis or para-testis are extremely rare tumors of Mullerian type. We report a case of high-grade serous papillary carcinoma of the tunica vaginalis, treated with radical orchiectomy and hemi-scrotectomy after being referred for a rapidly growing painless scrotal mass. In addition to negative testicular tumor markers, scrotal ultrasound, and conventional computerized tomography (CT) scanning, this patient's workup included a positron emission tomography (PET) scan using F-18-fluoro-deoxyglucose (FDG), demonstrating metabolically avid uptake of the disease. This patient is completing ongoing close follow up and is currently disease free at nine months post definitive treatment.

Keywords: FDG-PET; Serous carcinoma; Testicular cancer; Tunica vaginalis.

Fig. 1

Ultrasonographic and FDG-PET imaging of the scrotal mass. The ultrasonographic features of the scrotal mass [Fig. 1A] have been displayed in two images. There is a large hydrocele visualized, with nodular masses arising from the tunica vaginalis. The FDG-PET features of the mass [Fig. 1B] demonstrate a localized photopenic mass within the hemi-scrotum with high peripheral FDG-avid metabolic activity, with corresponding areas identified on CT [blue & red arrows].

Fig. 2

Intra-operative images of resected specimen and site of resection. Pre-operative image of the scrotal mass is shown [Fig. 2A]. Intra-operatively [Fig. 2B], artery forceps are reflecting the external oblique aponeurosis and roof of inguinal canal. The resected inguino-scrotal specimen [Fig. 2C] is demonstrated, with a marking suture [black arrow] indicating ligation of the cord at the level of the deep inguinal ring.

Fig. 3

Macroscopic and microscopic images of the resected specimen. The resected mass demonstrates an 813g 276 ×  75 ×  75mm inguino-scrotal resection, with a 144 ×  75 × 75mm cystic mass filled with loose hemorrhage [Fig. 3A]. Hematoxylin and eosin-stained section showing irregular slit-like glandular spaces, formed by markedly atypical cells (original magnification x200) [Fig. 3B]. Immunohistochemistry shows reactivity of tumor cells for oestrogen receptor ([Fig. 3C], original magnification x200), progesterone receptor ([Fig. 3D], original magnification x200), WT1 ([Fig. 3E], original magnification x100) and calretinin ([Fig. 3F], original magnification x200).