Eur J Anat, 22 (3): 241-256 (2018)

A comprehensive anatomical characterization and radiographic study of stage III testicular cancer in a 31-year-old male patient

Ernest F. Talarico, Jr.^1A, Jose L. Mas^1A and Jonathan A. Jones^2B

¹Anatomy & Cell Biology, ²Family Medicine Residency Program, ^AIndiana University School of Medicine-Northwest, Gary, Indiana, ^BUnion Hospital, Terre Haute, Indiana

ABSTRACT The purpose of this investigation was to characterize an unusual case of stage III testicular germ cell tumor (TGCT) in a 31-year-old male with metastases to nodes, bone, viscera and brain, and to understand all possible routes of metastatic disease. Testicular cancer (TC) has an increasing incidence worldwide, and its etiology, risk factors and pathogenesis are not completely understood. Medical records were reviewed, and the cadaveric specimen evaluated by physical examination and gross dissection. Paraffin embedded tissue sections of the primary tumor were stained with Hematoxylin and Eosin (H&E) for histological study. To examine metastatic spread, pre- and post-mortem digital radiologic image acquisition was done using x-ray films, and high- resolution CT Scans and MRI Scans. Image analysis, multi-planar reformatting, and three- dimensional (3-D) reconstruction were done on radiographic series. Dissection showed masses bilaterally from the apex through the lung base; masses on the internal thoracic wall, and hepatomegaly and splenomegaly with multiple tumor masses. Testicular parenchyma was composed of primitive germ cells that formed glomeruloid or embryonal-like structures, as well as areas with a micro-cystic histologic pattern and areas of fibrous dysplasia. Medical imaging 3- D video radiographic dissection was notable for a 38.45 mm diameter, mid-brain tumor; extreme hepatomegaly with numerous tumors, lung tumors, a large penetrating tumor of the left ilium, and multiple tumors throughout both lungs and the thoracolumbar spine (T5-S1). This study provides insight into the histology and metastatic spread of TGCT that is essential for clinicians to understand in the evaluation and treatment of TC patients.

Keywords: Testicular cancer â?? Germ cell tumor â?? Yolk sac tumor â?? Metastasis â?? Testicle â?? Brain