Balzer and Ulbright described histologic features of testicular germ cell tumors that have undergone spontaneous regression. The authors are from Stanford and Indiana Universities.
Requirements for making the diagnosis of regression in a testicular germ cell tumor:
(1) evidence of a germ cell tumor
(2) area of scarring in the testis with certain pathologic features
(3) no previous therapy (if to be called spontaneous)
(4) exclusion of other sites for a primary germ cell tumor
Evidence of germ cell tumor:
(1) focus of metastatic germ cell tumor in a distribution consistent with a testicular primary
(2) residual tumor at the site of testicular scarring (incomplete regression)
(3) intratubular germ cell tumor in adjacent testicular parenchyma
The area of scarring may be small and easily overlooked unless a complete and careful examination is performed.
Key pathologic features:
(1) ill-defined or stellate scar distinct from adjacent parenchyma
(2) presence of testicular atrophy with shrunken and hyalinized tubules
(3) lymphoplasmacytic infiltrate
(4) "ghost" tubules (eosinophilic tubular remnants lacking cytologic detail)
Other histologic features that may be present:
(1) increased vascularity, angiomatous foci
(2) siderophages
(3) coarse intratubular calcifications
(4) intratubular microlithiasis (round and psammoma body-like calcifications)
(5) clusters of Leydig cells in adjacent parenchyma
(6) necrosis in adjacent parenchyma
Differential diagnosis: area of scarring due to trauma, surgery, ischemia, infection or other causes.
Specialty: Hematology Oncology, Surgery, general, Urology
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