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Scrotal ultrasound right testicular mass
Figure 1. Scrotal ultrasound demonstrates a 5.5 × 5.5cm right intra-testicular mass with peripheral nodularity.
A 58-year-old white man with a history of hypertension presented for urologic evaluation for obstructive voiding symptoms and an elevated PSA (3.1 ng/dL).
On physical examination he was noted to have a palpable right testicular mass. He underwent a scrotal ultrasound that revealed a large (5.5 × 4.0 × 5.5cm) intra-testicular cystic mass with at least 7 peripheral soft tissue nodules (some with lobulated margins).
He underwent staging imaging (CT of the chest, abdomen, and pelvis) that revealed mild prostatomegaly and a 6mm non-obstructing right kidney stone but no evidence of retroperitoneal lymphadenopathy or visceral metastases. His tumor markers (LDH, AFP, ß-HCG) were within normal limits, and he elected to proceed with a right radical inguinal orchiectomy for definitive management. Pathologic evaluation of the excised testicular mass revealed an unusual histology.
Submit your diagnosis to see full explanation.
This clinical quiz was prepared by Marc C. Smaldone, MD, MSHP, FACS, of Fox Chase Cancer Center, Philadelphia.
References
1. Ibrahim AS, Li C, Al-Jafari MS, et al. Borderline serous papillary tumor of the testis: A case report and review of the literature. Anticancer Res. 2012;32:5011-5013.
2. Ma YK, Chaudri S, Cullen MH, et al. Metastatic serous carcinoma of the testis: A case report and review of the literature. Case Rep Oncol. 2011;4:246-249.
3. Hsieh A, Miller M, Shin D, et al. Serous borderline tumor of the testis and associated magnetic resonance imaging findings. Urol Case Rep. 2017;8:30-32.
Answer: E
Explanation
Serous borderline tumor (SBT) of the testis is a rare (less than 50 cases reported), epithelial-type tumor of the testis arising from mesothelial elements that share similar histological features to serous epithelial tumors of the ovaries.1 Although there have been cases of metastasis reported, development of metastatic disease has only been reported in cases that invasive elements on histopathology.2 Reported in men aged 14 to 68 years, the current standard of care for SBT of the testis is orchiectomy. The literature reports no cases of recurrence or metastasis when the tumor is confined to the testis.3
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