Testicular seminoma – unusual histology and staging with sub epithelial spread of seminoma along the vas deferans

Abstract

BackgroundThe route of local and metastatic spread of testicular seminoma is well recognised and accepted. The spread is via lymphatics to the paraaortic nodes.Case PresentationWe present a case report of testicular seminoma in a 56 year old man with previously unreported histological findings. In this case seminoma tumour cells did not appear to have spread by the expected lymphatic route. There was no involvement of retro-peritoneal para-aortic lymph nodes. The tumour appeared to have spread directly along the vas deferans in the sub epithelial plane to the mesenteric lymph nodes.ConclusionThis type of seminoma tumour spread has not previously been described and it is not a recognised route for metastasis by seminoma tumour. In this case the macroscopic clinical appearance was of a stage I tumour with normal tumour markers. However, the pathological stage of the tumour was surprisingly increased to stage III on the basis of histology and CT radiological findings. We present the unusual histological findings. In view of this unusual histological finding we reinforce the need for accurate staging and for resection of the spermatic cord close to the deep inguinal ring. Accurate staging is crucial in planning the treatment and follow up of seminoma and determines the prognosis.

Inguinal lymph node metastases from a testicular seminoma: a case report and a review of the literature

“…Lockett et al . postulated in his report that seminoma may have spread along a similar subepithelial capillary network along the vas [ 9 ]. For these reasons, radical inguinal orchidectomy is the procedure of choice for testicular tumors to avoid the sequelae associated with scrotal contamination.…”

Testicular seminoma with pagetoid spread into the vas deferens: A rare histopathological presentation

“…Furthermore, the patient presented with two distinct abdominal masses that completely resolved after chemotherapy, with no lymph nodes abnormalities. They hypothesised an existing atypical spreading route along a sub‐epithelial capillary network, not described in man but identified in rats (Lockett et al., 2006; Ohtani & Gannon, 1982). Although the similar unexpected spermatic cord involvement, in our case no seminoma cells were detected below the epithelium of the vas deferens, instead they had been identified within it.…”

Inguinal Lymphnode Metastatic Testicular Seminoma: A Case Report and Review of Literature

“…They found a subepithelial capillary network and it has been postulated that this capillary network exists in human. Lockett et al postulated in his report that seminoma may have spread along a similar subepitelial capillary network along the vas [7]. For these reasons radical inguinal orchidectomy is the procedure of choice for testicular tumors to avoid the sequelae associated with scrotal contamination.…”