J Pathol Transl Med.  2022 Jan;56(1):48-52. 10.4132/jptm.2021.09.10.

Chronic lymphocytic leukemia and concurrent seminoma in the same testis

• Miyai K
• Kumazawa F
• Sato K
• Tsuda H

• KMID: 2524229
• DOI: http://doi.org/10.4132/jptm.2021.09.10

Abstract

A 59-year-old man presented with a painless testicular mass and underwent a radical orchiectomy. The resected specimen showed a 5-cm-sized, white-yellow and homogenous solid mass in the testicular parenchyma. Histologically, the central part of the tumor exhibited typical features of seminoma. The peripheral part of the tumor exhibited diffuse infiltration of small, monotonous lymphoid cells involving the tunica albuginea. The monotonous lymphoid cells were immunoreactive for CD20, CD79a, CD5, and CD23, and negative for CD3, CD10, and cyclin D1. Kappa light chain restriction was detected on flow cytometry using the resected specimen. Considering the circulating lymphoid cell count of >5.0×10³/µL, we diagnosed the peripheral component of the tumor as an infiltration of chronic lymphocytic leukemia. This extremely rare combination of seminoma and lymphoid neoplasm should be considered in the differential diagnosis of classic seminoma with extensive lymphoid reaction in tumors arising in elderly patients.

Keyword

Testis; Seminoma; Chronic lymphocytic leukemia; Concurrent tumor

Figure

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  Fig. 1 The cut surface of the resected specimen shows a white-yellow, solid mass measuring 5.0 cm in the right testicular parenchyma.

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  Fig. 2 (A) The scan image showing a central multinodular component (arrows) and peripheral diffuse infiltrative component (arrowheads). (B) The multinodular component comprises large polygonal cells with clear cytoplasm and prominent nucleoli intermingled with variously sized lymphocytes. (C) The peripheral component showing diffuse, dense infiltration of small lymphoid cells involving the entire tunica albuginea. Lymphoid cells with hyperchromatic and monotonous nuclei are noted (inset). (D) The large polygonal cells are diffusely positive for octamer-binding transcription factor 4 (Oct-4) (left), and scattered Oct-4–positive cells are detected in the seminiferous tubules (right). (E, F) Small, monotonous lymphoid cells are diffusely immunoreactive for CD20 (E, left), CD5 (F, left), and CD23 (F, right) and negative for CD3 (E, right).

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  Fig. 3 (A) Meshwork of CD21+ follicular dendritic cells is retained in the lymphoid stroma of the seminoma; it is absent in the chronic lymphocytic leukemia (CLL). (B) The Ki-67 labeling indices in the lymphoid stroma of the seminoma and CLL were approximately 30% and < 5%, respectively.

Reference

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