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Testicular mixed germ-cell tumor - seminoma, embryonal carcinoma and yolk sac tumor

Natalia Dencheva, Kristiyana Dimitrova, Ivaylo Vakareev, Nevena Yanulova, Deyan Anakievski


Introduction: Germ-cell tumors are a heterogeneous group of neoplasms which are classified differ­ently according to different literature. Mixed germ-cell tumors are a combination of two or more his­tological types and can include a seminomatous and non-seminomatous component. The following case presents a rare mixed germ-cell tumor with the characteristics of embryonal carcinoma, semi­noma and yolk sac tumor.

Methods and Materials: A 27-year-old male presented with a history of left sided scrotal pain and swelling. By self-examination the patient discovered a rounded formation in the left testicle. After a consult with an urologist the patient was referred for surgery and a high funiculo-orchiectomy was performed, due to psychologically traumatic experience an insertion of prosthesis was suggested.

Results: Ultrasonography showed a capsulated hypoechoic tumor formation. Computed tomography (CT) of the chest, abdomen and pelvis revealed no evidence of lymphadenopathy and metastases. During blood tests increased levels of alpha-fetoprotein were established. Macroscopically the forma­tion was oval-shaped and solid, on the cut surface hemorrhages and necroses were observed. The bi­opsy materials showed a picture of heterogeneous three-component malignant tumor. The mass was partially consisted of atypical cells with optically empty cytoplasm forming tubular structures which demonstrated the seminomous part. The presence of Schiller-Duval bodies signified yolk sac malig­nancy. The embryonic component was represented by microcystic structures comprised of cells with hyperchromic nuclei.

Conclusion: Mixed germ cell tumors sometimes contain an unusual mixture of histologic types that are important to be correctly identified in reference to the selection of an appropriate treatment and therefore getting the best results for the patient.


mixed germ-cell tumor; seminoma; yolk sac; embryonal carcinoma; testicular tumor



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