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ISSN: 2574 -1241
ISSN: 2574 -1241
Received: January 29, 2024; Published: February 05, 2024
*Corresponding author: Anubha Bajaj, Consultant Histopathologist, AB diagnostics, A-1 Ring Road Rajouri Garden New Delhi 110027, India
DOI: 10.26717/BJSTR.2024.54.008612
Cystic trophoblastic tumour of testis emerges as a distinctive trophoblastic lesion arising spontaneously or as a consequence to chemotherapy induced retrogression of choriocarcinoma. Tumefaction is preponderantly encountered within post-chemotherapy phase or following retroperitoneal lymph node dissection within subjects of testicular germ cell tumours. Neoplasm may occur within testicular mixed germ cell tumours subjected to or devoid of therapy or within post-chemotherapy phase of primary central nervous system germ cell tumours. Cystic trophoblastic tumour was previously designated as choriocarcinoma-like lesion comprised of dual subtypes as teratomatous choriocarcinoma-like lesion and cystic atypical choriocarcinoma. Tumefaction exemplifies cystic proliferation of trophoblastic cells within post-chemotherapy surgical resection specimens obtained from metastatic, non seminomatous testicular germ cell tumours. The non aggressive tumefaction is associated with indolent biological behaviour and recapitulates the clinical course of post-chemotherapy residual teratoma. Characteristically, testicular cystic trophoblastic tumour is expounded within young male subjects between 16 years to 40 years [1,2].
Testicular cystic trophoblastic tumour commonly incriminates post-chemotherapy retroperitoneal lymph nodes implicated with mixed germ cell tumours or testicular mixed germ cell tumours subjected to or devoid of therapy or post-chemotherapy primary central nervous system germ cell tumour [1,2]. Neoplasm may arise from retrogressing choriocarcinoma as excessively aggressive cells are eradicated by chemotherapy or retrogress spontaneously. Consequently, a persistent, gradually progressive, minimally aggressive component of intermediate type of trophoblast transforms into cystic trophoblastic tumour [1,2]. Additionally, cystic trophoblastic tumour may represent an intermediate stage of maturation from choriocarcinoma into teratoma [2,3]. Genes implicated within genesis of testicular carcinoma are expounded as
1. UCK1: chromosome 1
2. HPGDS: chromosome 4
3. CENPE: chromosome 4
4. TERT: chromosome 5
5. TERT/CLPTM1L: chromosome 5
6. SPRY4: chromosome 5
7. BAK-1: chromosome 6
8. MAD1L1: chromosome 7
9. DMRT1: chromosome 9
10. AFT7IP: chromosome 12
11. KITLG: chromosome 12
12. RFWD3: chromosome 16
13. TEX14: chromosome 17
14. PPM1E: chromosome 17 [2,3].
Cystic trophoblastic tumour of testis is commonly encountered in subjects with testicular germ cell tumours following adoption of cisplatin associated chemotherapeutic agents [2,3]. Grossly, neoplasm is devoid of specific or distinctive features [2,3]. Upon microscopy, tumefaction represents with solid foci or miniature clusters of tumour cells. Neoplasm is composed of moderately pleomorphic trophoblastic cells admixed with degenerative cystic articulations of variable magnitude [3,4]. Typically, cystic structures appear < 3 millimetres and manifest with a well circumscribed perimeter. Singular or multiple layers of trophoblastic cells pervaded with abundant, eosinophilic cytoplasm appear to coat cystic articulations. Singular cell layer or several layers of trophoblastic cells with consequent configuration of intra-cystic papillary tufts or cribriform pattern may be delineated [3,4]. Layering trophoblastic cells are predominantly mononuclear and demonstrate smudged nuclear chromatin. Occasionally, multinucleated cells may concur with cytoplasmic lacunae. Additionally, trophoblastic cells may depicta squamoid countenance. However, extracellular keratin deposition appears absent. Mitotic activity is insignificant and mitotic figures are exceptionally discerned [3,4] (Figures 1 & 2, Tables 1 & 2). Testicular cystic trophoblastic tumour appears immune reactive to beta human chorionic gonadotrophin (βHCG) or inhibin. Tumour cells appear immune nonreactive to SALL4 and OCT4 [5,6].
Figure 1
Figure 2
Table 1: World Health Organization of Testicular Germ Cell Tumours [3].
Table 2: World Health Organization of Testicular Tumours [3].
Cystic trophoblastic tumour of testis requires segregation from neoplasms as epithelioid trophoblastic tumour, placental site trophoblastic tumour, regressing choriocarcinoma or somatic malignancies as squamous cell carcinoma. Besides, lesions such as epididymo-orchitis, haematoma, inguinal hernia, hydrocele, spermatocoele or epididymal head cyst, varicocele, syphilitic gumma, tuberculoma, malignant lymphoma generally incriminating bilateral testis in elderly population or distant metastasis emerging from various neoplasms as pulmonary carcinoma, malignant melanoma or carcinoma prostate necessitate exclusion [5,6]. Testicular cystic trophoblastic tumour is appropriately discerned with histological evaluation of incriminated tumour tissue. Tumour exhibits normal to mildly elevated serum levels of beta subunit of human chorionic gonadotropin (βHCG). Upon imaging, tumefaction is associated with enlarged retroperitoneal lymph nodes [5,6]. Testicular cystic trophoblastic tumour may be appropriately subjected to extensive monitoring or follow up. Generally, neoplasm does not mandate additional therapy [5-8].
Abstract
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