TESTICULAR TUMOR PRESENTING AS HEMATOSPERMIA

A 29-year-old man initially presented with a history of 3 episodes of hematospermia in the last 6 months, which had resolved spontaneously. He did not have any associated significant symptoms and physical examination including scrotal examination was unremarkable. Seven weeks later he returned with a 3-week history of left testicular ache and swelling. Examination revealed an enlarged, hard left testis and normal right testis. Abdominal and chest examination was unremarkable. Laboratory investigations revealed an increased serum a-fetoprotein and b-human chorionic gonadotropin. Scrotal ultrasound showed an enlarged left testis containing a mass of mixed echogenicity. The patient underwent high inguinal orchiectomy. Macroscopic examination revealed that the testis had been largely replaced by tumor. Microscopy demonstrated that 80% of the tumor was composed of immature elements with cartilagenous and glandular differentiation (see figure). However, 20% of the tumor was composed of undifferentiated malignant cells that stained positive for CD30 and broad-spectrum cytokeratins, therefore representing embryonal carcinoma. There was no vascular invasion and the epididymis, tunica vaginalis and resected margin of the cord were free of tumor.