Qap (Anatomical Pathology) 

QAP Peer Review

AP123
Case History: M/48, presented to the ER with left incarcerated inguinal hernia, for which an undescended testis was removed.
Intended diagnosis: Ectopic testis, Seminoma, classic type with extensive infarction; reactive hyperplasia of rete testis. Contributed by:FML
Code Diagnosis Comment Score
anonymous Testis - Infarcted seminoma, classical (100%) The remaining seminiferous tubules are atrophic with no evidence of intratubular germ cell neoplasia. Advise proper sampling to exclude other components of germ cell tumour.  100
anonymous Suggestive of infarcted seminoma, 100% Suggest confirmation with immunostaining for placental alkaline phosphatase( seminoma: positive immunostaning; non-neoplastic testicular tissue: negative immunostaining)  100
anonymous Infarcted seminoma; Atrophy and sclerosis of seminiferous tubules, consistent with undescended testis; 100% Sample more blocks and look for other germ cell tumor components.  100
anonymous Left undescended TESTIS : SEMINOMA with extensive infarction (100%). The tumour shows extensive infarction with relatively little viable tumour cells. More blocks may be necessary to exclude the presence of other elements and to have better assessment of the cells. The nature of the tumour may also be confirmed with immunostaining using PLAP. Lymphoma may enter into the differential diagnosis which can be eliminated by more blocks and using immunostaining with LCA.  100
anonymous Seminoma with infarction; reactive hyperplasia of rete testis To confirm diagnosis of seminoma by immunostaining for PLAP/CD117. Should also look for other germ cell components by extensive sampling.  100
anonymous INFARCTED TUMOR, favor SEMINOMA, with rete testis hyperplasia. 100% More sampling for viable tumor tissue for assessment.  100
anonymous Seminoma with marked tumoral necrosis and reactive hyperplasia of rete testis. (100%) Confirm seminoma by doing PLAP stain.  100
anonymous Testis - Germ cell tumor of testis ( more than one histologic type seen: yolk sac + seminoma ), with infarction 100% Thorough sampling required for accurate typing. Immunostains (PLAP,aFP,HCG) are also useful to delineate the components.  80
anonymous Mixed seminoma and yolk sac tumour in an atrophic testis 100% Suggest submit more blocks to exclude other germ cell components. Suggest immunostaining for PLAP and alpha fetal protein to highlight the seminoma and yolk sac component respectively.  80
anonymous Seminoma (infarcted) 100% nil  100
anonymous Extensively infarcted neoplasm, suggestive of Seminoma. To be confirmed by immunohistochemistry (atypical cells are P1AP+. LCA- and cytokeratin-). 100% nil  100
anonymous Infarcted classic seminoma (95%); no intra-tubular germ cell neoplasia; rete testis with hyperplastic change. DDx: Lymphoma (5%) Confirmed by immunostaining: seminoma - PLAP +, LCA -  100
anonymous Seminoma. Would perform immunohistochemical stain for confirmation and to rule out lymphoma. probability : 100% nil  100
anonymous Mixed germ cell tumour 100% The tumour contains seminoma and yolk sac tumour elements. The remainder of the testis shows marked atrophy of the seminiferous tubules, consistent with cryptorchidism.  80
anonymous Seminoma, 100% nil  100