BURNED-OUT PRIMARY TESTICULAR CANCER - SONOGRAPHIC AND PATHOLOGICAL CHARACTERISTICS

Purpose: Rarely, a testicular scar is discovered in a patient with a p resumed extragonadal germ cell tumor. Of 6 patients originally diagnos ed with retroperitoneal extragonadal germ cell tumors who had echogeni c foci on scrotal sonography 5 had definite histological evidence of a regressed primary testicular cancer. Materials and Methods: Six men 2 1 to 36 years old presented with palpably normal testes and a presumed retroperitoneal extragonadal germ cell tumor. After chemotherapy each patient underwent retroperitoneal lymph node dissection and ipsilater al orchiectomy. The entire testis was submitted for histological evalu ation and all calcifications were identified. Results: Scrotal sonogra phy revealed an echogenic focus or foci in all cases, which correspond ed to intratubular hematoxyphilic bodies in 2. In 3 cases the echogeni c foci were intratubular psammoma bodies close to a fibrous scar with hemosiderin deposition, 1 of which contained a focus of intratubular g erm cell neoplasia, The hematoxyphilic bodies appeared larger and more intensely echogenic on sonography than the psammoma bodies. The remai ning case had stromal calcifications near the rete testis. Conclusions : The hematoxyphilic bodies and fibrosis with hemosiderin deposits are believed to represent remnants of testicular carcinoma. Our finding o f intratubular germ cell neoplasia provides further proof that testicu lar carcinomas regress, In 5 of 6 patients (83%) with presumed extrago nadal germ cell tumors we showed definite pathological evidence of a b urned-out testicular carcinoma. With a presumed retroperitoneal germ c ell tumor and palpably normal testes, sonographic demonstration of an echogenic lesion in the absence of a hypoechoic mass probably represen ts a burned-out primary neoplasm.