My Wild Dipivefrine Conspriracy

On exam, the patient had a painless nodular mass in his left testis and a left-sided hydrocele. The right testis was unremarkable. His epididymides were normal bilaterally with no masses, tenderness, or induration. He had no palpable inguinal lymph nodes. His abdominal exam and the reminder of his genital exam were normal. Gynecomastia was present, and the breast tissue was tender to palpation. Serum blood counts and chemistries were normal. Alpha fetoprotein (AFP), human chorionic gonadotropin (hCG), and lactate dehydrogenase (LDH) were normal (0.8?ng/mL, Selleck CX 5461 and no evidence of metastatic disease. Figure 1 Testicular ultrasound. Longitudinal examination of the left testis demonstrates a heterogeneous mass, which has nearly replaced all normal testicular parenchyma. A small reactive hydrocele is present. The patient underwent left radical inguinal orchiectomy without complications. The left testis mass was 4.7?cm �� 2.8?cm �� 2.3?cm on gross examination. Histological examination revealed abundant neoplastic cells with scant cytoplasm and round-to-oval nuclei with longitudinal grooves. They infiltrated through the interstitium as nests, cords, and single cells, with focal rosetting, reminiscent of Call-Exner bodies. The immunohistochemical profile (coexpression of vimentin, inhibin, scattered Forskolin order cytokeratin, and CD56) was consistent with testicular GCT (Figure 2). Neuroendocrine tumor and malignant melanoma were excluded (negative chromogranin and synaptophysin; negative HMB-45 and Melan-A). Tumor invaded into the adnexa and lymphovascular space. Figure 2 Testicular granulosa cell tumor histology. Sections of the testis show a nested neoplasm composed of undifferentiated to poorly differentiated cells infiltrating through the interstitium. The cells have scant cytoplasm and round-to-oval nuclei with occasional ... The patient was counseled regarding Dipivefrine the paucity of literature related to the management of GCT. Treatment options including RPLND, chemotherapy, and active surveillance were discussed. The patient elected to undergo left-template laparoscopic RPLND. Twelve interaortocaval lymph nodes and 7 periaortic lymph nodes were removed. Microscopic examination revealed 2/12 interaortocaval nodes with histology consistent with GCT metastases (both