Testicular scar

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Testicular scar
Diagnosis in short

Testicular scar. H&E stain.

Synonyms scar of testis

LM seminiferous tubules replaced by fibrosis (hyaline material with a relatively low cellularity and no nuclear atypia) +/-hemosiderin-laden macrophages, atrophic changes (see testicular atrophy)
LM DDx necrotic tumour, (residual) testicular tumour (e.g. germ cell tumour)
Gross tan brown or white, well-circumscribed
Site testis

Clinical history +/-history of testicular tumour
Prevalence uncommon
Blood work unremarkable
Prognosis benign
Clin. DDx (residual) testicular tumour

Testicular scar, also scar of testis, is a phenomenon that may arise in the context of treatment for a germ cell tumour[1] or result from the spontaneous regression of a (germ cell) tumour.[2]

General

  • Well-reported uncommon finding.
  • May result from the spontaneous regression of a (germ cell) tumour.[2]
  • Can be the result of trauma, (a prior untreated) testicular torsion or infection.

Gross

  • Tan-brown or white lesion.
  • Well-circumscribed.

Microscopic

Features:

  • Seminiferous tubules replaced by fibrosis.
    • Hyaline material with a relatively low cellularity and no nuclear atypia.
  • +/-Hemosiderin-laden macrophages.
  • Atrophic changes[2] - see testicular atrophy.

DDx:

  • Necrotic tumour.
  • Germ cell tumour, e.g. seminoma.
  • Regressed germ cell tumour - suggestive features:[2]
    • Distinct scar +/-germ cell neoplasia in situ (GCNIS) +/-coarse calcifications (intratubular).
    • Scar with prominent (small) blood vessels (weakly suggestive).
    • Scar with lymphoplasmacytic inflammatory infiltrate (weakly suggestive).

Images

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TESTICLE, RIGHT, ORCHIECTOMY:
- TESTICULAR SCAR REPLACING MANY OF THE SEMINIFEROUS TUBULES.
- REMAINING SEMINIFEROUS TUBULES WITH ATROPHIC CHANGES.
- BENIGN SPERMATIC CORD AND EPIDIDYMIS.
- NO EVIDENCE OF RESIDUAL GERM CELL TUMOUR.
- NEGATIVE FOR MALIGNANCY.

See also

References

  1. Ramsey S, Kerr G, Howard GC, Donat R (2013). "Orchidectomy after primary chemotherapy for metastatic testicular cancer". Urol. Int. 91 (4): 439–44. doi:10.1159/000350858. PMID 24021555.
  2. 2.0 2.1 2.2 2.3 Balzer BL, Ulbright TM (July 2006). "Spontaneous regression of testicular germ cell tumors: an analysis of 42 cases". Am. J. Surg. Pathol. 30 (7): 858–65. doi:10.1097/01.pas.0000209831.24230.56. PMID 16819328.