Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 

 Table of Contents  
Year : 2009  |  Volume : 5  |  Issue : 3  |  Page : 213-215

Spermatocytic seminoma with rhabdomyosarcomatous differentiation: A case report with a review of the literature

Department of Pathology, Tata Memorial Hospital, Parel, Mumbai-400 012, India

Date of Web Publication16-Oct-2009

Correspondence Address:
Sangeeta Desai
Department of Pathology, Tata Memorial Hospital, Parel, Mumbai-400 012
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0973-1482.57131

Rights and Permissions
 > Abstract 

Spermatocytic seminoma is an uncommon testicular germ cell tumor associated with a favorable outcome. Sarcomatous transformation in a spermatocytic seminoma is extremely rare with only 13 cases being reported in English literature. The presence of a sarcomatous component is associated with an aggressive behavior, metastasis, and poor prognosis. We present a case of a spermatocytic seminoma with rhabdomyosarcomatous transformation in a long-standing testicular swelling in a 55-year-old male.

Keywords: Spermatocytic seminoma, rhabdomyosarcomatous differentiation

How to cite this article:
Menon S, Karpate A, Desai S. Spermatocytic seminoma with rhabdomyosarcomatous differentiation: A case report with a review of the literature. J Can Res Ther 2009;5:213-5

How to cite this URL:
Menon S, Karpate A, Desai S. Spermatocytic seminoma with rhabdomyosarcomatous differentiation: A case report with a review of the literature. J Can Res Ther [serial online] 2009 [cited 2022 Aug 7];5:213-5. Available from: https://www.cancerjournal.net/text.asp?2009/5/3/213/57131

 > Introduction Top

Spermatocytic seminoma is an uncommon germ cell neoplasm that accounts for 1-2% of all testicular tumors and usually arises in older men with a mean age of 53.6 years (range 19-72 year). [1],[2],[3] Spermatocytic seminoma is an indolent neoplasm characterized by a long duration of symptoms, early stage at presentation, and absence of metastasis. Rarely, its biological course is complicated by sarcomatous transformation [4],[5] which is clinically characterized by a rapid increase in the size of the tumor and propensity to metastasize. [6] Hence, the awareness of this rare occurrence is of utmost importance in planning further patient management. We present a case of rhabdomyosarcomatous transformation in a spermatocytic seminoma in a patient with a testicular mass. To the best of our knowledge, this is the first reported case from India and the 14 th in the literature. [4]

 > Case Report Top

A 55-year-old man had a history of a slowly enlarging, painless right scrotal swelling of 10-year duration. However, since the last 7 months, a progressive increase in its size was noted for which he underwent orchidectomy elsewhere. Clinically, the preoperative diagnosis was of a secondary hydrocele with an underlying testicular tumor. Preoperative radiological investigations and tumor marker evaluation were not done. Postsurgery, he was referred to the genitourinary surgical oncology unit of our institute for further management.

Macroscopic findings

The right high inguinal orchidectomy specimen submitted at our institute consisted of an enlarged testis, measuring 15.0 Χ 9.5 Χ 8.0 cm. The testicular shape was maintained. On cut surface, the normal testicular parenchyma was completely replaced by a solid tumor composed of varying-sized nodules separated by fibrous septae. Most of the nodules were fleshy, tan colored with foci of hemorrhage and gelatinous change. However, some of the nodules were grayish-white with a whorled appearance and were firm in consistency [Figure 1].

Light microscopy

The tumor was composed of two distinct histologic elements. The predominant component was formed of cellular sheets and nodules of tumor cells with little intervening stroma comprising fine connective tissue strands and edema fluid forming follicle-like spaces and small cystic pools [Figure 2]. A tripartite cell population of a variable size with small lymphocyte-like, intermediate-sized and large cells, characteristic of a spermatocytic seminoma, were appreciated on closer inspection. The intermediate cells formed the predominant population. The large cells either had a single large nucleus or were multinucleated.

The other contingent of the tumor had a sarcomatous appearance characterized by spindle cells dispersed in irregular nodules. The spindle cells closely arranged in short fascicles had an undifferentiated "blue appearance" at places whereas in other areas, they merged imperceptibly with strap-like cells with abundant eosinophilic cytoplasm, round nucleus, and prominent nucleolus consistent with rhabdomyosarcomatous differentiation [Figure 3]. Intimately admixed pleomorphic cells with irregular hyperchromatic nuclei were also identified. As in usual spermatocytic seminomas, no areas of intratubular germ cell neoplasia (IGCN) or other associated germ cell components were identified. The seminomatous component was largely circumscribed but the rhabdomyosarcomatous component was seen involving and destroying the rete testis and the epididymis. The tunica albuginea was, however, not infiltrated. Lymphovascular emboli were not seen. Immunohistochemically, the spermatocytic component was negative for CD30, smooth muscle actin, c-kit, placental alkaline phosphatase, and alpha-fetoprotein. The rhabdomyosarcomatous element was strongly positive for desmin [Figure 4] and weakly for myoglobin. The undifferentiated spindle cell component was positive only for vimentin.

 > Discussion Top

Spermatocytic seminoma is a relatively rare but well-defined pathologic entity, first described by Masson. [7] The usual age at diagnosis in the case of spermatocytic seminoma is 50 years in comparison to 30-40 years age of presentation of classical seminoma. Clinical presentation is usually in the form of a painless testicular swelling or long-standing hydrocele. The duration of symptoms as documented in the literature ranges from few months to 4 years. [3] Bilaterality, mostly asynchronous seminoma may be seen in 10% of cases. [1] Recently, a case of synchronous bilateral spermatocytic seminoma has been described for the first time in the literature in a 77-year-old man.

Spermatocytic seminoma is an indolent neoplasm characterized by a long duration of symptoms, early stage at presentation, and absence of metastasis. However, in a small fraction of cases (approximately 6%), it may undergo sarcomatous transformation. [10] The sarcomatous component is usually rhabdomyosarcoma or undifferentiated, high-grade sarcoma. [5] In the present case, the patient had a neglected, slowly enlarging testicular swelling which gained a rapid and alarming increase in size over a 7-month duration.

The seminomatous component was well circumscribed but the rhabdomyosarcomatous component was seen destroying the rete testis and the epididymis. It is important to recognize the epithelial structures of rete testis and epididymis so as not to mistake them for an epithelial component of a mixed nonseminomatous germ cell tumor. A minor sarcomatous component was undifferentiated and did not label with any myogenic antibody. The sarcomatous dedifferentiation in the spermatocytic seminoma is associated with aggressive behavior, presence of metastasis, and poor outcome. [4],[5],[9] The treatment of choice in spermatocytic seminoma is orchidectomy, followed by surveillance to detect a contralateral testicular tumor. However, in the presence of a sarcomatous component, adjuvant chemotherapy and radiotherapy may be beneficial. As risk of metastasis is increased with the presence of a sarcomatous component, close follow-up is essential. [9],[10] The prognosis for spermatocytic seminoma with sarcomatous transformation remains poor despite aggressive multimodality approach. In the present case, in view of the sarcomatous component a chemotherapy regimen was planned for the patient. However, he was noncompliant for further treatment, and no further outcome is available.

In conclusion, the present case highlights that although indolent in its behavior, a spermatocytic seminoma can rarely undergo sarcomatous dedifferentiation, especially in long-standing cases. Orchidectomy is the treatment of choice for spermatocytic seminomas whereas in tumors with sarcomatous differentiation, in addition, chemotherapy and radiotherapy may be beneficial.

 > References Top

1.Talerman A. Spermatocytic seminoma: a clinicopathological study of 22 cases. Cancer 1980;45:2169-76.  Back to cited text no. 1
2.Carriθre P, Baade P, Fritschi L. Population based incidence and age distribution of spermatocytic seminoma. J Urol 2007;178:125-8.  Back to cited text no. 2
3.Ro Jy, Amin MB, Sahin AA, Ayala AG. Tumours and tumourous conditions of male genital tract. In: Fletcher CDM editor. Diagnostic histopathology of tumours. 2 nd ed. London, England: Churchill Livingstone; 2000. p. 733-838.  Back to cited text no. 3
4.Chelly I, Mekni A, Gargouri MM, Bellil K, Zitouna M, Horchani A, et al. Spermatocytic seminoma with rhabdomyosarcomatous contigent. Prog Urol 2006;16:218-20.  Back to cited text no. 4
5.True LD, Otis CN, Delprado W, Scully RE, Rosai J. Spermatocytic seminoma of testis with sarcomatous transformation, a report of five cases. Am J Surg Pathol 1988;12:75-82.   Back to cited text no. 5
6.Matoska J, Ondrus D, Hornαk M. Metastatic spermatocytic seminoma, a case report with light microscopic, ultrastructural, and immunohistochemical findings. Cancer 1988;62:1197-201.   Back to cited text no. 6
7.Masson P. Etude sur le seminome. Rev Can Biol 1946;5:361-87.  Back to cited text no. 7
8.Leocαdio DE, Stein BS. A case of synchronous bilateral spermatocytic seminoma. Urol Oncol 2008;26:202-3.  Back to cited text no. 8
9.Robinson A, Bainbridge T, Kollmannsberger C. A spermatocytic seminoma with rhabdomyosarcoma transformation and extensive metastases. Am J Clin Oncol 2007;30:440-1.   Back to cited text no. 9
10.Chung PW, Bayley AJ, Sweet J, Jewett MA, Tew-George B, Gospodarowicz MK, et al. Spermatocytic seminoma: a review. Eur Urol 2004;45:495-8.  Back to cited text no. 10


  [Figure 1], [Figure 2], [Figure 3], [Figure 4]

This article has been cited by
1 Spermatocytic tumor: A rare case report
Mei-Ling Hao, Chun-Hui Li
World Journal of Clinical Cases. 2021; 9(35): 11115
[Pubmed] | [DOI]
2 Report From the International Society of Urological Pathology (ISUP) Consultation Conference on Molecular Pathology of Urogenital Cancers
Leendert H.J. Looijenga, Theodorus H. Van der Kwast, David Grignon, Lars Egevad, Glen Kristiansen, Chia-Sui Kao, Muhammad T. Idrees
American Journal of Surgical Pathology. 2020; 44(7): e66
[Pubmed] | [DOI]
3 Spermatocytic Seminoma With Sarcoma: An Indication for Adjuvant Chemotherapy in Localized Disease
David Wetherell,Nathan Lawrentschuk,Dennis Gyomber
Korean Journal of Urology. 2013; 54(12): 884
[Pubmed] | [DOI]
4 The management of retroperitoneal lymphadenopathy in spermatocytic seminoma of the testicle
Farhana Sharmeen,Michael H. Rosenthal,Stephanie A.H. Howard
Clinical Imaging. 2013;
[Pubmed] | [DOI]
5 Clinicopathologic analysis of spermatocyte seminoma
Tian, B.-L. and Gao, A.-F. and Xu, C. and Chang, X.-Y. and Xu, Z.-Q. and Su, Q.-H. and Yang, X.-H.
Chinese Journal of Pathology. 2012; 41(11): 752-755
6 Rhabdomyosarcomatous differentiation in a spermatocytic seminoma with review of literature
Narang, V. and Gupta, K. and Gupta, A. and Kumar, S.
Indian Journal of Urology. 2012; 28(4): 430-433
7 Review article: Spermatocytic seminoma: Review of the literature and description of a new case of the anaplastic variant
Lombardi, M., Valli, M., Brisigotti, M., Rosai, J.
International Journal of Surgical Pathology. 2011; 19(1): 5-10
8 Spermatocytic seminoma associated with undifferentiated sarcoma: A rare case report
Trivedi, P., Pasricha, S., Gupta, A.
Indian Journal of Pathology and Microbiology. 2011; 54(1): 138-140


Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

  >Abstract>Introduction>Case Report>Discussion>Article Figures
  In this article

 Article Access Statistics
    PDF Downloaded381    
    Comments [Add]    
    Cited by others 8    

Recommend this journal