Regressed Germ Cell Tumors
Regressed germ cell tumors correspond to fibrotic nodules in the testis occurring after either partial or complete regression of germ cell tumors (GCTs).
Less than 5% of testicular GCTs undergo complete or spontaneous regression (Miller et al. 2009).
It occurs among 0–5-year-old children.
Ipsilateral radical orchiectomy is the standard management for patients who present with retroperitoneal germ cell neoplasms.
Retroperitoneal so-called extragonadal GCTs are almost always associated with a regressed (“burnt-out”) tumor in the testis and, that could occur as back pain secondary to retroperitoneal mass or, less commonly, as testicular enlargement (Balzer and Ulbright 2006). Testicular sonography is not specific; characteristics can be hyperechogenic, hypoechogenic, or a mixture of the two (Comiter et al. 1996). Regressed GCTs, because of their commonly occult nature, usually present at higher stages, but it is unknown whether there is a different outcome respect nonregressed tumors.
The orchiectomy shows demarcated, white to tan, solitary fibrotic nodule, but they occur either single as multiple, nodular or linear, scar-like lesions.
Postinflammatory or Ischemic Scar
Trauma or vascular disease may cause a testicular scar. Scars in a testicular biopsy without a retroperitoneal tumor are not a priori “burnt-out” tumors, unless the scar is associated with GCNIS in the surrounding tubules.
Keeping in mind that an extensive sampling is the key to rule out germ cell tumor or GCNIS, the absence of neoplastic elements and the lack of elevation of serum markers address to the diagnosis of fibrosis occurring as healing process in a chronic or granulomatous orchitis. Informations about the clinical history of these patients are necessary.
References and Further Reading
- Balzer, B. L., & Ulbright, T. M. (2006). Spontaneous regression of testicular germ cell tumors: An analysis of 42 cases. The American Journal of Surgical Pathology, 30(7), 858–865.Google Scholar
- Miller, J. S., Lee, T. K., Epstein, J. I., & Ulbright, T. M. (2009). The utility of microscopic findings and immunohistochemistry in the classification of necrotic testicular tumors: A study of 11 cases. The American Journal of Surgical Pathology, 33(9), 1293–1298.Google Scholar