Case of the Month: May 2023

The answer to the May Case of the Month is Mixed Germ Cell Tumour with teratoma, yolk sac tumour, embryonal carcinoma, and choriocarcinoma components. Mixed germ cell tumours account for the majority of non-seminomatous tumours and are composed of a combination of tumour types including teratoma, yolk sac tumour, embryonal carcinoma, choriocarcinoma, and seminoma, all of which derive from germ cell neoplasia in situ. The average patient age at presentation is 30 years. In addition to the clinical findings of a testicular mass, patients may have elevated serum tumour markers such as LDH (general tumour marker), alpha-fetoprotein (yolk sac tumour marker), and human chorionic gonadotropin  (hCG, trophoblastic tumour marker). On gross examination of the tumour after surgery, tumours can have a variegated appearance depending on the presence of different components (can be a mix of solid white to grey areas, necrosis, hemorrhage, and cystic change). The surgical pathology is used to determine the tumour composition and pathological stage, which will then be combined with medical imaging and serum tumour markers to determine the overall clinical stage of the tumour and treatment approach.