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- 睾丸肿瘤
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doctorjing 离线
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Diffuse, interstitial infiltrative, highly cellular, relatively uniform large cells in an older man.
I agree with Dr. Ma...favor diffuse large B cell lymphoma.
Other tumors that have interstitial infiltrative pattern are classic seminoma and metastatic high grade prostate carcinoma.
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I think there are two important differential diagnoses for this case - seminoma (pure) and high grade diffuse large B cell lymphoma. Of the two, I favor the latter because of the diffuse infiltrative pattern, nuclear size (smaller than I would expect for seminoma), vesicular chromatin and prominent nucleoli (seminoma cells have hyperchromatic nuclei, not vesicular chromatin pattern). There are certainly many small lymphocytes that could exist in either neoplasms. A few simple immunohistochemical stains (AE1, PLAP, CD117, CD45, CD20 or CD79a, CD3 or CD43) should resolve the matter. If this is a case of testicular seminoma, it is most likely a pure form and classic. Although the age of the patient is advanced, I do not see a mixture of variably differentiated germs cells seen in spermatocytic seminoma.
聞道有先後,術業有專攻
| 以下是引用mjma在2009-8-18 8:46:00的发言： I think there are two important differential diagnoses for this case - seminoma (pure) and high grade diffuse large B cell lymphoma. Of the two, I favor the latter because of the diffuse infiltrative pattern, nuclear size (smaller than I would expect for seminoma), vesicular chromatin and prominent nucleoli (seminoma cells have hyperchromatic nuclei, not vesicular chromatin pattern). There are certainly many small lymphocytes that could exist in either neoplasms. A few simple immunohistochemical stains (AE1, PLAP, CD117, CD45, CD20 or CD79a, CD3 or CD43) should resolve the matter. If this is a case of testicular seminoma, it is most likely a pure form and classic. Although the age of the patient is advanced, I do not see a mixture of variably differentiated germs cells seen in spermatocytic seminoma. |
朱正龙
