腺瘤样瘤！

学习并欣赏！

I do think that this is a tough case...You just have to think about it.

The diagnosis is: adenomatoid tumor (cellular)

The differential diagnoses that were mentioned are all very appropriate.

The helpful features are:

1. usually small, well circumscribed nodule

2. paratesticular rather than intra-testicular location (can happen)

3. cells with vacuoles

4. no cytologic atypia or mitosis

5. can have dense stroma, smooth muscle, lymhphoid infiltrate

6. of course calretinin is helpful

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Please share your experience and interesting case!

 图中显示：梁索状、管状结构，玻璃样变间质，胞浆透亮细胞、胞浆嗜酸核偏位细胞、粘液样细胞，可见核内包涵体、嗜酸性小球。

1、首先考虑支持-间质细胞瘤，Inhibin，CD99，Calretinin。

2、需鉴别恶性间皮瘤：形态多样，也可出现这样的结构，胞浆透亮细胞、浆细胞样细胞、粘液样细胞，Calretinin、CK5、Vim、CK、D2-40，胶体铁染色及酶消化后染色。

3、需排除转移腺癌，CK8，CK18。

4、需排除浆细胞肿瘤：考虑的可能性较小，LCA，CD38，CD138.

5、需排除神经内分泌肿瘤：此部位发病极少，也不能排除转移的可能。CgA、Syn、CD56.

 支持细胞肿瘤 is a good guess! I hope you will agree that morphogy is very unique with haylinzed material around epithelial-like cord or trabeculae of cells. Differential diagnoses might be include:

1. Leydig cell tumor

2. Metastatic carcinoma

3. Malignant mesothelioma

4. Adenomatoid tumor

5. Any others?

what's your top choices and what stains (if necessary) do you want the most?  

支持，期待IHC