| A 77-year-old male patient with multiple cardiopathogenic factors and a benign prostatic hypertrophy as the only urological history. | |
| She was admitted to the Internal Medicine Department to study a constitutional picture of 4 months of evolution with anorexia and weight loss of about 15 kg, accompanied by generalized weakness and epigastric colic pain lasting minutes. | |
| There was no other accompanying clinic. | |
| A digestive study (gastroscopy, ultrasound endoscopy) was normal. | |
| Physical examination was normal, except for an increase in size of the genitals, so an ultrasound was performed, with the result of a bilateral hydrocele, more marked on the left side, with underlying non-malignant morphology test ruled out. | |
| On physical examination, a 4 cm hard nodule was found in the upper pole of the left testis, suggesting a solid mass. | |
| Distant imaging tests (DCT, MRI) were negative. | |
| Germline tumor markers and LDH were requested, which were negative. | |
| Left inguinal radical orchiectomy was performed. | |
| The macroscopic description of the specimen, about 9 x 6.5cm, showed little healthy testicular parenchyma adjacent to the upper pole, in which a solid, multinodular, brownish-colored tumour mass of 4 cm diameter was found. | |
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| Microscopic analysis showed areas of sarcomatoid pattern and growth on sheets together with areas where cells were arranged in a cordonal pattern or trabecular patterns with presence of vascular structures. | |
| The cells were pyramidal, of great cytoplasm, with prominent nuclear pleomorphism and acquired in areas a very clear, lipidized cytoplasm. | |
| The mitotic index was high, being higher than 5 mitosis x10 HPF in growing areas on sheet. | |
| The tumor contacted the albuginea and the epididymis without practically remaining viable seminiferous tubules. | |
| Images suggestive of vascular invasion were also observed. | |
| In the sections of testicular parenchyma respected, the tubules presented hyalinized basal membrane with atrophic aspect. | |
| Immunohistochemical techniques showed positivity for Inhibina, keratin, CK8, CK18, Vimentin, EMA and S-100. | |
| Ki67 showed intense positivity in approximately 30-40% of tumor cells. | |
| The patient was negative for Progesterone, PLAP, AFP, HCG, Cromogranin and HMB45. | |
| With all these findings, the diagnosis was malignant Sertoli cell tumor, with variation of histological patterns, as classic type. | |
| Twelve months later, the general situation persisted, which led to a new admission to Internal Medicine, suffering from an inherited disorder. | |
| Serum and imaging controls in relation to the testicular process remain within normal parameters. | |