Question

A 30-year-old man presents with a painless testicular mass. Ultrasound shows a well-circumscribed, homogeneous, non-hemorrhagic tumor. Histology is shown. What is the likely diagnosis?

• A. Yolk sac tumor
• B. Choriocarcinoma
• C. Teratoma
• D. Seminoma

Hint:

Painless testicular mass with homogeneous non-hemorrhagic tumor = seminoma.

Answer 1

The Correct Option is D

Step 1: Understanding the Question:
The age (30s) and the classic ultrasound appearance (homogeneous, non-hemorrhagic) are key indicators for the most common germ cell tumor of the testis.
Step 2: Detailed Explanation:

Seminoma: This is the most common germ cell tumor, typically occurring in the 4th decade of life.

Radiology: On ultrasound, it appears as a well-circumscribed, hypoechoic, and notably homogeneous mass. It rarely shows the cystic or hemorrhagic areas seen in non-seminomatous tumors.

Histology (as implied): Shows nests of large, uniform cells with clear cytoplasm (due to glycogen) and "fried-egg" appearance, separated by fibrous septa containing lymphocytic infiltrates.

Tumor Markers: Seminomas classically do NOT produce AFP. They may sometimes cause a mild elevation in hCG if syncytiotrophoblastic giant cells are present.

Choriocarcinoma: Usually very aggressive, small, and highly hemorrhagic/necrotic with very high hCG.

Yolk Sac Tumor: More common in children; shows Schiller-Duval bodies and elevated AFP.

Step 3: Final Answer:
A homogeneous, well-circumscribed testicular mass in a 30-year-old man is the classic presentation of a Seminoma.