13079              TERATOMA (EMBRYONAL CARCINOMA)

A young country man aged 26 was struck on the right testis by a cricket ball.  A symptomless swelling appeared during the next 2 weeks.  Examination showed a firm painless opaque swelling in the right scrotum.  The testis was not felt.  The mass was confined to the scrotum.  Attempted aspiration failed.  A month later an abscess in the mass pointed at the lower pole and was incised.  Three months later a further abscess pointed medial to the first sinus.  At that time the opening of the original sinus was surrounded by a mass of granulations 4 cms in diameter and 2 cms deep.  The patient had lost 19 kg in weight.  The haemoglobin was 8.5g%.  Two months later he was admitted to a country hospital in very poor general condition.  He was given antibiotics and was transfused 3 pints.  A mass was felt in the abdomen.  The testis was excised.

The specimen consists of the testis together with the epididymis and a few cms of the cord.  An area of scrotal skin 6 cms in diameter is attached to the lower pole.  A large mass of fungating granulation tissue 4 cms in diameter is visible on the cutaneous surface.  From this short wide sinus opens into a ragged 5 cm cavity in a tumour which measures 8 cms in diameter.  The tumour tissue forms a wall about 2.5 cms thick and its cut surface is pale, cellular, slightly lobulated and shows several areas of necrosis.  Stretched testicular tissue is visible over the upper left side of the mass.  Histology shows a relatively anaplastic embryonal carcinoma with some tubule formation but no definite teratoid or seminomatous development.  The granulation tissue around the sinus is heavily infiltrated by tumour.