15777              SECONDARY DEPOSIT (PRIMARY TERATOMA OF TESTIS)

The patient was a young man aged 20.  Twelve months before his death he had what was thought to be epididymo-orchitis, but 3 months later an underlying teratoma was found in the right testis which was accordingly resected.  Thereafter he remained well for 9 months but then vague abdominal pain began.  The pain increased and was unresponsive to analgesics.  He had lost 4 kg in weight in the month before admission.  On examination he was pale and the deep cervical lymph nodes were palpable.  Rales were present in the right midzone and X-ray showed secondary deposits.  These were treated with cyclophosphamide but the lung shadows enlarged and a right pleural effusion developed.  He died after a month in hospital.  At postmortem there were massive secondary deposits in the lungs and mediastinal nodes and there were grape-like tumour masses in the inferior vena cava.

The specimen consists of the lung sectioned to show a very massive secondary deposit 20 cms in diameter.  Its cut surface is lobular and there are many areas of opaque cellular necrosis and others of cystic degeneration.  Smaller yellow subpleural deposits are visible on the reverse of the specimen where there are also some fibrous adhesions.  Histology shows a terato-carcinoma with many cystic spaces lined by tall columnar cells.  Large nodular masses of cartilage are prominent in the interstitial tissue.