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Sodha e al. In e na ional Jou nal o Toxicological and Pha macological Resea ch
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O iginal Resea ch A icle
His opa hological Spec um o Tes icula Lesions a a Te ia y Ca e
Cen e in Wes e n Rajas han
Seema Sodha1, Nee u Sha ma2, Sau abh Soni3, D.P. Soni4
1Residen , Dep . o Pa hology, SPMC, Bikane
2Residen , Dep . o Pa hology, SPMC, Bikane
3DNB SS (Medical Oncology) Max. Supe speciali y Hospi al, Sake , New Delhi
4P o esso , Dep . o Pa hology, SPMC, Bikane
Recei ed: 18-10-2024 / Re ised: 21-11-2024 / Accep ed: 26-12-2024
Co esponding au ho : D . Seema Sodha
Con lic o in e es : Nil
Abs ac :
Backg ound: Bo h neoplas ic and non-neoplas ic condi ions a ec he es is. Al hough non neoplas ic es icula
lesions a e mo e common, s ill mos o he s udies we e done on es icula neoplasms only. Hence he p esen
s udy was unde aken o s udy his opa hological spec um o es icula and pa a es icula lesions, hei age
dis ibu ion and clinical p esen a ion.
Me hods: This was a e ospec i e eco d based 1 yea s udy conduc ed in Depa men o Pa hology, Sa da Pa el
Medical College, Bikane and included a o al o 60 Tes icula specimens which we e diagnosed by his o-
pa hological examina ion.
Resul s: A o al o 60 cases o es icula lesions we e encoun e ed in ou s udy. Ou o he o al 60 cases,15%
(9/60) we e diagnosed as malignan es icula umo . Mos o hese umo s we e seen be ween 3 d and 4 h decades.
Ge m cell umo was he mos common ype (77.7%) among which seminomas (44.44%) and mixed ge m cell
umo s (28.57%) we e mos equen ly encoun e ed. O he umo diagnosed was Non-Hodgkin lymphoma. Non-
neoplas ic lesions o he es is a e mos common in he second decade o li e. The younges pa ien was a bi h
and oldes was 71 yea s o age. Ou o all non-neoplas ic lesions, ascula lesions like o sion and in a c ion a e
he mos common indings (54.90%) ollowed by ube culous abscess (15.68%).
Conclusion: This s udy s ongly ecommends ou ine his opa hological examina ion o all sc o al specimens o
he de ec ion o a ious es icula and pa a es icula lesions, as well as neoplasms. His opa hology no only
p o ides a issue diagnosis in sc o al diso de s, bu i also adds o unde s anding e iopa hogenesis and can aid in
he de elopmen o u u e ea men op ions.
Keywo ds: Undescended es is, Ge m cell neoplasm, Epididymo-o chi is, seminoma, e a oma, yolk sac umou ,
non-neoplas ic lesion.
This is an Open Access a icle ha uses a unding model which does no cha ge eade s o hei ins i u ions o access and dis ibu ed unde
he e ms o he C ea i e Commons A ibu ion License (h p://c ea i ecommons.o g/licenses/by/4.0) and he Budapes Open Access Ini ia i e
(h p://www.budapes openaccessini ia i e.o g/ ead), which pe mi un es ic ed use, dis ibu ion, and ep oduc ion in any medium, p o ided
o iginal wo k is p ope ly c edi ed.
In oduc ion
Tes icula cance s comp ise 1% o all he male
cance s wo ldwide [1]. Tes icula umo s a e
ela i ely a e and comp ise 1% o all male cance s
wo ldwide 1 wi h peak p e alence in he age g oup
15-35 yea s [2]. Tes icula umou is he mos
common malignancy among young males [3].
The male geni al ac consis s o a pai o es es,
epididymis, as de e ens, ejacula o y duc ,
accesso y sex glands (seminal esicles, p os a e, and
bulbou e h al glands) and he penis which a e unde
he con ol o ho mones om hypo halamus,
pi ui a y, and gonads. Tes es is an o gan whe e he
con inuous p ocess o game e p oduc ion
(spe ma ogenesis) occu s and whe e es os e one is
p oduced. Epididymis is an excu en duc sys em
o anspo , ma u a ion, and s o age o he spe m.
Accesso y glandula o gans p oduce seminal luid
and sec e e complex molecules in o he inal
ejacula e. Penis, an e ec ile o gan o he pene a ion
and deli e y o he game es in o he emale
ep oduc i e ac . P oduc ion, elease and
ma u a ion o spe ma ozoa all depend on specialized
unc ions o he es icula cells and epididymal
epi helium. An equally a ied mo phology and
ul as uc u al composi ion e lec hese a ied
unc ions.
Ailmen s o he ep oduc i e o gans a e common
h ough he whole li e span o a man. Dis inc
pa hological condi ions a ec a ious componen s
o male geni al ac . Thei incidence has
con inuously inc eased du ing he las decades,
especially in he de eloped coun ies. They
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Sodha e al. In e na ional Jou nal o Toxicological and Pha macological Resea ch
195
cons i u e a g oup o lesions which a e di icul o
de ec and ea because o hei ana omical
loca ions, biological beha io as well as hei
consequences [4].
Non neoplas ic es icula lesions include c yp o chid
(undescended) es is, es icula o sion, es icula
a ophy, epide moid cys s, in ec ions o es is like
ube culosis, malakoplakia and asculi is [5]. Abou
1% o one-yea old boys a e a ec ed wi h
undescended es is. [3] A ge m cell umou is mo e
likely o de elop in an undescended es is han a
no mally placed es is. A ophy o es is may
de elop om c p o chidism, in ec ions like mumps,
li e ci hosis, adia ion he apy, chemo he apy,
es ogens adminis a ion, AIDS and exposu e o
en i onmen al oxins [6].
The p esen s udy was conduc ed o de e mine he
his opa hological spec um o o a ian lesions a a
e ia y ca e cen e in Wes e n Rajas han.
Ma e ials and me hods:
This is a e ospec i e s udy conduc ed o e a pe iod
o one yea om Janua y 2024 o Decembe 2024 a
he Depa men o Pa hology, a a e ia y ca e
eaching hospi al, Sa da Pa el Medical College and
associa ed g oup o hospi als, Bikane .
The specimens o es icula lesions ecei ed om
su ge y and su gical oncology depa men a he
Depa men o Pa hology du ing he s udy pe iod
we e included in ou s udy as pe he inclusion and
exclusion c i e ia. Specimens wi h imp ope clinical
eco ds, Au olyzed specimens o specimens
ecei ed wi hou ixa i e, pa ien s wi h benign and
in lamma o y lesions and pa ien s who e used o
gi e consen we e excluded om he s udy.
The clinical and ele an da a we e eco ded om
equisi ion o m and clinical eco ds. The specimens
ecei ed we e ixed in 10% bu e ed o malin. G oss
examina ion was done, and indings eco ded. The
issues we e sec ioned as pe p o ocol and p ocessed
by wax block me hod. Slides we e s ained wi h
Hema oxylin and Eosin (H&E) s ain and examined
unde ligh mic oscope. Va ious his opa hological
spec um o lesions in he es is we e obse ed and
classi ied as benign and malignan on he basis o
Wo ld Heal h O ganiza ion his ological
classi ica ion o he es icula umo s.
S a is ical analysis was done using Mic oso Excel
2019. Da a was collec ed and en e ed in o excel and
analysis was done by calcula ing a ios, p opo ion,
and pe cen age.
Resul s:
The e was a o al o 60 es icula biopsies e iewed
du ing Janua y 2024 o Decembe 2024. Se en y
pe cen (70%) o hese es icula biopsies we e
o chidec omy specimen and 30% we e small
biopsies. Thi y pe cen (30%) o he o al specimen
comp ised o undescended es is. Ou o he o al 60
cases, 15% (9/60) we e diagnosed as neoplas ic
lesions and 85% (51/60) we e non-neoplas ic
lesions.
Table 1 and Table 2 shows age wise dis ibu ion and
his ological diagnosis o neoplas ic and non-
neoplas ic lesions o es is espec i ely.
As shown in able 1 es icula umo s we e mo e
p e alen in he age g oup o 31-40 yea s. Only one
case o Non-Hodgkin lymphoma was seen a e 50
yea s o age. Ou o he 9 malignan umo s in his
s udy, 77.77% (7 cases) consis ed o ge m cell
umo s. Table 2 shows age wise dis ibu ion o non-
neoplas ic lesions o es is.
Ou younges pa ien was a bi h while he oldes
pa ien was 71-yea male. Maximum numbe s o
pa ien s p esen ed in second decade o li e (29.41%).
Second highes age incidence was ound in 3 d and
4 h decade o he li e, comp ising 17.64% each.
Va ious lesions we e obse ed in wide ange o age.
To sion and in a c ion o es is was seen in 28 cases
(54.9%) ollowed by es icula abscess (n=8;
15.6%). Since ube culosis is mo e common in ou
con ex , ube culosis o es is was ound in 4 cases
(7.8%). (Table 3)
Table 1: His ological diagnosis o es icula umo along wi h age dis ibu ion.
Age g oup
Seminoma
MGCT
NHL
Imma u e Te a oma
To al
31-40
2
2
1
-
5 (55.55%)
41-50
1
-
-
1
2 (22.22%)
51-60
-
-
-
-
0
61-70
-
-
1
-
1 (11.11%)
71-80
-
-
-
-
0
81-90
1
-
-
-
1 (11.11%)
To al
4 (44.44%)
2 (22.22%)
2 (22.22%)
1 (11.11%)
9 (100%)
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Table 2: F equency o nonneoplas ic es icula lesions a a ious age g oup
Age in yea s
Numbe o cases (n=51)
Pe cen age (%)
0-10
2
3.92 %
11-20
15
29.41 %
21-30
9
17.64 %
31-40
9
17.64 %
41-50
6
11.76 %
51-60
6
11.76 %
61-70
3
5.88 %
> 71
1
1.96 %
Table 3: His opa hological diagnosis o non-neoplas ic lesions.
HPE Diagnosis
Numbe o Cases (n=51)
Pe cen age (%)
Undescended es is
4
7.84 %
T.B. Epididymo-o chi is
5
9.80 %
G anuloma ous O chi is
1
1.96 %
Tes icula Abscess
8
15.68 %
Non-speci ic Epididymo-o chi is
5
9.80 %
To sion and In a c ion
28
54.90 %
Figu e 1: A:- G oss o Epididymo- o chi is. Sec ions shows des uc ion o na i e a chi ec u e o bo h
es is and epididymis. Findings included a mixed in lamma o y in il a e, semini e ous ubule des uc ion,
abscess o ma ion (co esponding o he yellow oci in es is) and ib osis. The in lamma o y p ocess
ex ends in o pa a es icula so issues which a e g ea ly expanded as seen in his g oss specimen
pho og aph.
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Figu e 1: B:-Mic oscopy o Epididymo- o chi is -The semini e ous ubules con ain esidual ge m cells
and Se oli cells; howe e , he e is no e idence o spe ma ogenesis. The in lamma o y in il a e is mixed
consis ing p edominan ly o lymphocy es, plasma cells, and his iocy es along wi h neu ophils. (H&E,
200X)
Figu e 2: A:-G oss o Seminoma- Sec ion shows Classic seminoma consis ing o a pink- an, Fi m,
mul inodula umo bulging om he su ounding es icula pa enchyma. Fib o ic bands can be seen on
he cu su ace. His opa hologic examina ion did indeed show ex ensi e scle osis h oughou he umo .
The yellow s uc u e abo e he umo is he epididymis.
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Figu e 2: B:- Mic oscopy o Seminoma. The classic his ologic appea ance consis s o a uni o m
popula ion o umo cells wi h ample clea cy oplasm (due o glycogen con en ), p ominen cell
memb anes, and a la ge nucleus wi h a p ominen nucleolus. The umo cells a e a anged in small nes s
o clus e s sepa a ed by ib ous abeculae con aining lymphocy es and plasma cells. (H&E, 200X)
Figu e 3-A: G oss o Yolk sac umou showing Pu e yolk sac umo s a e usually so , solid umo s wi h
a myxoid o gela inous quali y. The cu su ace is yellow- an o g eyish-whi e. La ge umo s may ha e
oci o hemo hage and nec osis o small cys ic a eas. In such cases, he possibili y o a mixed ge m cell
umo should be conside ed, especially in an adolescen o a young adul pa ien .
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Figu e 3-B: Mic oscopy o Yolk sac umou showing Mic ocys ic pa e n in a yolk sac umo . The e
a e in e connec ing ibbons and co ds o umo cells enclosing ound/i egula ex acellula spaces and
c ea ing a honeycomb-like meshwo k. Mic ocys ic is he mos common a chi ec u al pa e n in yolk sac
umo . (H&E, 200X)
Figu e 4-A: G oss o Imma u e e a oma in es is showing he g oss appea ance
o e a omas is he e ogenous and depends upon he componen s p esen . So , leshy, encephaloid (b ain-
like) o hemo hagic a eas (such as hose seen in his o chiec omy specimen) co espond o oci
o imma u e emb yonic issue.
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Figu e 4-B: Mic oscopy o Imma u e e a oma Nodules o hyaline ca ilage on he le and p esen
adjacen o a ocus wi h imma u e issue consis ing o p imi i e ubules, blas ema, and spindle s oma.
(H&E, 200X)
Figu e 5-A: G oss o Non-Hodgkin Lymphoma. Tes icula Lymphoma - G oss Pa hology:
In o chiec omy specimens, es icula lymphomas appea as disc e e, i m o leshy, yellow- an/whi e/g ey
nodules anging in size om < 1 cm o > 10 cm. The umo may eplace he en i e es is, some imes
lea ing only a hin im o unin ol ed pa enchyma (as in his case). Foci o nec osis may be p esen .
Tes icula lymphomas can mimic seminomas g ossly; howe e , hey a e mo e likely o show ex a
es icula sp ead as compa ed o seminomas.
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Figu e 5-B: Mic oscopy o Non-Hodgkin Lymphoma Di use La ge B-cell Lymphoma o he Tes is: The
la ge a ypical lymphoid cells in ade he pe iphe y o he semini e ous ubules, displacing he ge m cells
and Se oli cells cen ally o comple ely eplacing hem. P ominen in a ubula in ol emen is seen in
a e cases. The emnan s o a ophic ubules a e isible as ligh e pink islands in a sea o blue/pu ple
umo cells a low magni ica ion. (H&E, 200X)
Discussion:
Tes icula lesions a ies acco ding o i s occu ence
in di e en age g oups. Tes icula umou s a e
among he mos p e alen cance s in young adul s,
al hough ha ing a low equency. The majo i y o
he malignan cases in he cu en s udy occu ed in
he hi d and ou h decades o li e, which is
consis en wi h da a om Eu opean and A ican
se ies [7,8].
The li e a u e indica es ha he umou ’s beha iou
and his ologic pa e n a y wi h age. While
spe ma ocy ic seminoma and lymphoma occu in he
elde ly, seminoma is mo e common in he ou h
decade o li e. In young people, seminoma,
emb yonal cance , e a oma, and e a oca cinoma
a e all common.
In his s udy, ge m cell umou s made up 77.77% (7
cases) o he 9 malignan umo s. Acco ding o
Mos e i and P ice, ge m cell umo s cons i u e mo e
han 94% o es icula umo [9]. This s udy ound
ha 2 (28.57%) o he ge m cell umou cases we e
mixed ge m cell umou s, which is consis en wi h
indings om ea lie in es iga ions. The e we e wo
cases o mixed ge m cell umou s in his s udy: one
had solid o m yolk sac umou and emb yonal
ca cinoma, while he o he had seminoma wi h
cho ioca cinoma as he p edominan umou ype.
Seminoma ( ig.2) comp ises 35-71% o es icula
umo s. In his s udy, seminoma consis ed o 44.44%
(4 cases) o all es icula umo s. Two Non-Hodgkin
Lymphoma NHL cases (22.22%) we e obse ed
( ig. 5). A pa ien who was 31 yea s old had one, and
a pa ien who was 65 yea s old had ano he . Thei
non-Hodgkin lymphoma was o he di use la ge B-
cell ype.
Acco ding o Fonseca e al., he median age a which
ex a nodal NHL mani es s i sel is 68 yea s. The
mos equen cance in men o e 60 is p ima y
es icula lymphoma, which makes up a ound 1% o
all lymphomas [10].
The documen ed occu ence o leukemic in il a ion
o he es is anges om 8% o 25% in he li e a u e;
howe e , in he majo i y o s udies, his pe cen age
is below 10% [11,12]. This s udy did no obse e
leukemic in il a ion.
Pos pube al (adul ) es icula e a omas ( ig.4) a e
malignan . Malignan es icula e a omas exhibi a
g ea e me as asis a e o 20% compa ed o hei
o a ian equi alen [13]. Pu e e a oma in he es is
is uncommon, making up 4% o GCT in his o gan.
Te a oma ous cha ac e is ics a e mo e equen ly
no iced in mixed GCTs in he es is, ins ead o pu e
e a oma. In his s udy, one case (11.11%) was
obse ed wi h imma u e e a oma.
In he p esen s udy, o ube culous Epididymo-
o chi is ( ig.1) mean age was 49.6 yea s which is
simila o Suankwan U e al. [14] In he p esen
s udy, a case o g anuloma ous o chi is whose age
was 52 yea s which is simila o he s udy gi en by
G unbe g H [15] who ound he p e alence o be he
mos common in 5 h o 6 h decade. The e we e 5
cases o nonspeci ic Epididymo-o chi is ou o 51
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cases (9.80%). Age anging om 21-60 yea s which
is simila o he s udy gi en by Ka e e al. [16]
The abno mali y mos equen ly obse ed, o sion
and in a c ion, accoun ed o 54.90%, in his s udy,
wi h an a e age age o 26.5 yea s, which is
compa able o he esea ch conduc ed by Cuckow e
al. [17]
Limi a ions:
The limi a ion o he s udy is ha i was ca ied ou
in a single e ia y ca e hospi al in India; hence his
may no ep esen he en i e popula ion o he na ion.
Simila s udies wi h a la ge sample size should be
conduc ed in mul iple cen e s which would p o ide
a clea e pic u e o he Tes icula lesions in India.
Conclusion:
This s udy s ongly ecommends ou ine
his opa hological examina ion o all sc o al
specimens o he de ec ion o a ious es icula and
pa a es icula lesions, as well as neoplasms.
His opa hology no only p o ides a issue diagnosis
in sc o al diso de s, bu i also adds o unde s anding
e iopa hogenesis and can aid in he de elopmen o
u u e ea men op ions. The occu ence o
es icula neoplas ic lesions con inues o be low in
ou popula ion., as indica ed by he sca ci y o
s udies in published li e a u e.
Ge m cell umo s ep esen ed he la ges pe cen age
o seminoma sub ypes, ollowed by mixed ge m
cell umo s. Among all non-neoplas ic lesions,
ascula lesions such as o sion and in a c ion a e
he mos equen ly obse ed indings, ollowed by
ube cula abscess.
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