Spermatocytic seminoma is a clinical pathologic distinct entity that has a goad prognosis and rarely is associated with other neoplastic elements. Two cases of testicular spermatocytic seminoma with a sarcomatous element are reported. Both patients were older than 40 years and presented with 1-year and 2-year histories of progressive testicular enlargement and recent onset of testicular pain. Histologically, the spermatocytic seminoma in both cases consisted of three distinct cell types as has been previously described. Ultrastructurally, one case showed crystalloid structures similar to the Lubarsch's crystalloids described in spermatogonia of human testis. The sarcomatous component in one case was a rhabdomyosarcoma confirmed by light and by electron microscopic study whereas the second case was a primitive mesenchymal spindte cell sarcoma. Only the sarcomatous element metastasized; metastatic sites included lung and paraaortic lymph nodes in the first patient and lung and liver in the second. Despite aggressive treatment with combined surgery and multiagent chemotherapy, the first patient died within 1 year of diagnosis and the second at 14 months.
Cancer 61:409-414,1988.
PERMATOCYTIC seminoma is a distinct entity,'-' S different from classic seminoma. It has variously been reported to account for between 1.7% and 12.0% of all seminomas.' As a rule, spermatocytic seminoma occurs only in the testis, has a distinctive histologic appearance, and does not metastasize; the typical patient is older than 40 years of age and the prognosis is usually good. Spermatocytic seminoma is not associated with other germ cell elements3 although there is a description of a case associated with a teratoma with malignant areas6 We report two cases of spermatocytic seminoma with an associated sarcomatous element in which the latter component metastasized and pursued an aggressive course despite aggressive treatment with surgery and multiagent chemotherapy.
Case
Reports
Case I
This 42-year-old white man presented with an approximately 1 -year history of a slowly enlarging, nontender left tes-