Fig. 1(A, D) Abdominal enhanced computed tomography (CT) at the time of the first diagnosis. (A) A huge heterogeneous enhancing mass (12×9 cm) in the right scrotum. (D) Multiple enlarged (about 2 cm) lymphadenopathies at the para-aortic and peri-caval areas (arrows). (B, E) Abdominal enhanced CT after four cycles of chemotherapy. (B) The orchiectomy site showing no evidence of tumor recurrence. (E) The lymphadenopathy has decreased in size to less than 1 cm (circle). (C, F) Whole body positron emission tomography-CT after nine cycles of chemotherapy. (C) Coronal view without fructose-1,6-bisphosphate (FDP) uptake. (F) Axial view showing the significant decrease in size of lymph nodes without FDP uptake.
Fig. 2Gross findings. A well-defined huge solid mass (13×10 cm) is seen adjacent to the testis. The testis is of normal size and is grossly intact. The tumor is completely separated from the testis and has a whitish tan, solid and trabeculated cut surface.
Fig. 3Microscopic findings. (A) The lower power view shows tumor cells arranged in a whorled or intersecting pattern and a partially necrotic portion is identified (H&E staining, ×12.5). (B) The tumor shows high atypism and is composed of spindle cells, indicating their probable mesenchymal origin (H&E staining, ×100). (C) The high power view displays the nuclear pleomorphism and many mitoses of the tumor cells (H&E staining, ×400). (D) Immunohistochemical staining shows diffuse and strong positivity for smooth muscle actin (×200).