Carcinosarcoma of the spermatic cord

Our plain-English summary of Carcinosarcoma of the spermatic cord, by M. Nistal, F. Burgos, R. Paniagua (Urologia Internationalis, 1990).

The study

• Authors: M. Nistal, F. Burgos, R. Paniagua
• Journal: Urologia Internationalis
• Published: 1990;45(5):313-6
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The first case of carcinosarcoma in the spermatic cord is reported in a 40-year-old man. The tumor was a 2.5 X 2 cm pseudoencapsulated formation located in the connective tissue of the spermatic cord among the blood vessels. Light microscopy examination of the neoplasm revealed two different histological patterns: epithelial and sarcomatous. Mitoses and atypias were infrequent in both types of areas. The epithelial cells formed papillary and gland-like structures stained with PAS, Hale and mucicarmine stains, and showed positive reaction for immunohistochemical demonstration of both keratin and epithelial membrane antigen. The lumen content of the gland-like structures reacted positively for the carcinoembryonic antigen. Electron microscopy revealed that the epithelial cells were joined by junctional complexes and displayed numerous short microvilli. The sarcomatous areas consisted of spindle cells embedded in a ground substance that occasionally presented myxoid changes. Mast cells and focal calcifications were seen. Sarcomatous cells showed positive reaction for vimentin but not for the other histochemical and immunohistochemical techniques mentioned above. The ultrastructure of sarcomatous cells was similar to that of epithelial cells except for the occurrence of small desmosomes instead of junctional complexes. The differential diagnosis with adenomatoid tumor and malignant mixed mesothelioma is discussed.

In plain English

This article was a case report from Madrid, Spain. It described one 40-year-old man with a carcinosarcoma of the spermatic cord, a tumor also called synovial sarcoma. The authors described it as the first such case reported. The man had a painless lump in the right groin for 9 months. His right testis, epididymis and 12 cm of spermatic cord were removed. He had no chemotherapy or radiotherapy and was healthy 10 years after surgery. The tumor measured 2.5 by 2 cm, had sharp limits, and mixed gland-like epithelial areas with spindle-cell sarcomatous areas. The epithelial cells stained for keratin and epithelial membrane antigen. Material inside the gland-like spaces stained intensely for carcinoembryonic antigen (CEA). The spindle cells stained for vimentin only. The authors discussed how to tell this tumor apart from adenomatoid tumor (benign mesothelioma) and malignant mixed mesothelioma. They noted that this CEA staining is characteristic of carcinoma, not of synovial sarcoma or mixed mesothelioma. The article did not mention asbestos or any exposure history. The authors judged that the tumor had most features suggesting a good outcome.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient), examined with light microscopy, immunohistochemistry and electron microscopy
• Who was studied: one 40-year-old man seen at a hospital in Madrid, Spain, with a painless right inguinal tumor of 9 months' duration
• Main results:
  • The tumor in the spermatic cord measured 2.5 by 2 cm and was sharply circumscribed
  • The tumor grew as a nodule that did not infiltrate surrounding tissue and had a pseudocapsule
  • The epithelial cells stained intensely for epithelial membrane antigen in their apical cytoplasm
  • The epithelial cells stained intensely with AE1-AE3 antikeratin antisera
  • The material inside the gland-like structures reacted intensely for CEA. In the authors' discussion, this is characteristic of carcinoma but not of synovial sarcoma or mixed mesothelioma.
  • The sarcomatous (spindle) cells stained intensely for vimentin but not for the other immunohistochemical stains
  • Under the electron microscope, the sarcomatous cells resembled the epithelial cells except that they had small desmosomes instead of junctional complexes
  • The right testis and epididymis were removed together with 12 cm of spermatic cord, and the patient was healthy 10 years after surgery
• The authors' conclusion: The authors considered that the tumor had most of the features that suggest a good outcome. They also stated that the patient lacked the features that would point to malignant mixed mesothelioma: neither the tunica vaginalis testis nor the abdominal cavity was affected.

Topics

Medical terms in this study, explained in our Lexicon: Spermatic Cord, Neoplasm, Epithelial Membrane Antigen (EMA), Carcinoembryonic Antigen (CEA), Spindle Cell, Differential Diagnosis, Adenomatoid Tumor, Biphasic Mesothelioma.

Related studies

• Treatment of malignant tumors of the spermatic cord: a study of 10 cases and a review of the literature — P.H. Blitzer, D.E. Dosoretz, et al. (1981)
• Tumors of the spermatic cord: a review of the literature and a report of a case of lymphangioma — A.A. el-Badawi, M.M. al-Ghorab (1965)
• Mesothelioma of spermatic cord: electron microscopic and histochemical characteristics of its mucopolysaccharides — P. Pizzolato, J. Lamberty (1976)
• Malignant Mesothelioma of Spermatic Cord in an Elderly Man With a History of Asbestos Exposure — A. D'Antonio, F. Mastella, et al. (2016)
• Histochemical and ultrastructural features of an unusual pulmonary carcinosarcoma — K.G. Zimmerman, R.E. Sobonya, et al. (1981)
• 'Pleural' and pulmonary carcinosarcomas — F.G. Mayall, A.R. Gibbs (1992)

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