Clinical case of testicular serous papillary tumor with ovarian stroma

Serous tumors are rare in the group of non-germ cell testicular tumors, ad are morphologically similar to serous ovarian tumors. Preoperative diagnosis of this tumor is difficult due to the lack of specific signs according to clinical and instrumental research methods. In turn, histological verification of a serous borderline tumor is also a difficult task and requires differential diagnosis, primarily with serous cystadenocarcinoma, which, unlike a serous borderline tumor, can metastasize and is generally characterized by worse prognosis. Immunohistochemical examination allows to exclude other tumors with a similar morphological structure, including mesothelial tumors. Due to the rare occurrence of testicular serous tumors, there is minimal clinical experience in the treatment of these tumors worldwide, and there is still no consensus on guidelines for their treatment. Radical orchiectomy is recommended for patients with border-line serous tumors.

This article presents a clinical case of a testicular serous borderline papillary tumor with a discussion of the literature data on the instrumental, morphological, and immunohistochemical characteristics of this rare tumor in men.

1. WHO Classification of Tumours Editorial Board. Urinary and male genital tumours. WHO Classification of Tumours Series, 5th edn., vol. 8. Lyon (France): International Agency for Research on Cancer, 2022. Available at: https://publications.iarc.fr/610.

2. Lin M.S., Ayala A.G., Ro J.Y. Ovarian-type tumors (Mullerian tumors) of the testis: clinicopathologic findings with recent advances. Ann Urol Oncol 2019;2(1):36–45. Available at: https://doi.org/10.32948/auo.2019.03.07

3. Aravind S., Nayanar S.K., Varadharajaperumal R. et al. High grade serous cystadenocarcinoma of testis-case report of a rare ovarian epithelial type tumour. J Clin Diagn Res 2017;11(6):ED13–5. DOI: 10.7860/JCDR/2017/27743.10097

4. Tickoo S.K., Paner G.P., Zhou M. et al. Protocol for the examination of radical orchiectomy specimens from patients with malignant germ cell and sex cord-stromal tumors of the testis. Version: 4.1.0.1.

5. Cundell D., Pawade J., Sohail M., Melegh Z. The V600E BRAF mutation in a borderline serous tumour of the testis is genotypic evidence of similarity with its phenotypic ovarian counterpart. Histopathology 2015;67(1):142–4. DOI: 10.1111/his.12630

6. Algaba F., Mikuz G., Boccon-Gibod L. et al. Pseudoneoplastic lesions of the testis and paratesticular structures. Virchows Arch 2007;451(6):987–97. DOI: 10.1007/s00428-007-0502-8

7. Gwiti P., Vereczkey I., Cundell D. et al. The mutational frequency of BRAF and KRAS in low-grade serous testicular neoplasms-a case series. Histopathology 2017;71(5):686–92. DOI: 10.1111/his.13261

8. Hsieh A., Miller M., He W., Shin D. Serous borderline tumor of the testis and associated magnetic resonance imaging findings. Urol Case Rep 2017;14:30–2. DOI: 10.1016/j.eucr.2017.06.007

9. Cassidy F.H., Ishioka K.M., McMahon C.J. et al. MR imaging of scrotal tumors and pseudotumors. Radiographics 2010;30(3):665–83. DOI: 10.1148/rg.303095049

10. Bürger T., Schildhaus H.U., Inniger R. et al. Ovarian-type epithelial tumours of the testis: immunohistochemical and molecular analysis of two serous borderline tumours of the testis. Diagn Pathol 2015;10:118. DOI: 10.1186/s13000-015-0342-9

11. Fonseca D., Manasa P.L., Sharma R., Giridhar A. Borderline serous papillary tumor of the testis. Indian J Pathol Microbiol 2020;63(4):618–9. DOI: 10.4103/IJPM.IJPM_837_19

12. Mayr D., Hirschmann A., Lohrs U., Diebold J. KRAS and BRAF mutations in ovarian tumors: a comprehensive study of invasive carcinomas, borderline tumors and extraovarian implants. Gynecol Oncol 2006;103(3):883–7. DOI: 10.1016/j.ygyno.2006.05.029

13. Kurman R.J., Shih I. Molecular pathogenesis and extraovarian origin of epithelial ovarian cancer--shifting the paradigm. Hum Pathol 2011;42(7):918–31. DOI: 10.1016/j.humpath.2011.03.003

14. Emmanuel C., Chiew Y.E., George J. et al. Genomic classification of serous ovarian cancer with adjacent borderline differentiates RAS pathway and TP53-mutant tumors and identifies NRAS as an oncogenic driver. Clin Cancer Res 2014;20(24):6618–30. DOI: 10.1158/1078-0432.CCR-14-1292

15. Shih I., Kurman R.J. Ovarian tumorigenesis: a proposed model based on morphological and molecular genetic analysis. Am J Pathol 2004;164(5):1511–8. DOI: 10.1016/s0002-9440(10)63708-x