A RARE CASE REPORT OF MIXED GERM CELL TUMOR (SEMINOMA, EMBRYONAL CARCINOMA, YOLK SAC TUMOUR AND IMMATURE TERATOMA) OF TESTIS

Germ cell tumors occur at all ages.The tumors are identified as pure form (those of one histologic type) and mixed form (more than one histologic type).Over half of germ cell tumors consist of more than one cell type, requiring appropriate sampling for the correct diagnosis and correlation with the serum tumor markers & immunohistochemistry.We report a case of mixed germ cell tumour of testis in a 28-year-old male who presented with right sided scrotal swelling since 6 months associated with loss of appetite and weight.Trans-illumination positive, fluctuation positive.No engorged veins.Penis & opposite scrotum -normal.No gynaecomastia or cryptorchidism was noticed clinically.Alpha-Fetoprotein (AFP) and beta-HCG values were found to be abnormal.USG of the scrotum revealed a right sided testicular mass.The CT scan of abdomen and pelvis was normal.The patient underwent right-sided high orchidectomy.Grossly, grey white to yellow enlarged testicular mass measuring 10 X 6 X 5 cm, firm-to-hard in consistency was found.Cut-section revealed a variegated mass of solid and cystic areas with hemorrhage and necrosis.Microscopically,a mixed germ cell tumor with seminoma, embryonal carcinoma, yolk sac tumor and immature teratoma & syncytiotrophoblast components was found.Immunohistochemistry showed immuno-positivity for PLAP, CD 117, Alfa feto-protein (AFP) and OCT 3/4, betaHCG, confirming the diagnosis of Mixed Germ cell tumour.