Spermatocytic seminoma in a 92-year-old man: report of a case in which SALL4, a potential novel marker for testicular germ cell tumors, was useful for the diagnosis

Spermatocytic seminoma (SS) is a rare testicular germ cell tumor (TGCT), occurring exclusively in the testes. Diagnosis of SS is important because, unlike other testicular tumors, SS must be treated by orchiectomy alone without further adjuvant therapy owing to its inability to metastasize. However, an accurate diagnosis of SS is often difficult given its rarity and the lack of a reliable marker. We report the occurrence of SS in a 92-year-old man-one of the oldest SS patients reported thus far. The patient presented with a painful right scrotal mass, which had been present for 6 months. A computed tomography scan revealed a testicular mass. There was no significant increase in the serum levels of alpha-fetoprotein (AFP) or human chorionic gonadotropin (hCG). A right orchiectomy was performed, which showed a well-circumscribed white-gray mass. A histological examination revealed sheets of non-cohesive cells with little intervening stroma. The tumor consisted of small, medium, and large cells with frequent mitoses, which is suggestive of SS. Whereas common TGCT markers including AFP, hCG, CD30, and placental alkaline phosphatase were all negative, nuclear reactivity for SALL4, a new TGCT marker, and positivity for CD117 (c-kit) finally helped establish the diagnosis of SS. We conclude that SALL4 immunostaining can be helpful for the diagnosis of TGCT when tumors are negative for conventional TGCT markers.