2019-41 / DECEMBER 2

A 36 year-old male underwent an orchiectomy for a 1.1 cm. testicular mass.


1. What is the correct diagnosis?

a. Benign prepubertal-type teratoma

b. Malignant (ie post-pupertal-type) teratoma

c. Hamartoma

d. Inclusion cysts

1. Benign prepubertal-type teratoma

The lesion consisted of a cluster of glands that were surrounded by smooth muscle in an organoid arrangement. The glands were lined by ciliated epithelium. This lesion is analogous to teratomas obscuring prepubertally based on its cystic organized mature components, lack of adjacent germ cell neoplasia in situ, normal spermatogenesis in surrounding testis and lack of amplification of isochromosome 12p by FISH done at Johns Hopkins. The existence of a benign form of postpubertal testicular teratoma, apart from the rare dermoid cyst, is not widely recognized and was first described by Zhang et al. under the senior leadership of Thomas Ulbright. Prior to this article, all teratomas occurring in post-pobertal males were considered malignant. All 17 patients in the Zhang study that had follow-up information were alive at postoperative intervals of 5 to 168 months. This study supports the recognition and separate classification of not only dermoid cysts but also a small subset of apparently benign testicular teratomas in postpubertal patients that share many features with dermoid cysts but lack cutaneous-type adnexal structures. Features important in the recognition of both forms of these specialized teratomas of the postpubertal testis include absence of all of the following: cytologic atypia; intratubular germ cell neoplasia, unclassified type; significant tubular atrophy/tubular sclerosis; scarred zones; impaired spermatogenesis; microlithiasis; and evidence of chromosome 12p amplification. Other features include frequent organoid morphology and prominent components of ciliated epithelium and smooth muscle

Zhang C, Berney DM, Hirsch MS, Cheng L, Ulbright TM. Evidence supporting the existence of benign teratomas of the postpubertal testis: a clinical, histopathologic, and molecular genetic analysis of 25 cases.
Am J Surg Pathol. 2013 Jun;37:827-35.

Jonathan Epstein
Johns Hopkins Hospital


Pre-pubertal-type teratoma