Testicular feminization syndrome secondary to a seminoma in a cryptorchid testis-Case report

Background: The authors report a rare case of testicular feminization syndrome in which the initial symptom was an inguinal mass. Case: A 62-year-old phenotypic female came to our hospital complaining of a mass in the right inguinal area. Aspiration cytology was performed because malignant lymphoma was suspected. Large atypical cells containing nucleoli were seen interspersed among small lymphocytes, and the differential diagnosis based on the cytology findings was malignant lymphoma dysgerminoma, anaplastic carcinoma, and malignant lymphoma. The tumor was removed, and histological examination revealed a diffuse, sheet-like pattern of neoplastic cells with clear cytoplasm that contained abundant intracytoplasmic glycogen. The stroma contained a lymphocytic infiltrate.Hyalinized seminiferous tubules were also seen. Immunohistochemistry revealed that the tumor cells reacted positively for placental ALP and negatively for lymphoma markers. These findings led to a diagnosis of seminoma in an undescended testis. Subsequent karyotyping yielded 46XY. Conclusion: When cytologic findings with a biphasic pattern compatible with ovarian dysgerminoma in a “woman's” inguinal area are seen, in a case of testicular feminization syndrome, “seminoma” should also be included in the differential diagnosis