Metastatic Testicular Mixed Germ Cell Tumors. A Diagnostic Dilemma in Cytology

Germ cell tumours (GCTs) are the most common malignant tumours of the testes. Metastasis to cervical lymph nodes as the initial manifestation is rare. Mixed GCTs are a diagnostic challenge to the pathologist, particularly in cytology because of their histologic diversity; more so when they occur at unexpected sites, with unknown primary. Two young adult males presented with enlarged cervical lymph nodes. Fine needle aspiration cytology (FNAC) was reported as metastatic undifferentiated carcinoma, suspected to be arising from testis. Subsequently, left testes were found to be enlarged in both; histopathological examination confirmed mixed GCT. GCTs are important differential diagnoses for metastatic undifferentiated carcinomas in cervical lymph nodes in young adult males. A reliable diagnosis can be made on cytology, even in those patients in whom the primary is not known. This study aims to highlight the cytologic hallmarks of metastatic mixed GCT to arrive at an accurate diagnosis.