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Diagnostics Histology

Case of the Month

A 77-year-old man presented with an arcuate, erythematous patch on his lower back. The lesion was painful and pruritic. A biopsy was performed; histology from the case is presented above.

What is the most likely diagnosis?

a. Wells’ syndrome
b. Ofuji disease
c. Angiolymphoid hyperplasia with eosinophilia
d. Tungiasis
e. Allergic contact dermatitis

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We will reveal the answer next month.

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D. Primary signet ring stromal tumor of the testis

Primary signet ring stromal tumor of the testis (PSRSTT) is a rare benign testicular tumor originally described in 2005 (1). The tumor is typically composed of low-grade epithelioid cells, most of which contain a large cytoplasmic vacuole. These vacuoles compress and displace peripherally the nucleus of each tumor cell, imparting a signet ring-like appearance. PSRSTT must be distinguished from metastatic signet ring carcinoma of the gastrointestinal tract; in this case, negative IHC data were useful for the final diagnosis. Data from the literature indicate that the tumors are positive for β-catenin, cyclin D1, CD10, galectin-3, claudin 7, and neuron-specific enolase (2).

The histogenesis of these rare tumors is unknown. Recent immunohistochemical and molecular biology data suggest that this tumor is a testicular analogue of pancreatic solid pseudopapillary tumor (2).


  1. M Michal et al., “Primary signet-ring stromal tumor of the testis”, Virchows Arch, 447, 107 (2005). PMID: 15909171.
  2. K Michalova et al., “Primary signet ring stromal tumor of the testis: a study of 13 cases indicating their phenotypic and genotypic analogy to pancreatic solid pseudopapillary neoplasm”, Hum Pathol, 67, 85 (2017). PMID: 28739499.

Submitted by Živka Eri, Professor of Pathology, Medical Faculty, University of Novi Sad, Serbia.

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