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Testicular germ cell tumors may have multiple histologic subtypes. Teratoma components are capable of transformation into somatic malignancies. An alternative hypothesis for the development of angiosarcoma in a patient with germ cell tumors is secondary to radiation or chemotherapy. We report a patient with a mixed testicular germ cell tumor who presented with retroperitoneal, mediastinal, and pulmonary metastases after chemotherapy. Forty months after his original diagnosis, a mediastinal angiosarcoma was diagnosed. Using tissue microdissection-loss of heterozygosity analysis and fluorescence in situ hybridization, we analyzed the clonality of the primary germ cell tumor, angiosarcoma, and metastatic teratoma. Six microsatellite polymorphic markers from 3 different chromosomes were used to examine the pattern of allelic loss; chromosome 12p alterations, including isochromosome 12p and 12p overrepresentation, were investigated. Loss of heterozygosity was demonstrated for microsatellite loci of all 3 chromosomes, and completely concordant loss of heterozygosity patterns were observed among primary germ cell tumor components, metastatic teratoma, and angiosarcoma. Isochromosome 12p and 12p overrepresentations were consistently found in the primary germ cell tumor components, metastatic teratoma, and angiosarcoma. The results indicated a clonal origin of the tumors, which supports that angiosarcoma, as well as the teratomas, arose from the testicular germ cell tumors.

Hepatic amyloid deposition in the form of globular inclusions is a rare occurrence. Only 24 such cases have been reported to date. Its clinical and pathological significance are undefined. Unawareness of such a pattern can cause diagnostic confusion. We herein describe a case of globular hepatic amyloid in a patient with a B-cell lymphoma and chronic hepatitis C. The findings in our case support the literature data in that (1) it is often an incidental finding during workup for other coexisting conditions and (2) its morphology is peculiar but can be recognized with ease if one is aware of its existence. Our case also provides new insights into this condition. First, it represents the first nonautopsy case to demonstrate that globular hepatic amyloid is an indication of systemic amyloidosis, thus emphasizing the clinical importance of the recognition of this condition. Second, in our case, there was a coexisting B-cell lymphoma, the constituent cells of which showed immunoglobulin lambda light chain restriction, and patient's serum lambda light chain was elevated. However, light chain restriction was not demonstrated in the globular inclusions, and there was no evidence of monoclonal gammopathy by serum electrophoresis. Whether immunoglobulin light-chain abnormality played a causal role in this condition is to be determined.