Juvenile Granulosa Cell Tumor of the Testis is a rare testicular tumor that falls within the category of stromal cord neoplasms. There have been less than 50 cases described in the literature with all cases being described as having a cystic component (1, 2). We present a case of a 6 month old boy presenting with unilateral scrotal swelling. Ultrasound evaluation revealed an entirely solid, hypervascular, intratesticular mass. Alpha-fetoprotein levels were negative. At surgery, radical orchiectomy was performed and pathology revealed a Juvenille Granulosa Cell Tumor. Testicular tumors arising in the neonatal and prepubescent period are a unique set of tumors distinct from their adult counterparts. In this younger age group, germ cell tumors predominate. Of the germ cell tumors, Yolk Sac tumors are the main tumor of clinical significant, and the reason why alpha-fetoprotein is such a relevant marker (3). Stromal cell tumors account for only a small percentage of testicular tumors within this age group. When they do occur, Juvenile Granulosa Cell Tumors (JGC) predominate, particularly if the child is under 1 year of age, with this tumor type being the most common testicular tumor present at birth (3,4). JGC tumors are associated with genetic and structural anomalies of the Y chromosome, ambiguous genitalia, and contralateral undescended testis. One of their defining pathologic characteristics is positive staining with Inhibin (3).To date there are no cases of metastatic JGC tumors. In all reported cases, Sonographic evaluation demonstrates a grossly multicystic tumor (2). The adult variant of Granulosa Cell tumors can appear as a solid mass with little or no cystic component and carries the risk of metastasis of approximately 20% (2). Surgical management of testicular JGC tumors has largely been radical orchiectomy but, some studies have shown tumor sparing excision to be curative in cases with salvageable testicular parenchyma (2). This finding highlights the importance of including stromal cell tumors, particularly JGC, in the differential for solid appearing testicular masses in the neonate. With more reported cases of JGC tumors of the testes, surgical management could include a more conservative approach. Although JGC tumor of the testis is not known to be malignant, given the atypical features of this tumor and similarities with its more malignant adult counterpart, close surveillance is warranted to ensure benign course. Read More

Meeting name: IPR 2016 Conjoint Meeting & Exhibition , 2016

Authors: Harvey Carly, Allbery Sandra, Powers Andria

Keywords: Juvenille Granulosa Cell Tumor, Testicular Tumor, Pediatric, Solid

We present a case of an 18YO male high school baseball player with acute onset posterior pain in his non-throwing left shoulder, the leading shoulder in his batting swing. Pain began on a missed attempt at hitting an outside pitch. The pain only occurred when he was batting and resulted in subsequent loss of batting power and accuracy. Patient was asymptomatic when he was not batting. Prior to the acute event, patient had low grade pain in this location during intermittent at bats. Physical exam showed 1-2+ left shoulder posterior instability and mildly asymmetric left less than right shoulder strength. He had negative Neer, Whipple, Speed’s, and Hawkin’s tests. MRI left shoulder showed posterior labral tear with paralabral cyst. Patient underwent laparoscopic posterior labral repair with placement of four anchoring sutures and Bankart reconstruction. He did well post-operatively, returning to preinjury strength and range of motion in four months and returning to play in 6 months. Batter’s shoulder is a rare condition recently recognized in the orthopedic literature and has not been reported to our knowledge in the radiologic literature. Although the adolescent/young adult spectrum of shoulder injuries in the throwing arm have been well described, injury types and mechanisms involving the non-throwing arm are not commonly known. The mechanics of hitting places considerable stress on the leading shoulder. Biomechanics studies by Welch CM et al show that as the hitter slides forward, the force applied by the front foot equals 123% of body weight and the hip segment rotates to a maximum speed of 714 degrees/second. This is followed by maximum shoulder segment velocity of 937 degrees/second and maximum linear bat velocity of 31 m/second. During a missed pitch, these forces are magnified due to lack of a counterforce against the dynamic posterior pulling force on the lead shoulder. Athletes with labral tear of the leading shoulder during batting (Batter’s shoulder) have a better prognosis than throwing arm labral tear, with approximately 90% returning to previous level of play. This exhibit will display biomechanics, pre-operative and post-operative MRIs, and intra-operative laparoscopic images of Batter’s Shoulder. Read More

Meeting name: IPR 2016 Conjoint Meeting & Exhibition , 2016

Authors: Allbery Sandra, Powers Andria, Love Terri, Wheelock Lisa

Keywords: Hitter's shoulder, Posterior labral tear, Posterior shoulder instability, Arthroscopy, Batter's shoulder