Testicular embryonal carcinoma presenting as chest wall subcutaneous mass

Embryonal carcinoma affects young males in the prime of life with a majority of these tumors already having metastasis at the time of diagnosis. Subcutaneous metastasis from embryonal carcinoma are very rare and often associated with wide spread disease and poor prognosis. We report a case of chest wall subcutaneous metastasis of embryonal carcinoma in a 27 year-old man that was the first presentation of the disease and was diagnosed on fine needle aspiration cytology (FNAC). Subsequent search led to the discovery of the primary in the testis. The cytomorphological features of embryonal carcinoma are quite distinctive and FNAC plays a vital role in early diagnosis. The criteria for diagnosis includes presence of cellular smears exhibiting disperse cells as well as cell aggregates forming microglandular patterns. Cells have large nuclei with prominent nucleoli and pale indistinct often vacuolated cytoplasm. Early diagnosis and treatment with platinum based chemotherapy in conjunction with radiotherapy and surgery have high cure rate.