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Presented by Hind Nassar, M.D. and prepared by Julie M. Wu, M.D.
Case 5: 21 year old male with a testicular tumor.
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1. Question
Week 343: Case 5
21 year old male with a testicular tumorimages/jmw042108/5.1.jpg
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images/jmw042108/5.5.jpgCorrect
Answer: Mixed germ cell tumors with seminoma and embryonal carcinoma components
Histology: In most areas the tumor consists of sheets of neoplastic cells with clear cytoplasm, prominent nucleoli and monotonous morphology, admixed with a lymphoplasmacytic infiltrate diagnostic of seminoma. Focally, one nodule is composed of papillary formations and sheets of highly atypical cells with pleomorphism, mitosis and necrosis. There is no evidence of vascular invasion. The cells in this nodule stain for positive for CD30 and OCT3 (which also stains the nuclei of the seminomatous component) and negative for AFP consistent of an embryonal carcinoma component.
Discussion: The morphological features of the tumor are diagnostic of a mixed germ cell tumor (MGCT) with a predominant seminomatous component and a non-seminomatous component. The latter appeared to have features of yolk sac tumor (fibrovascular areas resembling Schiller-Duvall bodies) and embryonal carcinoma (high grade cytology with mitoses). Immunostains in this case are diagnostic of an embryonal carcinoma component (CD30 +; AFP -). A high percentage (40%) of embryonal carcinoma in a (MGCT) is an independent predictor of metastatic disease in stage I tumors.
Reference(s):
– Arch Pathol Lab Med. 2007 Aug;131(8):1267-80.Incorrect
Answer: Mixed germ cell tumors with seminoma and embryonal carcinoma components
Histology: In most areas the tumor consists of sheets of neoplastic cells with clear cytoplasm, prominent nucleoli and monotonous morphology, admixed with a lymphoplasmacytic infiltrate diagnostic of seminoma. Focally, one nodule is composed of papillary formations and sheets of highly atypical cells with pleomorphism, mitosis and necrosis. There is no evidence of vascular invasion. The cells in this nodule stain for positive for CD30 and OCT3 (which also stains the nuclei of the seminomatous component) and negative for AFP consistent of an embryonal carcinoma component.
Discussion: The morphological features of the tumor are diagnostic of a mixed germ cell tumor (MGCT) with a predominant seminomatous component and a non-seminomatous component. The latter appeared to have features of yolk sac tumor (fibrovascular areas resembling Schiller-Duvall bodies) and embryonal carcinoma (high grade cytology with mitoses). Immunostains in this case are diagnostic of an embryonal carcinoma component (CD30 +; AFP -). A high percentage (40%) of embryonal carcinoma in a (MGCT) is an independent predictor of metastatic disease in stage I tumors.
Reference(s):
– Arch Pathol Lab Med. 2007 Aug;131(8):1267-80.
