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Presented by Jonathan Epstein, MD and prepared by Jason Kern, MD
Case 3: A 65 year old man underwent an orchiectomy for a testicular mass.
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Question 1 of 1
1. Question
Week (number): Case 1
A 65 year old man underwent an orchiectomy for a testicular mass. Choose the correct diagnosis:
Correct
Answer: Yolk sac tumor
Histology:
The tumor is composed of a uniform proliferation of glands with dense eosinophilic cytoplasm. Many of the glands have prominent subnuclear vacuoles.Discussion:
Amongst germ cell tumors, yolk sac tumors are the most diverse histologically. The most common patterns are: Microcystic, solid, glandular, and endodermal sinus with the latter having characteristic Schiller-Duval bodies. Less common patterns are: myxomatous, hepatoid, papillary, sarcomatoid, parietal with eosinophilic basement membrane deposits, and polyvesicular vitelline which are dilated cysts with an hour glass configuration. The glandular, also known as alveolar, pattern must be distinguished from teratoma. In contrast to teratoma, there is the presence of subnuclear vacuoles and also the absence of smooth muscle cuffs around the glands. Verification of the diagnosis of yolk sac tumor can be made with immunohistochemistry using antibodies against AFP and Glypican 3. The latter antibody is specific for yolk sac differentiation and a more sensitive marker with less background staining than AFP.Incorrect
Answer: Yolk sac tumor
Histology:
The tumor is composed of a uniform proliferation of glands with dense eosinophilic cytoplasm. Many of the glands have prominent subnuclear vacuoles.Discussion:
Amongst germ cell tumors, yolk sac tumors are the most diverse histologically. The most common patterns are: Microcystic, solid, glandular, and endodermal sinus with the latter having characteristic Schiller-Duval bodies. Less common patterns are: myxomatous, hepatoid, papillary, sarcomatoid, parietal with eosinophilic basement membrane deposits, and polyvesicular vitelline which are dilated cysts with an hour glass configuration. The glandular, also known as alveolar, pattern must be distinguished from teratoma. In contrast to teratoma, there is the presence of subnuclear vacuoles and also the absence of smooth muscle cuffs around the glands. Verification of the diagnosis of yolk sac tumor can be made with immunohistochemistry using antibodies against AFP and Glypican 3. The latter antibody is specific for yolk sac differentiation and a more sensitive marker with less background staining than AFP.
