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Presented by Dr. Jonathan Epstein and prepared by Dr. Yembur Ahmad
This case talks about a 40-year-old man with a testicular mass.
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1. Question
History: A 28 year old man presented with a large testicular mass and an orchiectomy was performed. In addition to small foci of embryonal carcinoma, there is:
Choose the correct diagnosis:
Correct
Answer: C
Histological Description: The tumor consists of nodules of atypical cartilage, some with necrosis. In areas, the cartilage nodules occupy areas of a 4x field without intervening other germ cell components. In addition to the embryonal carcinoma, there is a single cluster of acellular keratin.
Discussion: This is an example of a teratoma with associated non-germ cell malignancy, also known as a somatic malignancy arising in a teratoma. It is seen in 3%-6% of germ cell tumors with a teratomatous component, more frequently in metastatic sites following chemotherapy for a germ cell tumor. Most common somatic malignancies arising in teratomas are: Wilms tumor; primitive neuroectodermal tumor (PNET); and rhabdomyosarcoma, where these elements sheet out occupying <4x field without intervening other germ cell elements. Also can see sheets of various patterns of carcinoma or sarcoma where the glands sheet out greater than a 4x field. Atypia in epithelium or mesenchymal elements that do not sheet out >4x field have no significance and are not even noted in the pathology report and are just part of post-pubertal type teratoma. Non germ cell malignancies arising in teratomas retain chromosomal gains in 12p seen in usual germ cell tumors. Somatic malignancy in a teratoma does not alter the prognosis if confined to the testis. When a non-germ cell malignancy arises in a metastatic teratoma the prognosis is markedly worsened. Chemotherapy protocol specific to its somatic lineage is often used, although it is controversial whether it is superior to germ cell therapy. Best chance for cure is if the metastases are surgically resectable.
Incorrect
Answer: C
Histological Description: The tumor consists of nodules of atypical cartilage, some with necrosis. In areas, the cartilage nodules occupy areas of a 4x field without intervening other germ cell components. In addition to the embryonal carcinoma, there is a single cluster of acellular keratin.
Discussion: This is an example of a teratoma with associated non-germ cell malignancy, also known as a somatic malignancy arising in a teratoma. It is seen in 3%-6% of germ cell tumors with a teratomatous component, more frequently in metastatic sites following chemotherapy for a germ cell tumor. Most common somatic malignancies arising in teratomas are: Wilms tumor; primitive neuroectodermal tumor (PNET); and rhabdomyosarcoma, where these elements sheet out occupying <4x field without intervening other germ cell elements. Also can see sheets of various patterns of carcinoma or sarcoma where the glands sheet out greater than a 4x field. Atypia in epithelium or mesenchymal elements that do not sheet out >4x field have no significance and are not even noted in the pathology report and are just part of post-pubertal type teratoma. Non germ cell malignancies arising in teratomas retain chromosomal gains in 12p seen in usual germ cell tumors. Somatic malignancy in a teratoma does not alter the prognosis if confined to the testis. When a non-germ cell malignancy arises in a metastatic teratoma the prognosis is markedly worsened. Chemotherapy protocol specific to its somatic lineage is often used, although it is controversial whether it is superior to germ cell therapy. Best chance for cure is if the metastases are surgically resectable.
