Mixed germ cell tumour

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Mixed germ cell tumour
Diagnosis in short

Mixed germ cell tumour. H&E stain.

LM depends on the components
LM DDx other germ cell tumours
IHC variable
Site ovary, testis, mediastinum, other

Signs mass lesion
Prevalence most common germ cell tumour
Blood work +/-AFP elevated, +/-beta-hCG elevated, +/-LDH elevated
Prognosis worse than seminoma/dysgerminoma
Clin. DDx gonads: germ cell tumours, other tumours

Mixed germ cell tumour, abbreviated MGCT, is a lesion composed of different germ cell tumours. Most germ cell tumours are mixed.

General

  • 60% of GCTs are mixed. †

Common combinations:

  1. Teratoma + embryonal carcinoma + endodermal sinus tumour (yolk sac tumour) (TEE).
  2. Seminoma + embryonal (SE).
  3. Teratoma + embryonal +(TE).

Memory device: TEE + all combinations have embryonal carcinoma.

Note:

  • † Numbers vary between sources. One series suggests it is almost 70%.[1]
  • There has been in increase in MGCTs over the past 20 years that is probably due to changes how in how GCTs are classified.[2]

Microscopic

Features:

  • Depends on components.

Notes:

  • If one cannot identify the component... it is probably yolk sac as this has so many different patterns.

Images

www:

IHC

  • Beta-hCG +ve - if syncytiotrophoblasts are present.
  • AFP +ve - a yolk sac tumour component is present.
  • GFAP +ve - if neuroepithelium is present.

A panel:

  • PLAP.
  • CD30 +ve -- embryonal carcinoma.
  • CD117 +ve -- seminoma.
  • D2-40 +ve -- seminoma, useful for LVI.
  • Pankeratin +ve -- embryonal carcinoma.
  • CEA-M.
  • EMA +ve -- metastatic carcinoma.[3]
  • Vimentin.
  • AFP +ve -- yolk sac tumour.
  • A1A +ve -- yolk sac tumour.

Sign out

TESTIS, RIGHT, ORCHIECTOMY:
- MIXED GERM CELL TUMOUR, pT1 pNx:
-- 80% OF TUMOUR TERATOMA.
-- 20% OF TUMOUR SEMINOMA.
-- PLEASE SEE TUMOUR SUMMARY.

See also

References

  1. Mosharafa, AA.; Foster, RS.; Leibovich, BC.; Ulbright, TM.; Bihrle, R.; Einhorn, LH.; Donohue, JP. (Apr 2004). "Histology in mixed germ cell tumors. Is there a favorite pairing?". J Urol 171 (4): 1471-3. doi:10.1097/01.ju.0000116841.30826.85. PMID 15017200.
  2. Trabert, B.; Stang, A.; Cook, MB.; Rusner, C.; McGlynn, KA. (Aug 2011). "Impact of classification of mixed germ-cell tumours on incidence trends of non-seminoma.". Int J Androl 34 (4 Pt 2): e274-7. doi:10.1111/j.1365-2605.2011.01187.x. PMID 21623833.
  3. Shek, TW.; Yuen, ST.; Luk, IS.; Wong, MP. (Mar 1996). "Germ cell tumour as a diagnostic pitfall of metastatic carcinoma.". J Clin Pathol 49 (3): 223-5. PMID 8675733.