Difference between revisions of "Embryonal carcinoma"

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#Indistinct cell borders
#Indistinct cell borders
#Mitoses - common.
#Mitoses - common.
#Variable architecture:
#Variable architecture:<ref name=pmid24503753>{{Cite journal  | last1 = Kao | first1 = CS. | last2 = Ulbright | first2 = TM. | last3 = Young | first3 = RH. | last4 = Idrees | first4 = MT. | title = Testicular embryonal carcinoma: a morphologic study of 180 cases highlighting unusual and unemphasized aspects. | journal = Am J Surg Pathol | volume = 38 | issue = 5 | pages = 689-97 | month = May | year = 2014 | doi = 10.1097/PAS.0000000000000171 | PMID = 24503753 }}</ref>
#*Tubulopapillary.
#*Solid (predominant in ~55% of cases).
#*Glandular.
#*Glandular (predominant in ~17% of cases).
#*Solid.  
#*Papillary (predominant in ~11% of cases).
#*Nested.
#*Micropapillary.
#*Anastomosing glandular.
#*Sieve-like glandular.
#*Pseudopapillary.
#*Blastocyst-like.
#*Embryoid bodies - ball of cells in surrounded by empty space on three sides.
#*Embryoid bodies - ball of cells in surrounded by empty space on three sides.


Notes:
Notes:
*Cytoplasmic staining variable (eosinophilic to basophilic).
*Cytoplasmic staining variable (eosinophilic to basophilic).
*[[Syncytiotrophoblasts]] commonly seen (~40-50% of cases<ref name=pmid24503753/>).


DDx:
DDx:
*[[Mixed germ cell tumour]].
*[[Mixed germ cell tumour]].
*[[Yolk sac tumour]].
*[[Yolk sac tumour]].
*[[Seminoma]].


===Images===
===Images===

Revision as of 15:48, 26 November 2014

Embryonal carcinoma
Diagnosis in short

Embryonal carcinoma. H&E stain.

LM vesicular nuclei, nuclear overlap, necrosis (common), mitoses, variable architecture (tubulopapillary, glandular, solid, embryoid bodies)
LM DDx seminoma, mixed germ cell tumour, yolk sac tumour, other carcinomas
IHC OCT3 +ve, CD30 +ve, AE1/AE3 +ve, CD117 -ve
Site testis, ovary, mediastinum

Signs testicular mass, pelvic mass

Embryonal carcinoma is a type of germ cell tumour. It is commonly as a component of mixed germ cell tumours.

General

  • Affects young adults.
    • May be seen in women.

Gross

Microscopic

Features:[2]

  1. Nucleoli - key feature.
  2. Vesicular nuclei (clear, empty appearing nuclei) - key feature.
  3. Nuclei overlap.
  4. Necrosis - common.
    • Not commonly present in seminoma.
  5. Indistinct cell borders
  6. Mitoses - common.
  7. Variable architecture:[3]
    • Solid (predominant in ~55% of cases).
    • Glandular (predominant in ~17% of cases).
    • Papillary (predominant in ~11% of cases).
    • Nested.
    • Micropapillary.
    • Anastomosing glandular.
    • Sieve-like glandular.
    • Pseudopapillary.
    • Blastocyst-like.
    • Embryoid bodies - ball of cells in surrounded by empty space on three sides.

Notes:

  • Cytoplasmic staining variable (eosinophilic to basophilic).
  • Syncytiotrophoblasts commonly seen (~40-50% of cases[3]).

DDx:

Images

IHC

ISUP consensus

General panel:[4]

  • OCT4 +ve.
    • Choriocarcinoma, yolk sac tumour and spermatocytic seminoma all -ve.
  • CD30 +ve.
  • CD117 -ve.[5]

Additional notes

  • AE1/AE3 +ve.
  • OCT3/4 +ve.[6]
  • D2-40 -ve.[6]
    • Iczkowski et al. suggest it is useful for discriminating from seminoma. This is somewhat disputed by Lau et al.[5]
  • PLAP +ve.[7]

See also

References

  1. Yalçın, B.; Demir, HA.; Tanyel, FC.; Akçören, Z.; Varan, A.; Akyüz, C.; Kutluk, T.; Büyükpamukçu, M. (Oct 2012). "Mediastinal germ cell tumors in childhood.". Pediatr Hematol Oncol 29 (7): 633-42. doi:10.3109/08880018.2012.713084. PMID 22877235.
  2. Zhou, Ming; Magi-Galluzzi, Cristina (2006). Genitourinary Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 549. ISBN 978-0443066771.
  3. 3.0 3.1 Kao, CS.; Ulbright, TM.; Young, RH.; Idrees, MT. (May 2014). "Testicular embryonal carcinoma: a morphologic study of 180 cases highlighting unusual and unemphasized aspects.". Am J Surg Pathol 38 (5): 689-97. doi:10.1097/PAS.0000000000000171. PMID 24503753.
  4. Ulbright TM, Tickoo SK, Berney DM, Srigley JR (August 2014). "Best practices recommendations in the application of immunohistochemistry in testicular tumors: report from the international society of urological pathology consensus conference". Am. J. Surg. Pathol. 38 (8): e50–9. doi:10.1097/PAS.0000000000000233. PMID 24832161.
  5. 5.0 5.1 Lau, SK.; Weiss, LM.; Chu, PG. (Mar 2007). "D2-40 immunohistochemistry in the differential diagnosis of seminoma and embryonal carcinoma: a comparative immunohistochemical study with KIT (CD117) and CD30.". Mod Pathol 20 (3): 320-5. doi:10.1038/modpathol.3800749. PMID 17277761.
  6. 6.0 6.1 Iczkowski, KA.; Butler, SL.; Shanks, JH.; Hossain, D.; Schall, A.; Meiers, I.; Zhou, M.; Torkko, KC. et al. (Feb 2008). "Trials of new germ cell immunohistochemical stains in 93 extragonadal and metastatic germ cell tumors.". Hum Pathol 39 (2): 275-81. doi:10.1016/j.humpath.2007.07.002. PMID 18045648.
  7. Jacobsen, GK.; Nørgaard-Pedersen, B. (Sep 1984). "Placental alkaline phosphatase in testicular germ cell tumours and in carcinoma-in-situ of the testis. An immunohistochemical study.". Acta Pathol Microbiol Immunol Scand A 92 (5): 323-9. PMID 6209917.