Difference between revisions of "Seminoma"

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| Micro      = fried egg-like cells (clear or eosinophilic cytoplasm, central nucleus), lymphocytic infiltrate (common), +/-[[syncytiotrophoblast]]s (rare), +/-granulomas (uncommon)
| Micro      = fried egg-like cells (clear or eosinophilic cytoplasm, central nucleus), lymphocytic infiltrate (common), +/-[[syncytiotrophoblast]]s (rare), +/-granulomas (uncommon)
| Subtypes  =
| Subtypes  =
| LMDDx      = [[embryonal carcinoma]], [[ITGCN]], [[mixed germ cell tumour]], granulomatous orchitis  
| LMDDx      = [[embryonal carcinoma]], [[GCNIS]], [[mixed germ cell tumour]], [[granulomatous orchitis]], [[testicular scar]], [[atrophic testis]]
| Stains    =
| Stains    =
| IHC        = OCT3/4 +ve, PLAP +ve, D2-40 +ve, CD30 -ve
| IHC        = OCT4 +ve, [[CD117]] +ve, CD30 -ve
| EM        =
| EM        =
| Molecular  =
| Molecular  =
| IF        =
| IF        =
| Gross      =
| Gross      = solid, white/tan
| Grossing  =
| Grossing  = [[orchiectomy grossing]]
| Staging    = [[testicular cancer staging]]
| Site      = [[testis]]
| Site      = [[testis]]
| Assdx      = [[ITGCN]]
| Assdx      = [[GCNIS]]
| Syndromes  =
| Syndromes  =
| Clinicalhx =
| Clinicalhx =
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| Symptoms  =
| Symptoms  =
| Prevalence =
| Prevalence =
| Bloodwork  = +/-beta-hCG elevated
| Bloodwork  = LDH elevated, beta-hCG normal or slightly elevated
| Rads      =
| Rads      =
| Endoscopy  =
| Endoscopy  =
| Prognosis  = good
| Prognosis  = good
| Other      =
| Other      =
| ClinDDx    = other [[testis|testicular tumours]] ([[germ cell tumour]]s, [[lymphoma)
| ClinDDx    = other [[testis|testicular tumours]] ([[germ cell tumour]]s, [[lymphoma]])
| Tx        =
}}
}}
'''Seminoma''' is a common [[testis|testicular]] [[germ cell tumour]].
'''Seminoma''' is a common [[testis|testicular]] [[germ cell tumour]].


It should ''not'' be confused with the unrelated tumour called ''[[spermatocytic seminoma]]''.
It should ''not'' be confused with ''[[spermatocytic tumour]]'' (previously known as ''spermatocytic seminoma'').


===General===
==General==
*Male counterpart of the [[dysgerminoma]], which arise in the [[ovary]].
*Male counterpart of the [[dysgerminoma]], which arise in the [[ovary]].
*Most common [[germ cell tumour]] of the testis.
*Most common [[germ cell tumour]] of the testis.
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*Elevated serum LDH.
*Elevated serum LDH.
*Normal serum alpha fetoprotein.  
*Normal serum alpha fetoprotein.  
*Usually normal beta-hCG.
*Usually normal beta-hCG ''or'' slightly elevated.<ref name=pmid9311009>{{cite journal |authors=Hori K, Uematsu K, Yasoshima H, Yamada A, Sakurai K, Ohya M |title=Testicular seminoma with human chorionic gonadotropin production |journal=Pathol Int |volume=47 |issue=9 |pages=592–9 |date=September 1997 |pmid=9311009 |doi=10.1111/j.1440-1827.1997.tb04547.x |url=}}</ref>


Note:
Note:
*Rarely, it may present a retroperitoneal mass.<ref name=pmid21424055>{{Cite journal  | last1 = Preda | first1 = O. | last2 = Nicolae | first2 = A. | last3 = Loghin | first3 = A. | last4 = Borda | first4 = A. | last5 = Nogales | first5 = FF. | title = Retroperitoneal seminoma as a first manifestation of a partially regressed (burnt-out) testicular germ cell tumor. | journal = Rom J Morphol Embryol | volume = 52 | issue = 1 | pages = 193-6 | month =  | year = 2011 | doi =  | PMID = 21424055 }}</ref>
*Rarely, it may present a retroperitoneal mass.<ref name=pmid21424055>{{Cite journal  | last1 = Preda | first1 = O. | last2 = Nicolae | first2 = A. | last3 = Loghin | first3 = A. | last4 = Borda | first4 = A. | last5 = Nogales | first5 = FF. | title = Retroperitoneal seminoma as a first manifestation of a partially regressed (burnt-out) testicular germ cell tumor. | journal = Rom J Morphol Embryol | volume = 52 | issue = 1 | pages = 193-6 | month =  | year = 2011 | doi =  | PMID = 21424055 }}</ref>


====Epidemiology & etiology====
===Epidemiology & etiology===
*Arises from ''[[intratubular germ cell neoplasia]]'' (ITGCN).
*Arises from ''[[germ cell neoplasia in situ]]'', abbreviated ''GCNIS'' (previously known as ''intratubular germ cell neoplasia'').


===Microsopic===
==Gross==
*Solid, white/tan.
 
<gallery>
Image:Seminoma_of_the_Testis.jpg|Seminoma (WC/Ed Uthman).
</gallery>
==Microsopic==
Features:
Features:
*Cells with fried egg appearance - '''key feature''':
*Cells with fried egg appearance - '''key feature''':
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*+/-Lymphoctyes - interspersed (very common).
*+/-Lymphoctyes - interspersed (very common).
*+/-[[Syncytiotrophoblast]]s, [[AKA]] ''syncytiotrophoblastic giant cells'' (STGCs),<ref name=Ref_GUP542>{{Ref GUP|542}}</ref> present in ~10-20% of seminoma.<ref>URL: [http://www.webpathology.com/image.asp?case=31&n=10 http://www.webpathology.com/image.asp?case=31&n=10]. Accessed on: 22 May 2012.</ref>
*+/-[[Syncytiotrophoblast]]s, [[AKA]] ''syncytiotrophoblastic giant cells'' (STGCs),<ref name=Ref_GUP542>{{Ref GUP|542}}</ref> present in ~10-20% of seminoma.<ref>URL: [http://www.webpathology.com/image.asp?case=31&n=10 http://www.webpathology.com/image.asp?case=31&n=10]. Accessed on: 22 May 2012.</ref>
**Large + irregular, vesicular nuclei.  
**Large + irregular, [[vesicular nuclei]].  
**Eosinophilic vacuolated cytoplasm (contains hCG).
**Eosinophilic vacuolated cytoplasm (contains hCG).
***Syncytiotrophoblasts = closest to mom in normal [[chorionic villi]] - covers cytotrophoblast.<ref>URL: [http://upload.wikimedia.org/wikipedia/commons/4/45/Gray37.png http://upload.wikimedia.org/wikipedia/commons/4/45/Gray37.png]. Accessed on: 31 May 2010.</ref>
***Syncytiotrophoblasts = closest to mom in normal [[chorionic villi]] - covers cytotrophoblast.<ref>URL: [http://upload.wikimedia.org/wikipedia/commons/4/45/Gray37.png http://upload.wikimedia.org/wikipedia/commons/4/45/Gray37.png]. Accessed on: 31 May 2010.</ref>
*+/-Florid granulomatous reaction.
*+/-Florid granulomatous reaction.


Memory device: 3 Cs - clear cytoplasm, central nucleus, corners on the nuclear membrane.
Notes:
*Memory device: 3 Cs - clear cytoplasm, central nucleus, corners on the nuclear membrane.
*Approximately 24% of Stage I seminomas have [[lymphovascular invasion]].<ref name=pmid23275274>{{Cite journal  | last1 = Soper | first1 = MS. | last2 = Hastings | first2 = JR. | last3 = Cosmatos | first3 = HA. | last4 = Slezak | first4 = JM. | last5 = Wang | first5 = R. | last6 = Lodin | first6 = K. | title = Observation versus adjuvant radiation or chemotherapy in the management of stage I seminoma: clinical outcomes and prognostic factors for relapse in a large US cohort. | journal = Am J Clin Oncol | volume = 37 | issue = 4 | pages = 356-9 | month = Aug | year = 2014 | doi = 10.1097/COC.0b013e318277d839 | PMID = 23275274 }}</ref>
**Stage I = Tx N0 M0.<ref>URL: [http://emedicine.medscape.com/article/2006777-overview http://emedicine.medscape.com/article/2006777-overview]. Accessed on: October 8, 2014.</ref>
*Intertubular seminoma may ''not'' form a discrete mass and mimic a benign testis.<ref name=pmid15316315>{{Cite journal  | last1 = Henley | first1 = JD. | last2 = Young | first2 = RH. | last3 = Wade | first3 = CL. | last4 = Ulbright | first4 = TM. | title = Seminomas with exclusive intertubular growth: a report of 12 clinically and grossly inconspicuous tumors. | journal = Am J Surg Pathol | volume = 28 | issue = 9 | pages = 1163-8 | month = Sep | year = 2004 | doi =  | PMID = 15316315 }}</ref>


DDx:
DDx:
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*[[Mixed germ cell tumour]].
*[[Mixed germ cell tumour]].
*[[Choriocarcinoma]] - esp. if (multinucleated) syncytiotrophoblasts are present.<ref name=pmid157614>{{Cite journal  | last1 = Hedinger | first1 = C. | last2 = von Hochstetter | first2 = AR. | last3 = Egloff | first3 = B. | title = Seminoma with syncytiotrophoblastic giant cells. A special form of seminoma. | journal = Virchows Arch A Pathol Anat Histol | volume = 383 | issue = 1 | pages = 59-67 | month = Jul | year = 1979 | doi =  | PMID = 157614 }}</ref>
*[[Choriocarcinoma]] - esp. if (multinucleated) syncytiotrophoblasts are present.<ref name=pmid157614>{{Cite journal  | last1 = Hedinger | first1 = C. | last2 = von Hochstetter | first2 = AR. | last3 = Egloff | first3 = B. | title = Seminoma with syncytiotrophoblastic giant cells. A special form of seminoma. | journal = Virchows Arch A Pathol Anat Histol | volume = 383 | issue = 1 | pages = 59-67 | month = Jul | year = 1979 | doi =  | PMID = 157614 }}</ref>
*Granulomatous orchitis - if [[granuloma]]s are present.
*[[Granulomatous orchitis]] - if [[granuloma]]s are present.
*[[Testicular scar]] - seminomas may regress spontaneously.
*[[Testicular atrophy]] - esp. for intertubular predominant seminoma.<ref name=pmid15316315>{{Cite journal  | last1 = Henley | first1 = JD. | last2 = Young | first2 = RH. | last3 = Wade | first3 = CL. | last4 = Ulbright | first4 = TM. | title = Seminomas with exclusive intertubular growth: a report of 12 clinically and grossly inconspicuous tumors. | journal = Am J Surg Pathol | volume = 28 | issue = 9 | pages = 1163-8 | month = Sep | year = 2004 | doi =  | PMID = 15316315 }}</ref>


====Images====
===Images===
<gallery>
<gallery>
Image:Seminoma_high_mag.jpg |Seminoma - high mag. (WC/Nephron)
Image:Seminoma_high_mag.jpg |Seminoma - high mag. (WC/Nephron)
Image:Seminoma_intermed_mag.jpg |Seminoma - intermed. mag. (WC/Nephron)
Image:Seminoma_intermed_mag.jpg |Seminoma - intermed. mag. (WC/Nephron)
Image:Rete_testis_with_seminoma.jpg |Seminoma in the rete testis. (WC/Nephron)
Image:Rete_testis_with_seminoma.jpg |Seminoma in the rete testis. (WC/Nephron)
</gallery>
====Syncytiotrophoblasts====
<gallery>
Image:Seminoma_with_syncytiotrophoblasts_-_intermed_mag.jpg |Seminoma with syncytiotrophoblasts - intermed. mag. (WC/Nephron)
Image:Seminoma_with_syncytiotrophoblasts_-_intermed_mag.jpg |Seminoma with syncytiotrophoblasts - intermed. mag. (WC/Nephron)
Image:Seminoma_with_syncytiotrophoblasts_-_very_high_mag.jpg |Seminoma with syncytiotrophoblasts - very high mag. (WC/Nephron)
Image:Seminoma_with_syncytiotrophoblasts_-_very_high_mag.jpg |Seminoma with syncytiotrophoblasts - very high mag. (WC/Nephron)  
</gallery>
====Intertubular seminoma====
<gallery>
Image: Intertubular seminoma -- very low mag.jpg | ITS - very low mag. (WC)
Image: Intertubular seminoma -- low mag.jpg | ITS - low mag. (WC)
Image: Intertubular seminoma - alt -- low mag.jpg | ITS - low mag. (WC)
Image: Intertubular seminoma -- intermed mag.jpg | ITS - intermed. mag. (WC)
Image: Intertubular seminoma -- high mag.jpg | ITS - high mag. (WC)
Image: Intertubular seminoma -- very high mag.jpg | ITS - very high mag. (WC)
</gallery>
 
====Lymph node metastasis====
<gallery>
Image: Testicular seminoma (1) nodal metastasis.jpg | Seminoma in LN. (WC/KGH)
Image: Testicular seminoma (2) nodal metastasis.jpg | Seminoma in LN. (WC/KGH)
</gallery>
====Seminoma with granulomas====
<gallery>
Image: Seminoma with granulomas -- intermed mag.jpg | Seminoma with granulomas - intermed. mag.
Image: Seminoma with granulomas -- high mag.jpg | Seminoma with granulomas - high mag.
Image: Seminoma with granulomas -- very high mag.jpg | Seminoma with granulomas - very high mag.
Image: Seminoma with granulomas --- low mag.jpg | Seminoma with granulomas - low mag.
Image: Seminoma with granulomas --- intermed mag.jpg | Seminoma with granulomas - intermed. mag.
Image: Seminoma with granulomas --- high mag.jpg | Seminoma with granulomas - high mag.
Image: Seminoma with granulomas --- very high mag.jpg | Seminoma with granulomas - very high mag.
</gallery>
</gallery>


===IHC===
==IHC==
*D2-40 +ve ~100% of cases.<ref name=pmid17277761>{{Cite journal  | last1 = Lau | first1 = SK. | last2 = Weiss | first2 = LM. | last3 = Chu | first3 = PG. | title = D2-40 immunohistochemistry in the differential diagnosis of seminoma and embryonal carcinoma: a comparative immunohistochemical study with KIT (CD117) and CD30. | journal = Mod Pathol | volume = 20 | issue = 3 | pages = 320-5 | month = Mar | year = 2007 | doi = 10.1038/modpathol.3800749 | PMID = 17277761 }}</ref>
===ISUP consensus===
A general panel:<ref name=pmid24832161>{{cite journal |author=Ulbright TM, Tickoo SK, Berney DM, Srigley JR |title=Best practices recommendations in the application of immunohistochemistry in testicular tumors: report from the international society of urological pathology consensus conference |journal=Am. J. Surg. Pathol. |volume=38 |issue=8 |pages=e50–9 |year=2014 |month=August |pmid=24832161 |doi=10.1097/PAS.0000000000000233 |url=}}</ref>
*OCT4 +ve.
**Choriocarcinoma, yolk sac tumour and [[spermatocytic tumour]] all -ve.
*CD117 +ve.
**-ve in embryonal carcinoma.
*CD30 -ve.
**+ve in embryonal carcinoma.
 
Seminoma versus choriocarcinoma:<ref name=pmid25025364>{{Cite journal  | last1 = Amin | first1 = MB. | last2 = Epstein | first2 = JI. | last3 = Ulbright | first3 = TM. | last4 = Humphrey | first4 = PA. | last5 = Egevad | first5 = L. | last6 = Montironi | first6 = R. | last7 = Grignon | first7 = D. | last8 = Trpkov | first8 = K. | last9 = Lopez-Beltran | first9 = A. | title = Best practices recommendations in the application of immunohistochemistry in urologic pathology: report from the international society of urological pathology consensus conference. | journal = Am J Surg Pathol | volume = 38 | issue = 8 | pages = 1017-22 | month = Aug | year = 2014 | doi = 10.1097/PAS.0000000000000254 | PMID = 25025364 }}</ref>
*OCT4 (uniformily) +ve.
**Choriocarcinoma = patchy staining.
 
===Additional notes===
*D2-40 +ve ~100% of cases in one series.<ref name=pmid17277761>{{Cite journal  | last1 = Lau | first1 = SK. | last2 = Weiss | first2 = LM. | last3 = Chu | first3 = PG. | title = D2-40 immunohistochemistry in the differential diagnosis of seminoma and embryonal carcinoma: a comparative immunohistochemical study with KIT (CD117) and CD30. | journal = Mod Pathol | volume = 20 | issue = 3 | pages = 320-5 | month = Mar | year = 2007 | doi = 10.1038/modpathol.3800749 | PMID = 17277761 }}</ref>
**Useful for discriminating from [[embryonal carcinoma]].<ref name=pmid18045648/>
*CD117 +ve (ckit) ~92% of cases.<ref name=pmid17277761/>
*CD117 +ve (ckit) ~92% of cases.<ref name=pmid17277761/>
*CD30 -ve.<ref name=pmid16867864>{{Cite journal  | last1 = Cossu-Rocca | first1 = P. | last2 = Jones | first2 = TD. | last3 = Roth | first3 = LM. | last4 = Eble | first4 = JN. | last5 = Zheng | first5 = W. | last6 = Karim | first6 = FW. | last7 = Cheng | first7 = L. | title = Cytokeratin and CD30 expression in dysgerminoma. | journal = Hum Pathol | volume = 37 | issue = 8 | pages = 1015-21 | month = Aug | year = 2006 | doi = 10.1016/j.humpath.2006.02.018 | PMID = 16867864 }}</ref>
*CD30 -ve.<ref name=pmid16867864>{{Cite journal  | last1 = Cossu-Rocca | first1 = P. | last2 = Jones | first2 = TD. | last3 = Roth | first3 = LM. | last4 = Eble | first4 = JN. | last5 = Zheng | first5 = W. | last6 = Karim | first6 = FW. | last7 = Cheng | first7 = L. | title = Cytokeratin and CD30 expression in dysgerminoma. | journal = Hum Pathol | volume = 37 | issue = 8 | pages = 1015-21 | month = Aug | year = 2006 | doi = 10.1016/j.humpath.2006.02.018 | PMID = 16867864 }}</ref>
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*Cytokeratins usu. -ve, may have weak focal positivity.<ref name=pmid16867864/>
*Cytokeratins usu. -ve, may have weak focal positivity.<ref name=pmid16867864/>
*OCT3/4 +ve.<ref name=pmid20438407>{{Cite journal  | last1 = Emerson | first1 = RE. | last2 = Ulbright | first2 = TM. | title = Intratubular germ cell neoplasia of the testis and its associated cancers: the use of novel biomarkers. | journal = Pathology | volume = 42 | issue = 4 | pages = 344-55 | month = Jun | year = 2010 | doi = 10.3109/00313021003767355 | PMID = 20438407 }}</ref>
*OCT3/4 +ve.<ref name=pmid20438407>{{Cite journal  | last1 = Emerson | first1 = RE. | last2 = Ulbright | first2 = TM. | title = Intratubular germ cell neoplasia of the testis and its associated cancers: the use of novel biomarkers. | journal = Pathology | volume = 42 | issue = 4 | pages = 344-55 | month = Jun | year = 2010 | doi = 10.3109/00313021003767355 | PMID = 20438407 }}</ref>
**Also +ve in embryonal carcinoma.<ref name=pmid18045648>{{Cite journal  | last1 = Iczkowski | first1 = KA. | last2 = Butler | first2 = SL. | last3 = Shanks | first3 = JH. | last4 = Hossain | first4 = D. | last5 = Schall | first5 = A. | last6 = Meiers | first6 = I. | last7 = Zhou | first7 = M. | last8 = Torkko | first8 = KC. | last9 = Kim | first9 = SJ. | title = Trials of new germ cell immunohistochemical stains in 93 extragonadal and metastatic germ cell tumors. | journal = Hum Pathol | volume = 39 | issue = 2 | pages = 275-81 | month = Feb | year = 2008 | doi = 10.1016/j.humpath.2007.07.002 | PMID = 18045648 }}</ref>
*[[PLAP]] +ve.
**Largely replaced by ''OCT4'' or ''OCT3/4'' - which is more sensitive.<ref name=pmid15725806 >{{Cite journal  | last1 = Hattab | first1 = EM. | last2 = Tu | first2 = PH. | last3 = Wilson | first3 = JD. | last4 = Cheng | first4 = L. | title = OCT4 immunohistochemistry is superior to placental alkaline phosphatase (PLAP) in the diagnosis of central nervous system germinoma. | journal = Am J Surg Pathol | volume = 29 | issue = 3 | pages = 368-71 | month = Mar | year = 2005 | doi =  | PMID = 15725806 }}</ref>


===Sign out===
==Sign out==
<pre>
Right Testicle, Radical Orchitectomy:
    - SEMINOMA (pure).
    -- Margins clear.
    -- Germ cell neoplasia in situ (intratubular germ cell neoplasia) present.
    -- Please see synoptic report.
    - Background testis consists of Sertoli cells only, NEGATIVE for spermatogenesis.
</pre>
 
<pre>
Testis, Left, Radical Orchiectomy:
    - SEMINOMA (pure).
    -- Margins clear.
    -- Please see synoptic report.
</pre>
 
===Biopsy===
<pre>
<pre>
RETROPERITONEAL SOFT TISSUE, RIGHT, CORE BIOPSY:
RETROPERITONEAL SOFT TISSUE, RIGHT, CORE BIOPSY:
- SEMINOMA.
    - SEMINOMA.
</pre>
</pre>
====Micro====
====Micro====
The sections show large atypical, discohesive cells with prominent nucleoli, central
The sections show large atypical, discohesive cells with prominent nucleoli, central
Line 101: Line 179:
biopsy is at a high risk for having undersampled other tumour components should they be
biopsy is at a high risk for having undersampled other tumour components should they be
present. Correlation with serology and consideration of re-biopsy is suggested.
present. Correlation with serology and consideration of re-biopsy is suggested.


==See also==
==See also==
Line 113: Line 190:


[[Category:Diagnosis]]
[[Category:Diagnosis]]
[[Category:Genitourinary pathology]]
[[Category:Germ cell tumours]]

Latest revision as of 19:24, 12 April 2022

Seminoma
Diagnosis in short

Seminoma. H&E stain.
LM fried egg-like cells (clear or eosinophilic cytoplasm, central nucleus), lymphocytic infiltrate (common), +/-syncytiotrophoblasts (rare), +/-granulomas (uncommon)
LM DDx embryonal carcinoma, GCNIS, mixed germ cell tumour, granulomatous orchitis, testicular scar, atrophic testis
IHC OCT4 +ve, CD117 +ve, CD30 -ve
Gross solid, white/tan
Grossing notes orchiectomy grossing
Staging testicular cancer staging
Site testis
Associated Dx GCNIS
Signs testicular mass, +/-retroperitoneal lymphadenopathy
Blood work LDH elevated, beta-hCG normal or slightly elevated
Prognosis good
Clin. DDx other testicular tumours (germ cell tumours, lymphoma)

Seminoma is a common testicular germ cell tumour.

It should not be confused with spermatocytic tumour (previously known as spermatocytic seminoma).

General

Clinical:

  • Elevated serum LDH.
  • Normal serum alpha fetoprotein.
  • Usually normal beta-hCG or slightly elevated.[1]

Note:

  • Rarely, it may present a retroperitoneal mass.[2]

Epidemiology & etiology

Gross

  • Solid, white/tan.

  • Seminoma (WC/Ed Uthman).

Microsopic

Features:

  • Cells with fried egg appearance - key feature:
    • Clear cytoplasm.
    • Central nucleus, with prominent nucleolus.
      • Nucleus may have "corners", i.e. it is not round.
  • +/-Lymphoctyes - interspersed (very common).
  • +/-Syncytiotrophoblasts, AKA syncytiotrophoblastic giant cells (STGCs),[3] present in ~10-20% of seminoma.[4]
    • Large + irregular, vesicular nuclei.
    • Eosinophilic vacuolated cytoplasm (contains hCG).
      • Syncytiotrophoblasts = closest to mom in normal chorionic villi - covers cytotrophoblast.[5]
  • +/-Florid granulomatous reaction.

Notes:

  • Memory device: 3 Cs - clear cytoplasm, central nucleus, corners on the nuclear membrane.
  • Approximately 24% of Stage I seminomas have lymphovascular invasion.[6]
    • Stage I = Tx N0 M0.[7]
  • Intertubular seminoma may not form a discrete mass and mimic a benign testis.[8]

DDx:

Images

  • Seminoma - high mag. (WC/Nephron)

  • Seminoma - intermed. mag. (WC/Nephron)

  • Seminoma in the rete testis. (WC/Nephron)

Syncytiotrophoblasts

  • Seminoma with syncytiotrophoblasts - intermed. mag. (WC/Nephron)

  • Seminoma with syncytiotrophoblasts - very high mag. (WC/Nephron)

Intertubular seminoma

  • ITS - very low mag. (WC)

  • ITS - low mag. (WC)

  • ITS - low mag. (WC)

  • ITS - intermed. mag. (WC)

  • ITS - high mag. (WC)

  • ITS - very high mag. (WC)

Lymph node metastasis

  • Seminoma in LN. (WC/KGH)

  • Seminoma in LN. (WC/KGH)

Seminoma with granulomas

  • Seminoma with granulomas - intermed. mag.

  • Seminoma with granulomas - high mag.

  • Seminoma with granulomas - very high mag.

  • Seminoma with granulomas - low mag.

  • Seminoma with granulomas - intermed. mag.

  • Seminoma with granulomas - high mag.

  • Seminoma with granulomas - very high mag.

IHC

ISUP consensus

A general panel:[11]

  • OCT4 +ve.
  • CD117 +ve.
    • -ve in embryonal carcinoma.
  • CD30 -ve.
    • +ve in embryonal carcinoma.

Seminoma versus choriocarcinoma:[12]

  • OCT4 (uniformily) +ve.
    • Choriocarcinoma = patchy staining.

Additional notes

  • D2-40 +ve ~100% of cases in one series.[13]
  • CD117 +ve (ckit) ~92% of cases.[13]
  • CD30 -ve.[15]
  • Cytokeratins usu. -ve, may have weak focal positivity.[15]
  • OCT3/4 +ve.[16]
    • Also +ve in embryonal carcinoma.[14]
  • PLAP +ve.
    • Largely replaced by OCT4 or OCT3/4 - which is more sensitive.[17]

Sign out

Right Testicle, Radical Orchitectomy:
     - SEMINOMA (pure).
     -- Margins clear.
     -- Germ cell neoplasia in situ (intratubular germ cell neoplasia) present.
     -- Please see synoptic report.
     - Background testis consists of Sertoli cells only, NEGATIVE for spermatogenesis.

Testis, Left, Radical Orchiectomy:
     - SEMINOMA (pure).
     -- Margins clear.
     -- Please see synoptic report.

Biopsy

RETROPERITONEAL SOFT TISSUE, RIGHT, CORE BIOPSY:
     - SEMINOMA.

Micro

The sections show large atypical, discohesive cells with prominent nucleoli, central nuclei and moderate clear cytoplasm, intermixed with mature lymphocytes. Mitotic activity is present.

Small biopsy

A mixed germ cell tumour cannot be excluded; given the small quantity of tumour, this biopsy is at a high risk for having undersampled other tumour components should they be present. Correlation with serology and consideration of re-biopsy is suggested.

See also

References

  1. ↑ Hori K, Uematsu K, Yasoshima H, Yamada A, Sakurai K, Ohya M (September 1997). "Testicular seminoma with human chorionic gonadotropin production". Pathol Int 47 (9): 592–9. doi:10.1111/j.1440-1827.1997.tb04547.x. PMID 9311009.
  2. ↑ Preda, O.; Nicolae, A.; Loghin, A.; Borda, A.; Nogales, FF. (2011). "Retroperitoneal seminoma as a first manifestation of a partially regressed (burnt-out) testicular germ cell tumor.". Rom J Morphol Embryol 52 (1): 193-6. PMID 21424055.
  3. ↑ Zhou, Ming; Magi-Galluzzi, Cristina (2006). Genitourinary Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 542. ISBN 978-0443066771.
  4. ↑ URL: http://www.webpathology.com/image.asp?case=31&n=10. Accessed on: 22 May 2012.
  5. ↑ URL: http://upload.wikimedia.org/wikipedia/commons/4/45/Gray37.png. Accessed on: 31 May 2010.
  6. ↑ Soper, MS.; Hastings, JR.; Cosmatos, HA.; Slezak, JM.; Wang, R.; Lodin, K. (Aug 2014). "Observation versus adjuvant radiation or chemotherapy in the management of stage I seminoma: clinical outcomes and prognostic factors for relapse in a large US cohort.". Am J Clin Oncol 37 (4): 356-9. doi:10.1097/COC.0b013e318277d839. PMID 23275274.
  7. ↑ URL: http://emedicine.medscape.com/article/2006777-overview. Accessed on: October 8, 2014.
  8. ↑ 8.0 8.1 Henley, JD.; Young, RH.; Wade, CL.; Ulbright, TM. (Sep 2004). "Seminomas with exclusive intertubular growth: a report of 12 clinically and grossly inconspicuous tumors.". Am J Surg Pathol 28 (9): 1163-8. PMID 15316315.
  9. ↑ URL: http://webpathology.com/image.asp?case=34&n=8. Accessed on: March 8, 2010.
  10. ↑ Hedinger, C.; von Hochstetter, AR.; Egloff, B. (Jul 1979). "Seminoma with syncytiotrophoblastic giant cells. A special form of seminoma.". Virchows Arch A Pathol Anat Histol 383 (1): 59-67. PMID 157614.
  11. ↑ 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.
  12. ↑ Amin, MB.; Epstein, JI.; Ulbright, TM.; Humphrey, PA.; Egevad, L.; Montironi, R.; Grignon, D.; Trpkov, K. et al. (Aug 2014). "Best practices recommendations in the application of immunohistochemistry in urologic pathology: report from the international society of urological pathology consensus conference.". Am J Surg Pathol 38 (8): 1017-22. doi:10.1097/PAS.0000000000000254. PMID 25025364.
  13. ↑ 13.0 13.1 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.
  14. ↑ 14.0 14.1 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.
  15. ↑ 15.0 15.1 Cossu-Rocca, P.; Jones, TD.; Roth, LM.; Eble, JN.; Zheng, W.; Karim, FW.; Cheng, L. (Aug 2006). "Cytokeratin and CD30 expression in dysgerminoma.". Hum Pathol 37 (8): 1015-21. doi:10.1016/j.humpath.2006.02.018. PMID 16867864.
  16. ↑ Emerson, RE.; Ulbright, TM. (Jun 2010). "Intratubular germ cell neoplasia of the testis and its associated cancers: the use of novel biomarkers.". Pathology 42 (4): 344-55. doi:10.3109/00313021003767355. PMID 20438407.
  17. ↑ Hattab, EM.; Tu, PH.; Wilson, JD.; Cheng, L. (Mar 2005). "OCT4 immunohistochemistry is superior to placental alkaline phosphatase (PLAP) in the diagnosis of central nervous system germinoma.". Am J Surg Pathol 29 (3): 368-71. PMID 15725806.
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