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Difference between revisions of "Germ cell tumours"
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[[Image:Mixed_Germ_Cell_Tumor_of_Testis_(3260625567).jpg|thumb|right|Testicular [[mixed germ cell tumour]]. (WC/euthman)]] | |||
This article covers '''germ cell tumours''', often abbreviated [[GCT]], which classically arise in the gonads ([[ovary]], [[testis]]). They are also found in the midline and make appearances in [[neuropathology]] (e.g. [[pineal gland]]) and in the [[mediastinum]]. | This article covers '''germ cell tumours''', often abbreviated [[GCT]], which classically arise in the gonads ([[ovary]], [[testis]]). They are also found in the midline and make appearances in [[neuropathology]] (e.g. [[pineal gland]]) and in the [[mediastinum]]. | ||
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===Grossing=== | ===Grossing=== | ||
*1 cm | {{Main|Orchiectomy}} | ||
*1 cm<sup>2</sup> of tumour per cm of maximal tumour dimension - guideline for testicular cancer.<ref>URL: [http://www.uroweb.org/gls/pdf/10_Testicular_Cancer.pdf http://www.uroweb.org/gls/pdf/10_Testicular_Cancer.pdf]. Accessed on: 30 October 2012.</ref> | |||
===IHC for GCTs=== | ===IHC for GCTs=== | ||
ABCDs of GCTs | ====ISUP==== | ||
An algorithmic approach based on the ISUP consensus paper by Ulbright ''et al.'':<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> | |||
{{familytree/start}} | |||
{{familytree | | | | | | | | | | | | | A01 | | | | | | | | | | | | | | | | | | |A01=[[Germ cell tumours]]}} | |||
{{familytree | | | | | |,|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|.| | | | | | | | | | | |}} | |||
{{familytree | | | | | B01 | | | | | | | | | | | | | | B02 | | | | | | | | | | |B01=OCT4 +ve | B02=OCT4 -ve}} | |||
{{familytree | |,|-|-|-|^|-|-|-|.| | | | | |,|-|-|-|-|-|+|-|-|-|-|-|.| | | | | |}} | |||
{{familytree | C01 | | | | | | C02 | | | | C03 | | | | C04 | | | | C05 | | | | |C01=CD117 +ve<br>CD30 -ve |C02= CD117 -ve<br>CD30 +ve|C03=[[Glypican 3]] +ve<br>AFP +ve<br>beta-hCG -ve|C04=Glypican 3 ?<br>AFP -ve<br>beta-hCG +ve|C05=Glypican 3 -ve<br>AFP -ve<br>beta-hCG -ve}} | |||
{{familytree | |!| | | | | | | |!| | | | | |!| | | | | |!| | | | | |!| | | | | |}} | |||
{{familytree | D01 | | | | | | D02 | | | | D03 | | | | D04 | | | | D05 | | | | |D01=[[Seminoma]]|D02=[[Embryonal carcinoma]]|D03=[[Yolk sac tumour]]|D04=[[Choriocarcinoma]] |D05= [[Spermatocytic seminoma]] }} | |||
{{familytree/end}} | |||
====ABCDs of GCTs==== | |||
*AFP - yolk sac tumour. | *AFP - yolk sac tumour. | ||
*Beta-hCG - choriocarcinoma. | *Beta-hCG - choriocarcinoma. | ||
*CD30 - embryonal carcinoma. | *CD30 - embryonal carcinoma. | ||
*D2-40 - seminoma. | *D2-40 - seminoma. | ||
====GCT versus sex cord-stromal tumour==== | |||
The ISUP recommends:<ref name=pmid25025364>{{cite journal |author=Amin MB, Epstein JI, Ulbright TM, ''et al.'' |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 |year=2014 |month=August |pmid=25025364 |doi=10.1097/PAS.0000000000000254 |url=}}</ref> | |||
*[[SALL4]] +ve (in GCTs).<ref name=pmid24525512>{{cite journal |author=Miettinen M, Wang Z, McCue PA, ''et al.'' |title=SALL4 expression in germ cell and non-germ cell tumors: a systematic immunohistochemical study of 3215 cases |journal=Am. J. Surg. Pathol. |volume=38 |issue=3 |pages=410–20 |year=2014 |month=March |pmid=24525512 |doi=10.1097/PAS.0000000000000116 |url=}}</ref> | |||
*Alpha-inhibin -ve (+ve in [[SCST]]). | |||
*Calretinin -ve (+ve in SCST). | |||
Alternates for SALL4 are:<ref name=pmid25025364/> | |||
*OCT4 and GPC3. | |||
===Tabular summary of GCTs=== | ===Tabular summary of GCTs=== | ||
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! Image | ! Image | ||
|- | |- | ||
| [[ | | [[Germ cell neoplasia in situ]] (GCNIS) | ||
| nests of small fried egg cells | | nests of small fried egg cells | ||
| large central nucleus, clear <br>cytoplasm, squared-off nuclear membrane, nucleoli<ref name=Ref_GUP538>{{Ref GUP|538}}</ref> | | large central nucleus, clear <br>cytoplasm, squared-off nuclear membrane, nucleoli<ref name=Ref_GUP538>{{Ref GUP|538}}</ref> | ||
| CD117 | | CD117 +ve, CD30 -ve | ||
| appearance similar to [[seminoma]] | | appearance similar to [[seminoma]] | ||
| [[Image:Intratubular_germ_cell_neoplasia_high_mag_cropped.jpg|thumb|center|150px| | | [[Image:Intratubular_germ_cell_neoplasia_high_mag_cropped.jpg|thumb|center|150px|GCNIS (WC/Nephron)]] | ||
|- | |- | ||
| [[Germinoma]] / [[Seminoma]] / [[Dysgerminoma]] | | [[Germinoma]] / [[Seminoma]] / [[Dysgerminoma]] | ||
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| Schiller-Duval bodies | | Schiller-Duval bodies | ||
| Schiller-Duval b. = central blood vessel surrounded by epithelial-like cells a space and more epithelial-like cells, variable arch. | | Schiller-Duval b. = central blood vessel surrounded by epithelial-like cells a space and more epithelial-like cells, variable arch. | ||
| AFP | | [[AFP]] +ve, [[Glypican 3]] +ve | ||
| patterns: microcystic, solid, hepatoid | | patterns: microcystic, solid, hepatoid | ||
| [[Image:Mixed_germ_cell_tumour_-_very_high_mag.jpg|thumb|center|150px|Yolk sac tumour (WC)]] | | [[Image:Mixed_germ_cell_tumour_-_very_high_mag.jpg|thumb|center|150px|Yolk sac tumour (WC)]] | ||
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| prominent nucleoli, vescicular nuclei | | prominent nucleoli, vescicular nuclei | ||
| var. arch.: tubulopapillary, glandular, solid, embryoid bodies (ball of cells in surrounded by empty space on three sides), +/-nuclear overlap, mitoses common | | var. arch.: tubulopapillary, glandular, solid, embryoid bodies (ball of cells in surrounded by empty space on three sides), +/-nuclear overlap, mitoses common | ||
| CD30 | | CD30 +ve, CD117 -ve | ||
| usu. part of a mixed GCT | | usu. part of a mixed GCT | ||
| [[Image:Embryonal_carcinoma_high_mag.jpg|thumb|center|150px|Embryonal carcinoma (WC/Nephron)]] | | [[Image:Embryonal_carcinoma_high_mag.jpg|thumb|center|150px|Embryonal carcinoma (WC/Nephron)]] | ||
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| clear cytoplasm | | clear cytoplasm | ||
| cells with abundant clear cytoplasm and eccentric atypical nuclei (cytotrophoblast), very large (multinucleated) cells with abundant eosinophilic cytoplasm and extreme nuclear atypia (syncytiotrophoblast) | | cells with abundant clear cytoplasm and eccentric atypical nuclei (cytotrophoblast), very large (multinucleated) cells with abundant eosinophilic cytoplasm and extreme nuclear atypia (syncytiotrophoblast) | ||
| beta-hCG | | beta-hCG +ve | ||
| may be preceded by a [[complete mole|complete hydatidiform mole]] | | may be preceded by a [[complete mole|complete hydatidiform mole]] | ||
| [[Image:Choriocarcinoma_-2-_very_high_mag.jpg|thumb|center|150px|Choriocarcinoma. (WC/Nephron)]] | | [[Image:Choriocarcinoma_-2-_very_high_mag.jpg|thumb|center|150px|Choriocarcinoma. (WC/Nephron)]] | ||
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===Molecular pathology=== | ===Molecular pathology=== | ||
Most common cytogenetic abnormality in GCTs: | Most common cytogenetic abnormality in GCTs: | ||
* Isochromosome | *[[Isochromosome 12p]].<ref name=pmid10357096>{{Cite journal | last1 = Looijenga | first1 = LH. | last2 = Oosterhuis | first2 = JW. | title = Pathogenesis of testicular germ cell tumours. | journal = Rev Reprod | volume = 4 | issue = 2 | pages = 90-100 | month = May | year = 1999 | doi = | PMID = 10357096 }}</ref> | ||
** Isochromosome = one arm (p or q) is lost and replaced with a duplicate of the remaining one. | ** Isochromosome = one arm (p or q) is lost and replaced with a duplicate of the remaining one. | ||
***Example: isochromosome | ***Example: isochromosome 12p = chromosome 12 where q is lost and two p arms are present.<ref>URL: [http://ghr.nlm.nih.gov/handbook/illustrations/isochromosomes http://ghr.nlm.nih.gov/handbook/illustrations/isochromosomes]. Accessed on: 15 February 2012.</ref> | ||
==Germinoma== | ==Germinoma== | ||
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Image: [http://path.upmc.edu/cases/case525/images/fig02a.jpg Germinoma (upmc.edu)].<ref>URL: [http://path.upmc.edu/cases/case525.html http://path.upmc.edu/cases/case525.html]. Accessed on: 25 January 2012.</ref> | Image: [http://path.upmc.edu/cases/case525/images/fig02a.jpg Germinoma (upmc.edu)].<ref>URL: [http://path.upmc.edu/cases/case525.html http://path.upmc.edu/cases/case525.html]. Accessed on: 25 January 2012.</ref> | ||
<gallery> | |||
Image:Neuropathology_case_VIII_01.jpg | Germinoma of the brain, low mag. (WC/jensflorian) | |||
Image:Neuropathology_case_VIII_02.jpg | Germinoma intermed. mag. (WC/jensflorian) | |||
Image:Neuropathology_case_VIII_03.jpg | Germinoma very high. mag. (WC/jensflorian) | |||
Image:Neuropathology_case_VIII_05.jpg | Germinoma Oct3/4 staining (WC/jensflorian) | |||
</gallery> | |||
===Seminoma=== | ===Seminoma=== | ||
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==Gonadoblastoma== | ==Gonadoblastoma== | ||
{{Main|Gonadoblastoma}} | |||
==Polyembryoma== | ==Polyembryoma== | ||
{{Main|Polyembryoma}} | |||
==Mixed germ cell tumour== | ==Mixed germ cell tumour== | ||
{{Main|Mixed germ cell tumour}} | |||
==See also== | ==See also== | ||
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*[[Ovarian tumours]]. | *[[Ovarian tumours]]. | ||
*[[Trophoblast]]. | *[[Trophoblast]]. | ||
*[[Sex cord-stromal tumours]]. | |||
==References== | ==References== | ||