Difference between revisions of "Germ cell neoplasia in situ"
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| Caption = GCNIS (left of image). [[H&E stain]]. | | Caption = GCNIS (left of image). [[H&E stain]]. | ||
| Synonyms = | | Synonyms = intratubular germ cell neoplasia (old term) | ||
| Micro = "large" round or polygonal nuclei, prominent nucleoli, clear cytoplasm, +/-cells (completely) fill the tubule | | Micro = "large" round or polygonal nuclei, prominent nucleoli, clear cytoplasm, +/-cells (completely) fill the tubule | ||
| Subtypes = undifferentiated, differentiated (intratubular seminoma, intratubular | | Subtypes = undifferentiated, differentiated (intratubular seminoma, intratubular non-seminoma) | ||
| LMDDx = [[seminoma]], [[embryonal carcinoma]], Sertoli cell-only syndrome | | LMDDx = [[seminoma]], [[embryonal carcinoma]], Sertoli cell-only syndrome, [[mixed germ cell tumour]] | ||
| Stains = | | Stains = | ||
| IHC = OCT4, PLAP +ve, D2-40 +ve | | IHC = OCT4, PLAP +ve, D2-40 +ve | ||
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*[[Seminoma]] - especially intratubular predominant growth pattern. | *[[Seminoma]] - especially intratubular predominant growth pattern. | ||
*[[Embryonal carcinoma]]. | *[[Embryonal carcinoma]]. | ||
*[[Mixed germ cell tumour]]. | |||
===Images=== | ===Images=== | ||
Latest revision as of 04:41, 22 March 2016
| Germ cell neoplasia in situ | |
|---|---|
| Diagnosis in short | |
 GCNIS (left of image). H&E stain. | |
|
| |
| Synonyms | intratubular germ cell neoplasia (old term) |
|
| |
| LM | "large" round or polygonal nuclei, prominent nucleoli, clear cytoplasm, +/-cells (completely) fill the tubule |
| Subtypes | undifferentiated, differentiated (intratubular seminoma, intratubular non-seminoma) |
| LM DDx | seminoma, embryonal carcinoma, Sertoli cell-only syndrome, mixed germ cell tumour |
| IHC | OCT4, PLAP +ve, D2-40 +ve |
| Site | testis |
|
| |
| Prognosis | premalignant |
| Treatment | radiotherapy (?) |
Germ cell neoplasia in situ, abbreviated GCNIS, is a premalignant lesion of the testis.
It was previously known previously known as intratubular germ cell neoplasia (abbreviated ITGCN) and testicular intraepithelial neoplasia.[1][2]
General
- Considered the precursor lesion for germ cell tumours.
- Not all germ cell tumours (GCTs) arise from intratubular germ cell neoplasia.
The following testicular GCTs do not arise from GCNIS:
- Spermatocytic tumour.[3]
- Yolk sac tumours (endodermal sinus tumour).[4]
- Teratoma.[citation needed]
Classification:[5]
- Undifferentiated GCNIS.
- Differentiated GCNIS.[6]
- Intratubular seminoma.
- Intratubular non-seminoma.
Treatment:
- Radiotherapy.[1]
Microscopic
- "Large" round or polygonal nuclei.
- Size in relation to normal often not defined.
- Rakheja et al. say >= 5x a lymphocyte for intratubular embryonal carcinoma.[5]
- Polygonal nuclei = squared-off nuclear membrane.
- Size in relation to normal often not defined.
- Prominent nucleoli - key feature.
- Clear cytoplasm - important.
- +/-Cells fill the tubule.
Note:
- Sertoli cells may have a nucleolus... but they have eosinophilic ctyoplasm.[citation needed]
DDx:
- Sertoli cell-only syndrome - Sertoli cells also have nucleoli, wind swept appearance.[9]
- Seminoma - especially intratubular predominant growth pattern.
- Embryonal carcinoma.
- Mixed germ cell tumour.
Images
Case 1
GCNIS (ITGCN) - intermed. mag.
GCNIS (ITGCN) - high mag.
GCNIS (ITGCN) - very high mag.
GCNIS (ITGCN) - very high mag.
Case 2
GCNIS (ITGCN) - cropped. (WC/Nephron)
GCNIS (ITGCN). (WC/Nephron)
Case 3
GCNIS (ITGCN) & SCO - intermed. mag.
GCNIS (ITGCN) & SCO - high mag.
GCNIS (ITGCN) & SCO - intermed. mag.
GCNIS (ITGCN) & SCO - high mag.
GCNIS (ITGCN) & SCO - very high mag.
www
IHC
ISUP consensus
GCNIS (ITGCN) versus atypical intratubular germ cells:[10]
- OCT4 +ve.
Alternates:
Others
- CD117 +ve.
- Disputed: doesn't differentiate neoplastic from non-neoplastic according to Biermann et al.[12]
- OCT3/4 +ve.
See also
References
- ↑ 1.0 1.1 Dieckmann, KP.; Wilken, S.; Loy, V.; Matthies, C.; Kleinschmidt, K.; Bedke, J.; Martinschek, A.; Souchon, R. et al. (May 2013). "Treatment of testicular intraepithelial neoplasia (intratubular germ cell neoplasia unspecified) with local radiotherapy or with platinum-based chemotherapy: a survey of the German Testicular Cancer Study Group.". Ann Oncol 24 (5): 1332-7. doi:10.1093/annonc/mds628. PMID 23293116.
- ↑ Berney, DM.; Looijenga, L.; Idrees, M.; Oosterhuis, JW.; Rajpert-De Meyts, E.; Ulbright, TM.; Skakkebaek, NE. (Feb 2016). "Germ Cell Neoplasia In Situ (GCNIS). Evolution of the Current Nomenclature for Testicular Pre-invasive Germ Cell Malignancy.". Histopathology. doi:10.1111/his.12958. PMID 26918959.
- ↑ Müller J, Skakkebaek NE, Parkinson MC (February 1987). "The spermatocytic seminoma: views on pathogenesis". Int. J. Androl. 10 (1): 147–56. PMID 3583416.
- ↑ Manivel JC, Simonton S, Wold LE, Dehner LP (June 1988). "Absence of intratubular germ cell neoplasia in testicular yolk sac tumors in children. A histochemical and immunohistochemical study". Arch. Pathol. Lab. Med. 112 (6): 641–5. PMID 2837162.
- ↑ 5.0 5.1 5.2 Rakheja, D.; Hoang, MP.; Sharma, S.; Albores-Saavedra, J. (Apr 2002). "Intratubular embryonal carcinoma.". Arch Pathol Lab Med 126 (4): 487-90. doi:10.1043/0003-9985(2002)1260487:IEC2.0.CO;2. PMID 11900581. http://www.archivesofpathology.org/doi/full/10.1043/0003-9985(2002)126%3C0487:IEC%3E2.0.CO;2.
- ↑ Lau, SK.; Weiss, LM.; Chu, PG. (Jul 2007). "Association of intratubular seminoma and intratubular embryonal carcinoma with invasive testicular germ cell tumors.". Am J Surg Pathol 31 (7): 1045-9. doi:10.1097/PAS.0b013e31802b8712. PMID 17592271.
- ↑ URL: http://www.webpathology.com/image.asp?case=30&n=1. Accessed on: 18 May 2010.
- ↑ Gondos, B.; Migliozzi, JA. (Nov 1987). "Intratubular germ cell neoplasia.". Semin Diagn Pathol 4 (4): 292-303. PMID 3328244.
- ↑ URL: http://www.webpathology.com/image.asp?n=3&Case=28. Accessed on: 25 March 2013.
- ↑ 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.
- ↑ Schreiber, L.; Lifschitz-Mercer, B.; Paz, G.; Yavetz, H.; Elliott, DJ.; Kula, K.; Slowikowska-Hilczer, J.; Maymon, BB. (Jan 2003). "Double immunolabeling by the RBM and the PLAP markers for identifying intratubular (in situ) germ cell neoplasia of the testis.". Int J Surg Pathol 11 (1): 17-20. PMID 12598912.
- ↑ Biermann, K.; Stoop, H.; Looijenga, L. (May 2012). "c-KIT protein expression does not discriminate neoplastic from non-neoplastic intratubular germ cells.". Histopathology 60 (6): 1017-9. doi:10.1111/j.1365-2559.2011.04157.x. PMID 22340755.