Difference between revisions of "Seminoma"
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It should ''not'' be confused with the unrelated tumour called ''[[spermatocytic seminoma]]''. | It should ''not'' be confused with the unrelated tumour called ''[[spermatocytic seminoma]]''. | ||
==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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*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=== | |||
*Arises from ''[[intratubular germ cell neoplasia]]'' (ITGCN). | *Arises from ''[[intratubular germ cell neoplasia]]'' (ITGCN). | ||
==Microsopic== | |||
Features: | Features: | ||
*Cells with fried egg appearance - '''key feature''': | *Cells with fried egg appearance - '''key feature''': | ||
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*Granulomatous orchitis - if [[granuloma]]s are present. | *Granulomatous orchitis - if [[granuloma]]s are present. | ||
===Images=== | |||
<gallery> | <gallery> | ||
Image:Seminoma_high_mag.jpg |Seminoma - high mag. (WC/Nephron) | Image:Seminoma_high_mag.jpg |Seminoma - high mag. (WC/Nephron) | ||
| Line 79: | Line 79: | ||
</gallery> | </gallery> | ||
==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> | *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> | ||
*CD117 +ve (ckit) ~92% of cases.<ref name=pmid17277761/> | *CD117 +ve (ckit) ~92% of cases.<ref name=pmid17277761/> | ||
| Line 87: | Line 87: | ||
*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> | ||
==Sign out== | |||
<pre> | <pre> | ||
RETROPERITONEAL SOFT TISSUE, RIGHT, CORE BIOPSY: | RETROPERITONEAL SOFT TISSUE, RIGHT, CORE BIOPSY: | ||
- SEMINOMA. | - SEMINOMA. | ||
</pre> | </pre> | ||
===Micro=== | |||
The sections show large atypical, discohesive cells with prominent nucleoli, central | The sections show large atypical, discohesive cells with prominent nucleoli, central | ||
nuclei and moderate clear cytoplasm, intermixed with mature lymphocytes. Mitotic | nuclei and moderate clear cytoplasm, intermixed with mature lymphocytes. Mitotic | ||
activity is present. | activity is present. | ||
===Small biopsy=== | |||
A mixed germ cell tumour cannot be excluded; given the small quantity of tumour, this | 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 | 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== | ||
Revision as of 21:26, 10 July 2013
| 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, ITGCN, mixed germ cell tumour, granulomatous orchitis |
| IHC | OCT3/4 +ve, PLAP +ve, D2-40 +ve, CD30 -ve |
| Site | testis |
|
| |
| Associated Dx | ITGCN |
| Signs | testicular mass, +/-retroperitoneal lymphadenopathy |
| Blood work | LDH elevated, beta-hCG elevated (not common) |
| 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 the unrelated tumour called spermatocytic seminoma.
General
- Male counterpart of the dysgerminoma, which arise in the ovary.
- Most common germ cell tumour of the testis.
Clinical:
- Elevated serum LDH.
- Normal serum alpha fetoprotein.
- Usually normal beta-hCG.
Note:
- Rarely, it may present a retroperitoneal mass.[1]
Epidemiology & etiology
- Arises from intratubular germ cell neoplasia (ITGCN).
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),[2] present in ~10-20% of seminoma.[3]
- Large + irregular, vesicular nuclei.
- Eosinophilic vacuolated cytoplasm (contains hCG).
- Syncytiotrophoblasts = closest to mom in normal chorionic villi - covers cytotrophoblast.[4]
- +/-Florid granulomatous reaction.
Memory device: 3 Cs - clear cytoplasm, central nucleus, corners on the nuclear membrane.
DDx:
- Embryonal carcinoma.
- Solid variant of yolk sac tumour.
- Lacks fibrous septae and lymphocytes.[5]
- Mixed germ cell tumour.
- Choriocarcinoma - esp. if (multinucleated) syncytiotrophoblasts are present.[6]
- Granulomatous orchitis - if granulomas are present.
Images
Seminoma - high mag. (WC/Nephron)
Seminoma - intermed. mag. (WC/Nephron)
Seminoma in the rete testis. (WC/Nephron)
Seminoma with syncytiotrophoblasts - intermed. mag. (WC/Nephron)
Seminoma with syncytiotrophoblasts - very high mag. (WC/Nephron)
IHC
- D2-40 +ve ~100% of cases.[7]
- CD117 +ve (ckit) ~92% of cases.[7]
- CD30 -ve.[8]
- Done to r/o embryonal carcinoma.
- Cytokeratins usu. -ve, may have weak focal positivity.[8]
- OCT3/4 +ve.[9]
Sign out
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
- ↑ 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.
- ↑ 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.
- ↑ URL: http://www.webpathology.com/image.asp?case=31&n=10. Accessed on: 22 May 2012.
- ↑ URL: http://upload.wikimedia.org/wikipedia/commons/4/45/Gray37.png. Accessed on: 31 May 2010.
- ↑ URL: http://webpathology.com/image.asp?case=34&n=8. Accessed on: March 8, 2010.
- ↑ 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.
- ↑ 7.0 7.1 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.
- ↑ 8.0 8.1 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.
- ↑ 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.
