Seminoma

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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 the unrelated tumour called 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.
    • Choriocarcinoma, yolk sac tumour and spermatocytic seminoma all -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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