Mixed germ cell tumour

Mixed germ cell tumour, abbreviated MGCT, is a lesion composed of different germ cell tumours. Most germ cell tumours are mixed.

Mixed germ cell tumour
Diagnosis in short
Mixed germ cell tumour. H&E stain.
LM	depends on the components
LM DDx	other germ cell tumours
IHC	variable
Grossing notes	orchiectomy
Site	ovary, testis, mediastinum, other
Signs	mass lesion
Prevalence	most common germ cell tumour
Blood work	+/-AFP elevated, +/-beta-hCG elevated, +/-LDH elevated
Prognosis	worse than seminoma/dysgerminoma
Clin. DDx	gonads: germ cell tumours, other tumours

General

• 60% of GCTs are mixed. †

Common combinations:

1. Teratoma + embryonal carcinoma + endodermal sinus tumour (yolk sac tumour) (TEE).
2. Seminoma + embryonal (SE).
3. Teratoma + embryonal +(TE).

Memory device: TEE + all combinations have embryonal carcinoma.

Note:

• † Numbers vary between sources. One series suggests it is almost 70%.
• There has been in increase in MGCTs over the past 20 years that is probably due to changes how in how GCTs are classified.

Microscopic

Features:

• Depends on components.

Notes:

• If one cannot identify the component... it is probably yolk sac as this has so many different patterns.

Images

• 

  Mixed GCT - intermed mag. (WC/Nephron)

• 

  Mixed GCT - high mag. (WC/Nephron)

www:

• Mixed germ cell tumour - several images (upmc.edu).
• Mixed germ cell tumour - several cases (upmc.edu).

IHC

• Beta-hCG +ve - if syncytiotrophoblasts are present.
• AFP +ve - a yolk sac tumour component is present.
• GFAP +ve - if neuroepithelium is present.

A panel:

• PLAP.
• CD30 +ve -- embryonal carcinoma.
• CD117 +ve -- seminoma.
• D2-40 +ve -- seminoma, useful for LVI.
• Pankeratin +ve -- embryonal carcinoma.
• CEA-M.
• EMA +ve -- metastatic carcinoma.
• Vimentin.
• AFP +ve -- yolk sac tumour.
• A1A +ve -- yolk sac tumour.

Sign out

TESTIS, RIGHT, ORCHIECTOMY:
- MIXED GERM CELL TUMOUR, pT1 pNx:
-- 80% OF TUMOUR TERATOMA.
-- 20% OF TUMOUR SEMINOMA.
-- PLEASE SEE TUMOUR SUMMARY.

See also

• Germ cell tumours.
• Testis.
• Ovarian tumours.