Embryonal carcinoma

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Embryonal carcinoma is a type of germ cell tumour. It is commonly as a component of mixed germ cell tumours.

Embryonal carcinoma
Diagnosis in short

Embryonal carcinoma. H&E stain.
LM vesicular nuclei, nuclear overlap, necrosis (common), mitoses, variable architecture (tubulopapillary, glandular, solid, embryoid bodies)
LM DDx seminoma, mixed germ cell tumour, yolk sac tumour, other carcinomas
IHC OCT3 +ve, CD30 +ve, AE1/AE3 +ve, CD117 -ve
Grossing notes orchiectomy grossing
Staging testicular cancer staging
Site testis, ovary, mediastinum
Signs testicular mass, pelvic mass
Prevalence pure embryonal uncommon
Clin. DDx typically other testicular tumours

General

Gross

Microscopic

Features:[3]

  1. Nucleoli - key feature.
  2. Vesicular nuclei (clear, empty appearing nuclei) - key feature.
  3. Nuclei overlap.
  4. Necrosis - common.
    • Not commonly present in seminoma.
  5. Indistinct cell borders
  6. Mitoses - common.
  7. Variable architecture:[1]
    • Solid (predominant in ~55% of cases).
    • Glandular (predominant in ~17% of cases).
    • Papillary (predominant in ~11% of cases).
    • Nested.
    • Micropapillary.
    • Anastomosing glandular.
    • Sieve-like glandular.
    • Pseudopapillary.
    • Blastocyst-like.
    • Embryoid bodies - ball of cells in surrounded by empty space on three sides.

Notes:

  • Cytoplasmic staining variable (eosinophilic to basophilic).
  • Syncytiotrophoblasts commonly seen (~40-50% of cases[1]).

DDx:

Images

  • Embryonal carcinoma - very high mag. - cropped (WC/Nephron)

  • Embryonal carcinoma - high mag. (WC/Nephron)

  • Embryonal carcinoma - high mag. (WC/Nephron)

  • Embryonal carcinoma - intermed. mag. (WC/Nephron)

  • Embryonal carcinoma - low mag. (WC/Nephron)

IHC

ISUP consensus

General panel:[4]

  • OCT4 +ve.
    • Choriocarcinoma, yolk sac tumour and spermatocytic seminoma all -ve.
  • CD30 +ve.
  • CD117 -ve.[5]

Additional notes

  • CK19 -ve.[6]
  • AE1/AE3 +ve.
  • OCT3/4 +ve.[7]
  • D2-40 -ve.[7]
    • Iczkowski et al. suggest it is useful for discriminating from seminoma. This is somewhat disputed by Lau et al.[5]
  • PLAP +ve.[8]
  • CK7 +ve/-ve (~50% have weak staining).[9]
    • Seminoma -ve, choriocarcinoma +ve.

See also

References

  1. ↑ 1.0 1.1 1.2 Kao, CS.; Ulbright, TM.; Young, RH.; Idrees, MT. (May 2014). "Testicular embryonal carcinoma: a morphologic study of 180 cases highlighting unusual and unemphasized aspects.". Am J Surg Pathol 38 (5): 689-97. doi:10.1097/PAS.0000000000000171. PMID 24503753.
  2. ↑ Yalçın, B.; Demir, HA.; Tanyel, FC.; Akçören, Z.; Varan, A.; Akyüz, C.; Kutluk, T.; Büyükpamukçu, M. (Oct 2012). "Mediastinal germ cell tumors in childhood.". Pediatr Hematol Oncol 29 (7): 633-42. doi:10.3109/08880018.2012.713084. PMID 22877235.
  3. ↑ Zhou, Ming; Magi-Galluzzi, Cristina (2006). Genitourinary Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 549. ISBN 978-0443066771.
  4. ↑ 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.
  5. ↑ 5.0 5.1 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.
  6. ↑ Bremmer, F.; Ströbel, P.; Hubertus, H.; Strecker, J.; Gaisa, N.; Strauß, A.; Schweyer, S.; Radzun, H-J. et al. (2015). [www.diagnosticpathology.org/content/10/1/7‎Cached "CK19 is a sensitive marker for yolk sac tumours of the testis."]. Diagnostic Pathology 10 (7). doi:10.1186/s13000-015-0243-y. www.diagnosticpathology.org/content/10/1/7‎Cached.
  7. ↑ 7.0 7.1 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.
  8. ↑ Jacobsen, GK.; Nørgaard-Pedersen, B. (Sep 1984). "Placental alkaline phosphatase in testicular germ cell tumours and in carcinoma-in-situ of the testis. An immunohistochemical study.". Acta Pathol Microbiol Immunol Scand A 92 (5): 323-9. PMID 6209917.
  9. ↑ Wegman SJ, Parwani AV, Zynger DL (February 2019). "Cytokeratin 7, inhibin, and p63 in testicular germ cell tumor: superior markers of choriocarcinoma compared to β-human chorionic gonadotropin". Hum Pathol 84: 254–261. doi:10.1016/j.humpath.2018.10.007. PMID 30359635.
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