Difference between revisions of "Germ cell tumours"

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Germ cell tumours (view source)

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==Teratoma==
==Teratoma==
===General===
{{Main|Teratoma}}
*May be benign or malignant.
*Are supposed to consists of all three [[germ layers]] - this is not always true.
*May be associated with sacral agenesis.<ref name=omim176450>{{OMIM|176450}}</ref>
 
Important note:
*The site of the tumour, age and sex are very important for predicting the behaviour of a teratoma:<ref>URL: [http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/GermCell_11protocol.pdf http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/GermCell_11protocol.pdf]. Accessed on: 29 April 2012.</ref>
**Immature teratomas may have a benign or malignant behaviour.
**Mature teratomas may have a benign or malignant behaviour.
 
====Classification====
#Mature.
#*Common in females.
#*Usually benign.
#*Mature component may give rise to a malignancy like elsewhere in the body.
#**Most common malignancy arising from a mature teratoma: [[squamous cell carcinoma]].
#Immature.
#*Uncommon.
#*Often malignant.
#Monodermal.
#*Rare.
#*Highly specialized.
 
===Mature teratoma===
Features - three germ cell layers (usually):<ref>{{cite book |author=Moore, Keith L.; Persaud, T.V.N.|title=The Developing Human: Clinically Oriented Embryology |publisher=Saunders |location= |year=2002 |pages= 83 |edition=7th |isbn=978-0721694122 |oclc= |doi= |accessdate=}}</ref>
#Endoderm:
#*Skin, (mature) CNS.
#Mesoderm:
#*Muscle, bone, connective tissue, blood.
#Ectoderm:
#*Internal organs.
 
Note:
*May consist of skin only - in which case it is commonly called a ''dermoid''.
 
=====Images=====
<gallery>
Image:Teratoma_2_low_mag.jpg | Mature teratoma - low mag. (WC/Nephron)
Image:Teratoma_2_high_mag.jpg | Mature teratoma - high mag. (WC/Nephron)
</gallery>
 
====Fetus in fetu====
*Grouped with ''mature teratoma'', as it is considered a well-developed mature teratoma.<ref name=pmid3045784>{{Cite journal  | last1 = Heifetz | first1 = SA. | last2 = Alrabeeah | first2 = A. | last3 = Brown | first3 = BS. | last4 = Lau | first4 = H. | title = Fetus in fetu: a fetiform teratoma. | journal = Pediatr Pathol | volume = 8 | issue = 2 | pages = 215-26 | month =  | year = 1988 | doi =  | PMID = 3045784 }}</ref><ref name=pmid17183856>{{Cite journal  | last1 = Basu | first1 = A. | last2 = Jagdish | first2 = S. | last3 = Iyengar | first3 = KR. | last4 = Basu | first4 = D. | title = Fetus in fetu or differentiated teratomas? | journal = Indian J Pathol Microbiol | volume = 49 | issue = 4 | pages = 563-5 | month = Oct | year = 2006 | doi =  | PMID = 17183856 }}</ref>
**It has been suggested they are distinct from teratomas.<ref>{{Cite journal  | last1 = Basu | first1 = A. | last2 = Jagdish | first2 = S. | last3 = Iyengar | first3 = KR. | last4 = Basu | first4 = D. | title = Fetus in fetu or differentiated teratomas? | journal = Indian J Pathol Microbiol | volume = 49 | issue = 4 | pages = 563-5 | month = Oct | year = 2006 | doi =  | PMID = 17183856 }}</ref>
***They could be thought of as a parasitic twin.
 
Features:
*Discrete mass consisting of mature tissues that form well-developed structures with the normal anatomical relations.
**Separated from teratoma by the presence of a vertebral column.<ref name=pmid17334616>{{Cite journal  | last1 = Majhi | first1 = AK. | last2 = Saha | first2 = K. | last3 = Karmakar | first3 = M. | last4 = Sinha Karmakar | first4 = K. | last5 = Sen | first5 = A. | last6 = Das | first6 = S. | title = Fetus in fetu--a mystery in medicine. | journal = ScientificWorldJournal | volume = 7 | issue =  | pages = 252-7 | month =  | year = 2007 | doi = 10.1100/tsw.2007.56 | PMID = 17334616 }}</ref>
 
===Immature teratoma===
Features:
*Immature if neural tissue is present:<ref>RS. 2 May 2010.</ref>
**Vaguely resembles pseudostratified respiratory epithelium.
*Islands of small hyperchromatic cells - "blastema".
*+/-Cartilage.
*+/-Adipocytes.
*+/-Colonic type mucosa.
*+/-Stratified squamous epithelium (skin).
 
DDx:<ref>{{Ref BITFS|34}}</ref>
*[[Cerebellum]].
*[[Retina]].
 
=====Images=====
<gallery>
Image:Immature_teratoma_high_mag.jpg | Primitive neuroepithelium - high mag. (WC/Nephron)
Image:Primitive_neuroepithelium_intermed_mag.jpg | Primitive neuroepithelium - intermed mag. (WC/Nephron)
Image:Teratoma_intermed_mag.jpg | Teratoma - mature components (WC/Nephron)
</gallery>
 
Other images:
*[http://www.webpathology.com/image.asp?n=5&Case=35 Immature teratoma - myxomatous stroma (webpathology.com)].
*[http://www.webpathology.com/image.asp?n=6&Case=35 Immature teratoma - blastema (webpathology.com)].
*[http://www.webpathology.com/image.asp?n=7&Case=35 Immature teratoma - primitive neuroepithelium (webpathology.com)].
*[http://moon.ouhsc.edu/kfung/jty1/opaq/PathQuiz/N0C001-PQ01-M.htm Immature teratoma - primitive neuroepithelium (ouhsc.edu)].
 
====Grading (immature)====
Based on quantity of immature neuroepithelium:<ref name=pmid17080330>{{cite journal |author=Harms D, Zahn S, Göbel U, Schneider DT |title=Pathology and molecular biology of teratomas in childhood and adolescence |journal=Klin Padiatr |volume=218 |issue=6 |pages=296–302 |year=2006 |pmid=17080330 |doi=10.1055/s-2006-942271 |url=}}</ref><ref name=pmid15761467>{{cite journal |author=Ulbright TM |title=Germ cell tumors of the gonads: a selective review emphasizing problems in differential diagnosis, newly appreciated, and controversial issues |journal=Mod. Pathol. |volume=18 Suppl 2 |issue= |pages=S61–79 |year=2005 |month=February |pmid=15761467 |doi=10.1038/modpathol.3800310 |url=http://www.nature.com/modpathol/journal/v18/n2s/full/3800310a.html}}</ref><ref name=pmid7814189>{{cite journal |author=O'Connor DM, Norris HJ |title=The influence of grade on the outcome of stage I ovarian immature (malignant) teratomas and the reproducibility of grading |journal=Int. J. Gynecol. Pathol. |volume=13 |issue=4 |pages=283–9 |year=1994 |month=October |pmid=7814189 |doi= |url=}}</ref>
*G0 - mature teratoma; no immature neuroepithelium.
*G1 - less than one lower power field ([[LPF]]) of immature neuroepithelium; LPF defined field at 4X magnification.
*G2 - 1-3 LPFs.
*G3 - more than 3 LPFs.
 
Note:
*LPF not adequately defined - see [[LPFitis]]. Same BS as HPF.
 
====IHC (immature)====
Features:
*Primitive neuroepithelium:<ref name=pmid11598856>{{cite journal |author=Craver RD, Lipscomb JT, Suskind D, Velez MC |title=Malignant teratoma of the thyroid with primitive neuroepithelial and mesenchymal sarcomatous components |journal=Ann Diagn Pathol |volume=5 |issue=5 |pages=285–92 |year=2001 |month=October |pmid=11598856 |doi=10.1053/adpa.2001.27918 |url=}}</ref>
**Neuron-specific enolase (NSE) +ve.
**Neuron-specific B tubulin +ve.
**Synaptophysin +ve.
 
===Monodermal teratomas===
====Struma ovarii====
Features:
*Thyroid tissue present - colloid is seen.
**May develop pathologies seen in the [[thyroid gland]], e.g. [[papillary thyroid carcinoma]].
 
=====Images=====
<gallery>
Image:Struma_ovarii_-_low_mag.jpg | Struma ovarii - low mag. (WC/Nephron)
Image:Struma_ovarii_-_high_mag.jpg | Struma ovarii - high mag. (WC/Nephron)
</gallery>
====Strumal carcinoid====
Features:<ref name=pmid18509188>{{Cite journal  | last1 = Gorin | first1 = I. | last2 = Sastre-Garau | first2 = X. | title = Strumal carcinoid tumor of the ovary. | journal = J Clin Oncol | volume = 26 | issue = 16 | pages = 2780-1 | month = Jun | year = 2008 | doi = 10.1200/JCO.2008.16.1620 | PMID = 18509188 }}</ref><ref>{{Cite journal  | last1 = Tamsen | first1 = A. | last2 = Mazur | first2 = MT. | title = Ovarian strumal carcinoid in association with multiple endocrine neoplasia, type IIA. | journal = Arch Pathol Lab Med | volume = 116 | issue = 2 | pages = 200-3 | month = Feb | year = 1992 | doi =  | PMID = 1346363 }}</ref>
*Has components that suggest:
*#Carcinoid ([[neuroendocrine tumour]]).
*#*Nuclei with stippled chromatin (salt-and-pepper chromatin).
*#[[Thyroid]] - cystic spaces/follicular-like structures.
 
=====Images=====
<gallery>
Image:Strumal_carcinoid_-_intermed_mag.jpg | Strumal carcinoid - intermed. mag. (WC/Nephron)
Image:Strumal_carcinoid_-_high_mag.jpg | Strumal carcinoid - high mag. (WC/Nephron)
</gallery>
 
===Sign out===
====Mature teratoma====
<pre>
CYST ("DERMOID"), RIGHT OVARY, CYSTECTOMY:
- MATURE CYSTIC TERATOMA.
</pre>


==Gonadoblastoma==
==Gonadoblastoma==
Michael
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