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Germ cell neoplasia in situ (view source)
Revision as of 04:41, 22 March 2016
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| Image = Intratubular germ cell neoplasia - 2 - very high mag.jpg | | Image = Intratubular germ cell neoplasia - 2 - very high mag.jpg | ||
| Width = | | Width = | ||
| Caption = | | Caption = GCNIS (left of image). [[H&E stain]]. | ||
| Synonyms = | | Synonyms = intratubular germ cell neoplasia (old term) | ||
| Micro = "large" round or polygonal nuclei, prominent nucleoli, clear cytoplasm, +/-cells (completely) fill the tubule | | Micro = "large" round or polygonal nuclei, prominent nucleoli, clear cytoplasm, +/-cells (completely) fill the tubule | ||
| Subtypes = undifferentiated, differentiated (intratubular seminoma, intratubular | | Subtypes = undifferentiated, differentiated (intratubular seminoma, intratubular non-seminoma) | ||
| LMDDx = [[seminoma]], [[embryonal carcinoma]], Sertoli cell-only syndrome | | LMDDx = [[seminoma]], [[embryonal carcinoma]], Sertoli cell-only syndrome, [[mixed germ cell tumour]] | ||
| Stains = | | Stains = | ||
| IHC = OCT4, PLAP +ve, D2-40 +ve | | IHC = OCT4, PLAP +ve, D2-40 +ve | ||
| Line 30: | Line 30: | ||
| Tx = radiotherapy (?) | | Tx = radiotherapy (?) | ||
}} | }} | ||
''' | '''Germ cell neoplasia in situ''', abbreviated '''GCNIS''', is a premalignant lesion of the [[testis]]. | ||
It | It was previously known previously known as '''intratubular germ cell neoplasia''' (abbreviated '''ITGCN''') and '''testicular intraepithelial neoplasia'''.<ref name=pmid23293116 >{{Cite journal | last1 = Dieckmann | first1 = KP. | last2 = Wilken | first2 = S. | last3 = Loy | first3 = V. | last4 = Matthies | first4 = C. | last5 = Kleinschmidt | first5 = K. | last6 = Bedke | first6 = J. | last7 = Martinschek | first7 = A. | last8 = Souchon | first8 = R. | last9 = Pichlmeier | first9 = U. | title = Treatment of testicular intraepithelial neoplasia (intratubular germ cell neoplasia unspecified) with local radiotherapy or with platinum-based chemotherapy: a survey of the German Testicular Cancer Study Group. | journal = Ann Oncol | volume = 24 | issue = 5 | pages = 1332-7 | month = May | year = 2013 | doi = 10.1093/annonc/mds628 | PMID = 23293116 }}</ref><ref name=pmid26918959>{{Cite journal | last1 = Berney | first1 = DM. | last2 = Looijenga | first2 = L. | last3 = Idrees | first3 = M. | last4 = Oosterhuis | first4 = JW. | last5 = Rajpert-De Meyts | first5 = E. | last6 = Ulbright | first6 = TM. | last7 = Skakkebaek | first7 = NE. | title = Germ Cell Neoplasia In Situ (GCNIS). Evolution of the Current Nomenclature for Testicular Pre-invasive Germ Cell Malignancy. | journal = Histopathology | volume = | issue = | pages = | month = Feb | year = 2016 | doi = 10.1111/his.12958 | PMID = 26918959 }}</ref> | ||
==General== | ==General== | ||
| Line 38: | Line 38: | ||
*Not all germ cell tumours (GCTs) arise from ''intratubular germ cell neoplasia''. | *Not all germ cell tumours (GCTs) arise from ''intratubular germ cell neoplasia''. | ||
The following testicular GCTs do not arise from | The following testicular GCTs do not arise from GCNIS: | ||
*[[Spermatocytic | *[[Spermatocytic tumour]].<ref name=pmid2837162>{{cite journal |author=Müller J, Skakkebaek NE, Parkinson MC |title=The spermatocytic seminoma: views on pathogenesis |journal=Int. J. Androl. |volume=10 |issue=1 |pages=147–56 |year=1987 |month=February |pmid=3583416 |doi= |url=}}</ref> | ||
*[[Yolk sac tumour]]s (endodermal sinus tumour).<ref>{{cite journal |author=Manivel JC, Simonton S, Wold LE, Dehner LP |title=Absence of intratubular germ cell neoplasia in testicular yolk sac tumors in children. A histochemical and immunohistochemical study |journal=Arch. Pathol. Lab. Med. |volume=112 |issue=6 |pages=641–5 |year=1988 |month=June |pmid=2837162 |doi= |url=}}</ref> | *[[Yolk sac tumour]]s (endodermal sinus tumour).<ref>{{cite journal |author=Manivel JC, Simonton S, Wold LE, Dehner LP |title=Absence of intratubular germ cell neoplasia in testicular yolk sac tumors in children. A histochemical and immunohistochemical study |journal=Arch. Pathol. Lab. Med. |volume=112 |issue=6 |pages=641–5 |year=1988 |month=June |pmid=2837162 |doi= |url=}}</ref> | ||
*Teratoma.{{Fact}} | *Teratoma.{{Fact}} | ||
Classification:<ref name=pmid11900581/> | Classification:<ref name=pmid11900581/> | ||
*Undifferentiated | *Undifferentiated GCNIS. | ||
*Differentiated | *Differentiated GCNIS.<ref name=pmid17592271>{{Cite journal | last1 = Lau | first1 = SK. | last2 = Weiss | first2 = LM. | last3 = Chu | first3 = PG. | title = Association of intratubular seminoma and intratubular embryonal carcinoma with invasive testicular germ cell tumors. | journal = Am J Surg Pathol | volume = 31 | issue = 7 | pages = 1045-9 | month = Jul | year = 2007 | doi = 10.1097/PAS.0b013e31802b8712 | PMID = 17592271 }}</ref> | ||
**''Intratubular seminoma.'' | **''Intratubular seminoma.'' | ||
**''Intratubular non-seminoma''. | |||
Treatment: | Treatment: | ||
| Line 67: | Line 67: | ||
DDx: | DDx: | ||
*Sertoli cell-only syndrome - Sertoli cells also have nucleoli, wind swept appearance.<ref>URL: [http://www.webpathology.com/image.asp?n=3&Case=28 http://www.webpathology.com/image.asp?n=3&Case=28]. Accessed on: 25 March 2013.</ref> | *Sertoli cell-only syndrome - Sertoli cells also have nucleoli, wind swept appearance.<ref>URL: [http://www.webpathology.com/image.asp?n=3&Case=28 http://www.webpathology.com/image.asp?n=3&Case=28]. Accessed on: 25 March 2013.</ref> | ||
*[[Seminoma]]. | *[[Seminoma]] - especially intratubular predominant growth pattern. | ||
*[[Embryonal carcinoma]]. | *[[Embryonal carcinoma]]. | ||
*[[Mixed germ cell tumour]]. | |||
===Images=== | ===Images=== | ||
====Case 1==== | |||
<gallery> | <gallery> | ||
Image: Intratubular germ cell neoplasia - intermed mag.jpg | ITGCN - intermed. mag. | Image: Intratubular germ cell neoplasia - intermed mag.jpg | GCNIS (ITGCN) - intermed. mag. | ||
Image: Intratubular germ cell neoplasia - high mag.jpg | ITGCN - high mag. | Image: Intratubular germ cell neoplasia - high mag.jpg | GCNIS (ITGCN) - high mag. | ||
Image: Intratubular germ cell neoplasia - very high mag.jpg | ITGCN - very high mag. | Image: Intratubular germ cell neoplasia - very high mag.jpg | GCNIS (ITGCN) - very high mag. | ||
Image: Intratubular germ cell neoplasia - 2 - very high mag.jpg | ITGCN - very high mag. | Image: Intratubular germ cell neoplasia - 2 - very high mag.jpg | GCNIS (ITGCN) - very high mag. | ||
</gallery> | </gallery> | ||
====Case 2==== | |||
<gallery> | <gallery> | ||
Image:Intratubular_germ_cell_neoplasia_high_mag_cropped.jpg | ITGCN - cropped. (WC/Nephron) | Image:Intratubular_germ_cell_neoplasia_high_mag_cropped.jpg | GCNIS (ITGCN) - cropped. (WC/Nephron) | ||
Image:Intratubular_germ_cell_neoplasia_high_mag.jpg | ITGCN. (WC/Nephron) | Image:Intratubular_germ_cell_neoplasia_high_mag.jpg | GCNIS (ITGCN). (WC/Nephron) | ||
</gallery> | </gallery> | ||
www | ====Case 3==== | ||
<gallery> | |||
Image: ITGCN and Sertoli cells only -- intermed mag.jpg | GCNIS (ITGCN) & SCO - intermed. mag. | |||
Image: ITGCN and Sertoli cells only -- high mag.jpg | GCNIS (ITGCN) & SCO - high mag. | |||
Image: ITGCN and Sertoli cells only - PLAP -- intermed mag.jpg | GCNIS (ITGCN) & SCO - intermed. mag. | |||
Image: ITGCN and Sertoli cells only - PLAP -- high mag.jpg | GCNIS (ITGCN) & SCO - high mag. | |||
Image: ITGCN and Sertoli cells only - PLAP -- very high mag.jpg | GCNIS (ITGCN) & SCO - very high mag. | |||
</gallery> | |||
====www==== | |||
*[http://www.webpathology.com/image.asp?case=30&n=1 ITGCN (webpathology.com)]. | *[http://www.webpathology.com/image.asp?case=30&n=1 ITGCN (webpathology.com)]. | ||
*[http://www.archivesofpathology.org/na101/home/literatum/publisher/pinnacle/journals/content/arpa/2002/15432165-126.4/0003-9985%282002%29126%3C0487%3Aiec%3E2.0.co%3B2/production/images/large/i1543-2165-126-4-487-f01.jpeg Intratubular embryonal carcinoma (archivesofpathology.org)].<ref name=pmid11900581/> | *[http://www.archivesofpathology.org/na101/home/literatum/publisher/pinnacle/journals/content/arpa/2002/15432165-126.4/0003-9985%282002%29126%3C0487%3Aiec%3E2.0.co%3B2/production/images/large/i1543-2165-126-4-487-f01.jpeg Intratubular embryonal carcinoma (archivesofpathology.org)].<ref name=pmid11900581/> | ||
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==IHC== | ==IHC== | ||
===ISUP consensus=== | ===ISUP consensus=== | ||
ITGCN versus atypical intratubular germ cells:<ref name=pmid25025364>{{Cite journal | last1 = Amin | first1 = MB. | last2 = Epstein | first2 = JI. | last3 = Ulbright | first3 = TM. | last4 = Humphrey | first4 = PA. | last5 = Egevad | first5 = L. | last6 = Montironi | first6 = R. | last7 = Grignon | first7 = D. | last8 = Trpkov | first8 = K. | last9 = Lopez-Beltran | first9 = A. | title = Best practices recommendations in the application of immunohistochemistry in urologic pathology: report from the international society of urological pathology consensus conference. | journal = Am J Surg Pathol | volume = 38 | issue = 8 | pages = 1017-22 | month = Aug | year = 2014 | doi = 10.1097/PAS.0000000000000254 | PMID = 25025364 }}</ref> | GCNIS (ITGCN) versus atypical intratubular germ cells:<ref name=pmid25025364>{{Cite journal | last1 = Amin | first1 = MB. | last2 = Epstein | first2 = JI. | last3 = Ulbright | first3 = TM. | last4 = Humphrey | first4 = PA. | last5 = Egevad | first5 = L. | last6 = Montironi | first6 = R. | last7 = Grignon | first7 = D. | last8 = Trpkov | first8 = K. | last9 = Lopez-Beltran | first9 = A. | title = Best practices recommendations in the application of immunohistochemistry in urologic pathology: report from the international society of urological pathology consensus conference. | journal = Am J Surg Pathol | volume = 38 | issue = 8 | pages = 1017-22 | month = Aug | year = 2014 | doi = 10.1097/PAS.0000000000000254 | PMID = 25025364 }}</ref> | ||
*OCT4 +ve. | *OCT4 +ve. | ||
Alternates: | Alternates: | ||
*[[PLAP]] +ve.<ref>{{Cite journal | last1 = Schreiber | first1 = L. | last2 = Lifschitz-Mercer | first2 = B. | last3 = Paz | first3 = G. | last4 = Yavetz | first4 = H. | last5 = Elliott | first5 = DJ. | last6 = Kula | first6 = K. | last7 = Slowikowska-Hilczer | first7 = J. | last8 = Maymon | first8 = BB. | title = Double immunolabeling by the RBM and the PLAP markers for identifying intratubular (in situ) germ cell neoplasia of the testis. | journal = Int J Surg Pathol | volume = 11 | issue = 1 | pages = 17-20 | month = Jan | year = 2003 | doi = | PMID = 12598912 }}</ref> | *[[PLAP]] +ve.<ref name=pmid12598912>{{Cite journal | last1 = Schreiber | first1 = L. | last2 = Lifschitz-Mercer | first2 = B. | last3 = Paz | first3 = G. | last4 = Yavetz | first4 = H. | last5 = Elliott | first5 = DJ. | last6 = Kula | first6 = K. | last7 = Slowikowska-Hilczer | first7 = J. | last8 = Maymon | first8 = BB. | title = Double immunolabeling by the RBM and the PLAP markers for identifying intratubular (in situ) germ cell neoplasia of the testis. | journal = Int J Surg Pathol | volume = 11 | issue = 1 | pages = 17-20 | month = Jan | year = 2003 | doi = | PMID = 12598912 }}</ref> | ||
*D2-40 +ve. | *D2-40 +ve. | ||