Difference between revisions of "Seminoma"

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==Sign out==
==Sign out==
<pre>
Right Testis, Radical Orchiectomy:
- SEMINOMA (pure).
-- Margins clear.
-- Please see synoptic report.
</pre>
===Biopsy===
<pre>
<pre>
RETROPERITONEAL SOFT TISSUE, RIGHT, CORE BIOPSY:
RETROPERITONEAL SOFT TISSUE, RIGHT, CORE BIOPSY:
- SEMINOMA.
- SEMINOMA.
</pre>
</pre>
===Micro===
 
====Micro====
The sections show large atypical, discohesive cells with prominent nucleoli, central
The sections show large atypical, discohesive cells with prominent nucleoli, central
nuclei and moderate clear cytoplasm, intermixed with mature lymphocytes. Mitotic
nuclei and moderate clear cytoplasm, intermixed with mature lymphocytes. Mitotic
activity is present.
activity is present.


===Small biopsy===
====Small biopsy====
A mixed germ cell tumour cannot be excluded; given the small quantity of tumour, this
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
biopsy is at a high risk for having undersampled other tumour components should they be

Revision as of 22:24, 14 December 2016

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 OCT3 +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 elevated (not common)
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.

Note:

  • Rarely, it may present a retroperitoneal mass.[1]

Epidemiology & etiology

Gross

  • Solid, white/tan.

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),[2] present in ~10-20% of seminoma.[3]
    • Large + irregular, vesicular nuclei.
    • Eosinophilic vacuolated cytoplasm (contains hCG).
      • Syncytiotrophoblasts = closest to mom in normal chorionic villi - covers cytotrophoblast.[4]
  • +/-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.[5]
    • Stage I = Tx N0 M0.[6]
  • Intertubular seminoma may not form a discrete mass and mimic a benign testis.[7]

DDx:

Images

Syncytiotrophoblasts

Intertubular seminoma

Lymph node metastasis

IHC

ISUP consensus

A general panel:[10]

  • 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:[11]

  • OCT4 (uniformily) +ve.
    • Choriocarcinoma = patchy staining.

Additional notes

Sign out

Right Testis, 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. 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.
  2. 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.
  3. URL: http://www.webpathology.com/image.asp?case=31&n=10. Accessed on: 22 May 2012.
  4. URL: http://upload.wikimedia.org/wikipedia/commons/4/45/Gray37.png. Accessed on: 31 May 2010.
  5. 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.
  6. URL: http://emedicine.medscape.com/article/2006777-overview. Accessed on: October 8, 2014.
  7. 7.0 7.1 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.
  8. URL: http://webpathology.com/image.asp?case=34&n=8. Accessed on: March 8, 2010.
  9. 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.
  10. 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.
  11. 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.
  12. 12.0 12.1 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.
  13. 13.0 13.1 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.
  14. 14.0 14.1 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.
  15. 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.