Difference between revisions of "Seminoma"

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Seminoma (view source)

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| Micro      = fried egg-like cells (clear or eosinophilic cytoplasm, central nucleus), lymphocytic infiltrate (common), +/-[[syncytiotrophoblast]]s (rare), +/-granulomas (uncommon)
| Micro      = fried egg-like cells (clear or eosinophilic cytoplasm, central nucleus), lymphocytic infiltrate (common), +/-[[syncytiotrophoblast]]s (rare), +/-granulomas (uncommon)
| Subtypes  =
| Subtypes  =
| LMDDx      = [[embryonal carcinoma]], [[ITGCN]], [[mixed germ cell tumour]], granulomatous orchitis  
| LMDDx      = [[embryonal carcinoma]], [[GCNIS]], [[mixed germ cell tumour]], [[granulomatous orchitis]], [[testicular scar]], [[atrophic testis]]
| Stains    =
| Stains    =
| IHC        = OCT3 +ve, CD117 +ve, CD30 -ve
| IHC        = OCT4 +ve, [[CD117]] +ve, CD30 -ve
| EM        =
| EM        =
| Molecular  =
| Molecular  =
| IF        =
| IF        =
| Gross      = solid, white/tan
| Gross      = solid, white/tan
| Grossing  =
| Grossing  = [[orchiectomy grossing]]
| Staging    = [[testicular cancer staging]]
| Site      = [[testis]]
| Site      = [[testis]]
| Assdx      = [[ITGCN]]
| Assdx      = [[GCNIS]]
| Syndromes  =
| Syndromes  =
| Clinicalhx =
| Clinicalhx =
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| Symptoms  =
| Symptoms  =
| Prevalence =
| Prevalence =
| Bloodwork  = LDH elevated, beta-hCG elevated (not common)
| Bloodwork  = LDH elevated, beta-hCG normal or slightly elevated
| Rads      =
| Rads      =
| Endoscopy  =
| Endoscopy  =
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| Other      =
| Other      =
| ClinDDx    = other [[testis|testicular tumours]] ([[germ cell tumour]]s, [[lymphoma]])
| ClinDDx    = other [[testis|testicular tumours]] ([[germ cell tumour]]s, [[lymphoma]])
| Tx        =
}}
}}
'''Seminoma''' is a common [[testis|testicular]] [[germ cell tumour]].
'''Seminoma''' is a common [[testis|testicular]] [[germ cell tumour]].


It should ''not'' be confused with the unrelated tumour called ''[[spermatocytic seminoma]]''.
It should ''not'' be confused with ''[[spermatocytic tumour]]'' (previously known as ''spermatocytic seminoma'').


==General==
==General==
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*Elevated serum LDH.
*Elevated serum LDH.
*Normal serum alpha fetoprotein.  
*Normal serum alpha fetoprotein.  
*Usually normal beta-hCG.
*Usually normal beta-hCG ''or'' slightly elevated.<ref name=pmid9311009>{{cite journal |authors=Hori K, Uematsu K, Yasoshima H, Yamada A, Sakurai K, Ohya M |title=Testicular seminoma with human chorionic gonadotropin production |journal=Pathol Int |volume=47 |issue=9 |pages=592–9 |date=September 1997 |pmid=9311009 |doi=10.1111/j.1440-1827.1997.tb04547.x |url=}}</ref>


Note:
Note:
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===Epidemiology & etiology===
===Epidemiology & etiology===
*Arises from ''[[intratubular germ cell neoplasia]]'' (ITGCN).
*Arises from ''[[germ cell neoplasia in situ]]'', abbreviated ''GCNIS'' (previously known as ''intratubular germ cell neoplasia'').


==Gross==
==Gross==
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*+/-Lymphoctyes - interspersed (very common).
*+/-Lymphoctyes - interspersed (very common).
*+/-[[Syncytiotrophoblast]]s, [[AKA]] ''syncytiotrophoblastic giant cells'' (STGCs),<ref name=Ref_GUP542>{{Ref GUP|542}}</ref> present in ~10-20% of seminoma.<ref>URL: [http://www.webpathology.com/image.asp?case=31&n=10 http://www.webpathology.com/image.asp?case=31&n=10]. Accessed on: 22 May 2012.</ref>
*+/-[[Syncytiotrophoblast]]s, [[AKA]] ''syncytiotrophoblastic giant cells'' (STGCs),<ref name=Ref_GUP542>{{Ref GUP|542}}</ref> present in ~10-20% of seminoma.<ref>URL: [http://www.webpathology.com/image.asp?case=31&n=10 http://www.webpathology.com/image.asp?case=31&n=10]. Accessed on: 22 May 2012.</ref>
**Large + irregular, vesicular nuclei.  
**Large + irregular, [[vesicular nuclei]].  
**Eosinophilic vacuolated cytoplasm (contains hCG).
**Eosinophilic vacuolated cytoplasm (contains hCG).
***Syncytiotrophoblasts = closest to mom in normal [[chorionic villi]] - covers cytotrophoblast.<ref>URL: [http://upload.wikimedia.org/wikipedia/commons/4/45/Gray37.png http://upload.wikimedia.org/wikipedia/commons/4/45/Gray37.png]. Accessed on: 31 May 2010.</ref>
***Syncytiotrophoblasts = closest to mom in normal [[chorionic villi]] - covers cytotrophoblast.<ref>URL: [http://upload.wikimedia.org/wikipedia/commons/4/45/Gray37.png http://upload.wikimedia.org/wikipedia/commons/4/45/Gray37.png]. Accessed on: 31 May 2010.</ref>
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Notes:
Notes:
*Memory device: 3 Cs - clear cytoplasm, central nucleus, corners on the nuclear membrane.
*Memory device: 3 Cs - clear cytoplasm, central nucleus, corners on the nuclear membrane.
*Approximately 24% of Stage I seminomas have LVI.<ref>{{Cite journal  | last1 = Soper | first1 = MS. | last2 = Hastings | first2 = JR. | last3 = Cosmatos | first3 = HA. | last4 = Slezak | first4 = JM. | last5 = Wang | first5 = R. | last6 = Lodin | first6 = K. | title = 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. | journal = Am J Clin Oncol | volume = 37 | issue = 4 | pages = 356-9 | month = Aug | year = 2014 | doi = 10.1097/COC.0b013e318277d839 | PMID = 23275274 }}</ref>
*Approximately 24% of Stage I seminomas have [[lymphovascular invasion]].<ref name=pmid23275274>{{Cite journal  | last1 = Soper | first1 = MS. | last2 = Hastings | first2 = JR. | last3 = Cosmatos | first3 = HA. | last4 = Slezak | first4 = JM. | last5 = Wang | first5 = R. | last6 = Lodin | first6 = K. | title = 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. | journal = Am J Clin Oncol | volume = 37 | issue = 4 | pages = 356-9 | month = Aug | year = 2014 | doi = 10.1097/COC.0b013e318277d839 | PMID = 23275274 }}</ref>
**Stage I = Tx N0 M0.<ref>URL: [http://emedicine.medscape.com/article/2006777-overview http://emedicine.medscape.com/article/2006777-overview]. Accessed on: October 8, 2014.</ref>
**Stage I = Tx N0 M0.<ref>URL: [http://emedicine.medscape.com/article/2006777-overview http://emedicine.medscape.com/article/2006777-overview]. Accessed on: October 8, 2014.</ref>
*Intertubular seminoma may ''not'' form a discrete mass and mimic a benign testis.<ref name=pmid15316315>{{Cite journal  | last1 = Henley | first1 = JD. | last2 = Young | first2 = RH. | last3 = Wade | first3 = CL. | last4 = Ulbright | first4 = TM. | title = Seminomas with exclusive intertubular growth: a report of 12 clinically and grossly inconspicuous tumors. | journal = Am J Surg Pathol | volume = 28 | issue = 9 | pages = 1163-8 | month = Sep | year = 2004 | doi =  | PMID = 15316315 }}</ref>


DDx:
DDx:
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*[[Mixed germ cell tumour]].
*[[Mixed germ cell tumour]].
*[[Choriocarcinoma]] - esp. if (multinucleated) syncytiotrophoblasts are present.<ref name=pmid157614>{{Cite journal  | last1 = Hedinger | first1 = C. | last2 = von Hochstetter | first2 = AR. | last3 = Egloff | first3 = B. | title = Seminoma with syncytiotrophoblastic giant cells. A special form of seminoma. | journal = Virchows Arch A Pathol Anat Histol | volume = 383 | issue = 1 | pages = 59-67 | month = Jul | year = 1979 | doi =  | PMID = 157614 }}</ref>
*[[Choriocarcinoma]] - esp. if (multinucleated) syncytiotrophoblasts are present.<ref name=pmid157614>{{Cite journal  | last1 = Hedinger | first1 = C. | last2 = von Hochstetter | first2 = AR. | last3 = Egloff | first3 = B. | title = Seminoma with syncytiotrophoblastic giant cells. A special form of seminoma. | journal = Virchows Arch A Pathol Anat Histol | volume = 383 | issue = 1 | pages = 59-67 | month = Jul | year = 1979 | doi =  | PMID = 157614 }}</ref>
*Granulomatous orchitis - if [[granuloma]]s are present.
*[[Granulomatous orchitis]] - if [[granuloma]]s are present.
*[[Testicular scar]] - seminomas may regress spontaneously.
*[[Testicular scar]] - seminomas may regress spontaneously.
*[[Testicular atrophy]] - esp. for intertubular predominant seminoma.<ref name=pmid15316315>{{Cite journal  | last1 = Henley | first1 = JD. | last2 = Young | first2 = RH. | last3 = Wade | first3 = CL. | last4 = Ulbright | first4 = TM. | title = Seminomas with exclusive intertubular growth: a report of 12 clinically and grossly inconspicuous tumors. | journal = Am J Surg Pathol | volume = 28 | issue = 9 | pages = 1163-8 | month = Sep | year = 2004 | doi =  | PMID = 15316315 }}</ref>


===Images===
===Images===
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Image:Seminoma_intermed_mag.jpg |Seminoma - intermed. mag. (WC/Nephron)
Image:Seminoma_intermed_mag.jpg |Seminoma - intermed. mag. (WC/Nephron)
Image:Rete_testis_with_seminoma.jpg |Seminoma in the rete testis. (WC/Nephron)
Image:Rete_testis_with_seminoma.jpg |Seminoma in the rete testis. (WC/Nephron)
</gallery>
====Syncytiotrophoblasts====
<gallery>
Image:Seminoma_with_syncytiotrophoblasts_-_intermed_mag.jpg |Seminoma with syncytiotrophoblasts - intermed. mag. (WC/Nephron)
Image:Seminoma_with_syncytiotrophoblasts_-_intermed_mag.jpg |Seminoma with syncytiotrophoblasts - intermed. mag. (WC/Nephron)
Image:Seminoma_with_syncytiotrophoblasts_-_very_high_mag.jpg |Seminoma with syncytiotrophoblasts - very high mag. (WC/Nephron)
Image:Seminoma_with_syncytiotrophoblasts_-_very_high_mag.jpg |Seminoma with syncytiotrophoblasts - very high mag. (WC/Nephron)  
</gallery>
====Intertubular seminoma====
<gallery>
Image: Intertubular seminoma -- very low mag.jpg | ITS - very low mag. (WC)
Image: Intertubular seminoma -- low mag.jpg | ITS - low mag. (WC)
Image: Intertubular seminoma - alt -- low mag.jpg | ITS - low mag. (WC)
Image: Intertubular seminoma -- intermed mag.jpg | ITS - intermed. mag. (WC)
Image: Intertubular seminoma -- high mag.jpg | ITS - high mag. (WC)
Image: Intertubular seminoma -- very high mag.jpg | ITS - very high mag. (WC)
</gallery>
 
====Lymph node metastasis====
<gallery>
Image: Testicular seminoma (1) nodal metastasis.jpg | Seminoma in LN. (WC/KGH)
Image: Testicular seminoma (2) nodal metastasis.jpg | Seminoma in LN. (WC/KGH)
</gallery>
====Seminoma with granulomas====
<gallery>
Image: Seminoma with granulomas -- intermed mag.jpg | Seminoma with granulomas - intermed. mag.
Image: Seminoma with granulomas -- high mag.jpg | Seminoma with granulomas - high mag.
Image: Seminoma with granulomas -- very high mag.jpg | Seminoma with granulomas - very high mag.
Image: Seminoma with granulomas --- low mag.jpg | Seminoma with granulomas - low mag.
Image: Seminoma with granulomas --- intermed mag.jpg | Seminoma with granulomas - intermed. mag.
Image: Seminoma with granulomas --- high mag.jpg | Seminoma with granulomas - high mag.
Image: Seminoma with granulomas --- very high mag.jpg | Seminoma with granulomas - very high mag.
</gallery>
</gallery>


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A general panel:<ref name=pmid24832161>{{cite journal |author=Ulbright TM, Tickoo SK, Berney DM, Srigley JR |title=Best practices recommendations in the application of immunohistochemistry in testicular tumors: report from the international society of urological pathology consensus conference |journal=Am. J. Surg. Pathol. |volume=38 |issue=8 |pages=e50–9 |year=2014 |month=August |pmid=24832161 |doi=10.1097/PAS.0000000000000233 |url=}}</ref>
A general panel:<ref name=pmid24832161>{{cite journal |author=Ulbright TM, Tickoo SK, Berney DM, Srigley JR |title=Best practices recommendations in the application of immunohistochemistry in testicular tumors: report from the international society of urological pathology consensus conference |journal=Am. J. Surg. Pathol. |volume=38 |issue=8 |pages=e50–9 |year=2014 |month=August |pmid=24832161 |doi=10.1097/PAS.0000000000000233 |url=}}</ref>
*OCT4 +ve.
*OCT4 +ve.
**Choriocarcinoma, yolk sac tumour and spermatocytic seminoma all -ve.
**Choriocarcinoma, yolk sac tumour and [[spermatocytic tumour]] all -ve.
*CD117 +ve.
*CD117 +ve.
**-ve in embryonal carcinoma.
**-ve in embryonal carcinoma.
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*OCT3/4 +ve.<ref name=pmid20438407>{{Cite journal  | last1 = Emerson | first1 = RE. | last2 = Ulbright | first2 = TM. | title = Intratubular germ cell neoplasia of the testis and its associated cancers: the use of novel biomarkers. | journal = Pathology | volume = 42 | issue = 4 | pages = 344-55 | month = Jun | year = 2010 | doi = 10.3109/00313021003767355 | PMID = 20438407 }}</ref>
*OCT3/4 +ve.<ref name=pmid20438407>{{Cite journal  | last1 = Emerson | first1 = RE. | last2 = Ulbright | first2 = TM. | title = Intratubular germ cell neoplasia of the testis and its associated cancers: the use of novel biomarkers. | journal = Pathology | volume = 42 | issue = 4 | pages = 344-55 | month = Jun | year = 2010 | doi = 10.3109/00313021003767355 | PMID = 20438407 }}</ref>
**Also +ve in embryonal carcinoma.<ref name=pmid18045648>{{Cite journal  | last1 = Iczkowski | first1 = KA. | last2 = Butler | first2 = SL. | last3 = Shanks | first3 = JH. | last4 = Hossain | first4 = D. | last5 = Schall | first5 = A. | last6 = Meiers | first6 = I. | last7 = Zhou | first7 = M. | last8 = Torkko | first8 = KC. | last9 = Kim | first9 = SJ. | title = Trials of new germ cell immunohistochemical stains in 93 extragonadal and metastatic germ cell tumors. | journal = Hum Pathol | volume = 39 | issue = 2 | pages = 275-81 | month = Feb | year = 2008 | doi = 10.1016/j.humpath.2007.07.002 | PMID = 18045648 }}</ref>
**Also +ve in embryonal carcinoma.<ref name=pmid18045648>{{Cite journal  | last1 = Iczkowski | first1 = KA. | last2 = Butler | first2 = SL. | last3 = Shanks | first3 = JH. | last4 = Hossain | first4 = D. | last5 = Schall | first5 = A. | last6 = Meiers | first6 = I. | last7 = Zhou | first7 = M. | last8 = Torkko | first8 = KC. | last9 = Kim | first9 = SJ. | title = Trials of new germ cell immunohistochemical stains in 93 extragonadal and metastatic germ cell tumors. | journal = Hum Pathol | volume = 39 | issue = 2 | pages = 275-81 | month = Feb | year = 2008 | doi = 10.1016/j.humpath.2007.07.002 | PMID = 18045648 }}</ref>
*[[PLAP]] +ve.
**Largely replaced by ''OCT4'' or ''OCT3/4'' - which is more sensitive.<ref name=pmid15725806 >{{Cite journal  | last1 = Hattab | first1 = EM. | last2 = Tu | first2 = PH. | last3 = Wilson | first3 = JD. | last4 = Cheng | first4 = L. | title = OCT4 immunohistochemistry is superior to placental alkaline phosphatase (PLAP) in the diagnosis of central nervous system germinoma. | journal = Am J Surg Pathol | volume = 29 | issue = 3 | pages = 368-71 | month = Mar | year = 2005 | doi =  | PMID = 15725806 }}</ref>


==Sign out==
==Sign out==
<pre>
Right Testicle, Radical Orchitectomy:
    - SEMINOMA (pure).
    -- Margins clear.
    -- Germ cell neoplasia in situ (intratubular germ cell neoplasia) present.
    -- Please see synoptic report.
    - Background testis consists of Sertoli cells only, NEGATIVE for spermatogenesis.
</pre>
<pre>
Testis, Left, 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
Michael
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