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| LMDDx = [[embryonal carcinoma]], [[mixed germ cell tumour]] | | LMDDx = [[embryonal carcinoma]], [[mixed germ cell tumour]] | ||
| Stains = | | Stains = | ||
| IHC = AFP +ve | | IHC = [[AFP]] +ve, [[glypican 3]] +ve, OCT3 -ve, [[CK19]] +ve | ||
| EM = | | EM = | ||
| Molecular = | | Molecular = | ||
| IF = | | IF = | ||
| Gross = white/yellow mucinous infiltrative mass | | Gross = white/yellow mucinous infiltrative mass | ||
| Grossing = | | Grossing = [[orchiectomy grossing]] | ||
| Staging = [[testicular cancer staging]] | |||
| Site = [[testis]], other | | Site = [[testis]], other | ||
| Assdx = | | Assdx = | ||
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| Symptoms = | | Symptoms = | ||
| Prevalence = rare | | Prevalence = rare | ||
| Bloodwork = alpha fetoprotein (AFP) elevated | | Bloodwork = alpha-fetoprotein (AFP) elevated | ||
| Rads = | | Rads = | ||
| Endoscopy = | | Endoscopy = | ||
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| ClinDDx = other [[germ cell tumours]] | | ClinDDx = other [[germ cell tumours]] | ||
}} | }} | ||
'''Yolk sac tumour''' is an uncommon [[germ cell tumour]] that primarily | '''Yolk sac tumour''' is an uncommon [[germ cell tumour]] that primarily afflicts infants and young boys. | ||
It may be seen as part of [[mixed germ cell tumour]]. It is abbreviated '''YST'''. | |||
It may be referred to as '''endodermal sinus tumour'''. | It may be referred to as '''endodermal sinus tumour'''. | ||
==General== | |||
*Rare. | *Rare in pure form. | ||
*Aggressive - especially extragonadal tumours.<ref name=pmid18767035/> | *Aggressive - especially extragonadal tumours.<ref name=pmid18767035/> | ||
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*Elevated AFP. | *Elevated AFP. | ||
==Gross== | |||
*White/yellow mucinous infiltrative mass.<ref name=Ref_PCPBoD8_510>{{Ref PCPBoD8|510}}</ref> | *White/yellow mucinous infiltrative mass.<ref name=Ref_PCPBoD8_510>{{Ref PCPBoD8|510}}</ref> | ||
==Microscopic== | |||
Classic feature:<ref name=Ref_PCPBoD8_510>{{Ref PCPBoD8|510}}</ref> | Classic feature:<ref name=Ref_PCPBoD8_510>{{Ref PCPBoD8|510}}</ref> | ||
*Schiller-Duval bodies. | *Schiller-Duval bodies. | ||
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*Architecure - variable. | *Architecure - variable. | ||
*#Reticular - most common according to WMSP.<ref name=Ref_WMSP369>{{Ref WMSP|369}}</ref> | *#Reticular - most common according to WMSP.<ref name=Ref_WMSP369>{{Ref WMSP|369}}</ref> | ||
*#Microcystic | *#Microcystic. | ||
*#*Lace-like pattern. | *#*Lace-like pattern. | ||
*#Endodermal sinus-like - has Schiller-Duval bodies. | *#Endodermal sinus-like - has Schiller-Duval bodies. | ||
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Notes: | Notes: | ||
*Has a loose stroma/vaguely discohesive -- unlike embryonal carcinoma. | *Has a loose stroma/vaguely discohesive -- unlike embryonal carcinoma. | ||
*How to remember patterns ''REM PS GAPEH'' = reticular, endodermal sinus, microcystic, papillary, solid, glandular, alveolar, polyvesicular vitelline, enteric, hepatoid. | *How to remember patterns ''REMember PlS GAP EH'' (or ''REM PS GAPEH'') = reticular, endodermal sinus, microcystic, papillary, solid, glandular, alveolar, polyvesicular vitelline, enteric, hepatoid. | ||
*Yolk sac tumours in adults are essentially always a component of a [[mixed germ cell tumour]], i.e. if one sees a pure yolk sac tumour in an adult, it is probably under sampled.<ref name=pmid1203848>{{Cite journal | last1 = Talerman | first1 = A. | title = The incidence of yolk sac tumor (endodermal sinus tumor) elements in germ cell tumors of the testis in adults. | journal = Cancer | volume = 36 | issue = 1 | pages = 211-5 | month = Jul | year = 1975 | doi = | PMID = 1203848 }}</ref> | *Yolk sac tumours in adults are essentially always a component of a [[mixed germ cell tumour]], i.e. if one sees a pure yolk sac tumour in an adult, it is probably under sampled.<ref name=pmid1203848>{{Cite journal | last1 = Talerman | first1 = A. | title = The incidence of yolk sac tumor (endodermal sinus tumor) elements in germ cell tumors of the testis in adults. | journal = Cancer | volume = 36 | issue = 1 | pages = 211-5 | month = Jul | year = 1975 | doi = | PMID = 1203848 }}</ref> | ||
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DDx: | DDx: | ||
*[[Embryonal carcinoma]]. | *[[Embryonal carcinoma]] - more [[nuclear atypia]], nuclei usually overlap and classically vesicular. | ||
*[[Mixed germ cell tumour]]. | *[[Mixed germ cell tumour]]. | ||
==== | ===Images=== | ||
====Case 1==== | |||
<gallery> | <gallery> | ||
Image:Mixed_germ_cell_tumour_-_very_high_mag.jpg|Yolk sac tumour. (WC/Nephron) | Image:Mixed_germ_cell_tumour_-_very_high_mag.jpg|Yolk sac tumour. (WC/Nephron) | ||
</gallery> | </gallery> | ||
www | |||
====Case 2==== | |||
<gallery> | |||
Image: Yolk sac tumour with hyaline bodies -- intermed mag.jpg | YST with hyaline bodies - intermed. mag. (WC) | |||
Image: Yolk sac tumour with hyaline bodies -- high mag.jpg | YST with hyaline bodies - high mag. (WC) | |||
Image: Yolk sac tumour with hyaline bodies -- very high mag.jpg | YST with hyaline bodies - very high mag. (WC) | |||
</gallery> | |||
====Case 3==== | |||
<gallery> | |||
Image: Yolk sac tumour -- low mag.jpg | YST - low mag. (WC) | |||
Image: Yolk sac tumour -- intermed mag.jpg | YST - intermed. mag. (WC) | |||
Image: Yolk sac tumour -- high mag.jpg | YST - high mag. (WC) | |||
Image: Yolk sac tumour -- very high mag.jpg | YST - very high mag. (WC) | |||
</gallery> | |||
===www images=== | |||
*[http://webpathology.com/image.asp?case=34&n=6 Hepatoid Pattern (webpathology.com)]. | *[http://webpathology.com/image.asp?case=34&n=6 Hepatoid Pattern (webpathology.com)]. | ||
*[http://www.webpathology.com/image.asp?case=34&n=5 Schiller-Duval body (webpathology.com)]. | *[http://www.webpathology.com/image.asp?case=34&n=5 Schiller-Duval body (webpathology.com)]. | ||
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*[http://path.upmc.edu/cases/case152.html Yolk sac tumour - case 1 - several images (upmc.edu)]. | *[http://path.upmc.edu/cases/case152.html Yolk sac tumour - case 1 - several images (upmc.edu)]. | ||
*[http://path.upmc.edu/cases/case492.html Yolk sac tumour - case 2 - several images (upmc.edu)]. | *[http://path.upmc.edu/cases/case492.html Yolk sac tumour - case 2 - several images (upmc.edu)]. | ||
*[http://www.moffitt.org/ | *[http://www.moffitt.org/File%20Library/Main%20Nav/Research%20and%20Clinical%20Trials/Cancer%20Control%20Journal/v11n6/374.pdf Testicular germ cell tumours (moffitt.org)].<ref name=pmid15625525>{{Cite journal | last1 = Sesterhenn | first1 = IA. | last2 = Davis | first2 = CJ. | title = Pathology of germ cell tumors of the testis. | journal = Cancer Control | volume = 11 | issue = 6 | pages = 374-87 | month = | year = | doi = | PMID = 15625525 }}</ref> | ||
=== | ==IHC== | ||
*Alpha-fetoprotein (abbreviated AFP) +ve. | [[ISUP]] consensus paper by Ulbright ''et al.'':<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> | ||
*Glypican 3 +ve. | *OCT3 -ve. | ||
**Positive in [[seminoma]] and [[embryonal carcinoma]]. | |||
*[[Alpha-fetoprotein]] (abbreviated AFP) +ve. | |||
*[[Glypican 3]] +ve. | |||
**More sensitive than AFP.<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> | **More sensitive than AFP.<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> | ||
Others: | |||
*[[CK19]] +ve.<ref>{{Cite journal | last1 = Bremmer | first1 = F. | last2 = Ströbel | first2 = P. | last3 = Hubertus | first3 = H. | last4 = Strecker | first4 = J. | last5 = Gaisa | first5 = N. | last6 = Strauß | first6 = A. | last7 = Schweyer | first7 = S. | last8 = Radzun | first8 = H-J. | last9 = Behnes | first9 = C-L | title = CK19 is a sensitive marker for yolk sac tumours of the testis. | journal = Diagnostic Pathology | volume = 10 | issue = 7 | pages = | month = | year = 2015 | doi = 10.1186/s13000-015-0243-y | PMID = | url = www.diagnosticpathology.org/content/10/1/7Cached }}</ref> | |||
**Seminoma -ve, embryonal carcinoma -ve, [[GCNIS]] (ITGCN) -ve, normal testis -ve. | |||
*Cytokeratin +ve.{{fact}} | |||
*CD30 -ve. | |||
**Positive in [[embryonal carcinoma]].<ref name=pmid19396148>{{Cite journal | last1 = Gopalan | first1 = A. | last2 = Dhall | first2 = D. | last3 = Olgac | first3 = S. | last4 = Fine | first4 = SW. | last5 = Korkola | first5 = JE. | last6 = Houldsworth | first6 = J. | last7 = Chaganti | first7 = RS. | last8 = Bosl | first8 = GJ. | last9 = Reuter | first9 = VE. | title = Testicular mixed germ cell tumors: a morphological and immunohistochemical study using stem cell markers, OCT3/4, SOX2 and GDF3, with emphasis on morphologically difficult-to-classify areas. | journal = Mod Pathol | volume = 22 | issue = 8 | pages = 1066-74 | month = Aug | year = 2009 | doi = 10.1038/modpathol.2009.66 | PMID = 19396148 }}</ref> | |||
*OCT3/4 -ve. | |||
*Alpha-1-antitrypsin +ve (abbreviated A1A).<ref name=pmid89123>{{Cite journal | last1 = Beilby | first1 = JO. | last2 = Horne | first2 = CH. | last3 = Milne | first3 = GD. | last4 = Parkinson | first4 = C. | title = Alpha-fetoprotein, alpha-1-antitrypsin, and transferrin in gonadal yolk-sac tumours. | journal = J Clin Pathol | volume = 32 | issue = 5 | pages = 455-61 | month = May | year = 1979 | doi = | PMID = 89123 }}</ref> | *Alpha-1-antitrypsin +ve (abbreviated A1A).<ref name=pmid89123>{{Cite journal | last1 = Beilby | first1 = JO. | last2 = Horne | first2 = CH. | last3 = Milne | first3 = GD. | last4 = Parkinson | first4 = C. | title = Alpha-fetoprotein, alpha-1-antitrypsin, and transferrin in gonadal yolk-sac tumours. | journal = J Clin Pathol | volume = 32 | issue = 5 | pages = 455-61 | month = May | year = 1979 | doi = | PMID = 89123 }}</ref> | ||
* | *[[CDX2]] +ve in 8 of 20 cases with YST (versus glypican-3).<ref name=pmid19578052>{{Cite journal | last1 = Bing | first1 = Z. | last2 = Pasha | first2 = T. | last3 = Tomaszewski | first3 = JE. | last4 = Zhang | first4 = P. | title = CDX2 expression in yolk sac component of testicular germ cell tumors. | journal = Int J Surg Pathol | volume = 17 | issue = 5 | pages = 373-7 | month = Oct | year = 2009 | doi = 10.1177/1066896909338598 | PMID = 19578052 }}</ref> | ||
*SOX2 -ve (0 of 17<ref name=pmid19369635>{{cite journal |authors=Nonaka D |title=Differential expression of SOX2 and SOX17 in testicular germ cell tumors |journal=Am J Clin Pathol |volume=131 |issue=5 |pages=731–6 |date=May 2009 |pmid=19369635 |doi=10.1309/AJCP7MNCNBCRN8NO |url=}}</ref>). | |||
*SOX17 +ve (17 of 17 cases<ref name=pmid19369635/>). | |||
* | |||
==See also== | ==See also== |
edits