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{{ Infobox diagnosis | |||
| Name = {{PAGENAME}} | |||
| Image = Mixed_germ_cell_tumour_-_very_high_mag.jpg | |||
| Width = | |||
| Caption = Yolk sac tumour. [[H&E stain]]. | |||
| Micro = Schiller-Duval bodies (glomerulerus-like structures), variable architecture - usually reticular or microcystic | |||
| Subtypes = | |||
| LMDDx = [[embryonal carcinoma]], [[mixed germ cell tumour]] | |||
| Stains = | |||
| IHC = [[AFP]] +ve, [[glypican 3]] +ve, OCT3 -ve, [[CK19]] +ve | |||
| EM = | |||
| Molecular = | |||
| IF = | |||
| Gross = white/yellow mucinous infiltrative mass | |||
| Grossing = [[orchiectomy grossing]] | |||
| Staging = [[testicular cancer staging]] | |||
| Site = [[testis]], other | |||
| Assdx = | |||
| Syndromes = | |||
| Clinicalhx = | |||
| Signs = | |||
| Symptoms = | |||
| Prevalence = rare | |||
| Bloodwork = alpha-fetoprotein (AFP) elevated | |||
| Rads = | |||
| Endoscopy = | |||
| Prognosis = poor | |||
| Other = | |||
| ClinDDx = other [[germ cell tumours]] | |||
}} | |||
'''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'''. | |||
==General== | |||
*Rare in pure form. | |||
*Aggressive - especially extragonadal tumours.<ref name=pmid18767035/> | |||
Epidemiology: | |||
*Most common GCT in infants and young boys. | |||
*Bimodal age distribution:<ref name=pmid18767035>{{Cite journal | last1 = Shah | first1 = JP. | last2 = Kumar | first2 = S. | last3 = Bryant | first3 = CS. | last4 = Ali-Fehmi | first4 = R. | last5 = Malone | first5 = JM. | last6 = Deppe | first6 = G. | last7 = Morris | first7 = RT. | title = A population-based analysis of 788 cases of yolk sac tumors: A comparison of males and females. | journal = Int J Cancer | volume = 123 | issue = 11 | pages = 2671-5 | month = Dec | year = 2008 | doi = 10.1002/ijc.23792 | PMID = 18767035 }}</ref> | |||
**<4 years. | |||
**10-30 years. | |||
Clinical: | |||
*Elevated AFP. | |||
==Gross== | |||
*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> | |||
*Schiller-Duval bodies. | |||
**Look like glomerulus - central blood vessel surrounded by epithelial-like cells a space and more epithelial-like cells | |||
*Architecure - variable. | |||
*#Reticular - most common according to WMSP.<ref name=Ref_WMSP369>{{Ref WMSP|369}}</ref> | |||
*#Microcystic. | |||
*#*Lace-like pattern. | |||
*#Endodermal sinus-like - has Schiller-Duval bodies. | |||
*#Solid. | |||
*#Papillary. | |||
*#Glandular. | |||
*#Alveolar. | |||
*#Enteric. | |||
*#Polyvesicular vitelline. | |||
*#Hepatoid. | |||
*+/-Eosinophilic hyaline globules (contain alpha-fetoprotein). | |||
Notes: | |||
*Has a loose stroma/vaguely discohesive -- unlike embryonal carcinoma. | |||
*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> | |||
Variants: | |||
*Hepatoid pattern.<ref>URL: [http://webpathology.com/image.asp?case=34&n=6 http://webpathology.com/image.asp?case=34&n=6]. Accessed on: March 8, 2010.</ref> | |||
**Vaguely resembles liver. | |||
***[[Hyaline globules]] (light red well-circumscribed globs). | |||
***Bile canaculi. | |||
*Solid pattern.<ref>URL: [http://webpathology.com/image.asp?case=34&n=8 http://webpathology.com/image.asp?case=34&n=8]. Accessed on: March 8, 2010.</ref> | |||
**Vaguely resembles ''seminoma''. | |||
DDx: | |||
*[[Embryonal carcinoma]] - more [[nuclear atypia]], nuclei usually overlap and classically vesicular. | |||
*[[Mixed germ cell tumour]]. | |||
===Images=== | |||
====Case 1==== | |||
<gallery> | |||
Image:Mixed_germ_cell_tumour_-_very_high_mag.jpg|Yolk sac tumour. (WC/Nephron) | |||
</gallery> | |||
====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://www.webpathology.com/image.asp?case=34&n=5 Schiller-Duval body (webpathology.com)]. | |||
*[http://www.webpathology.com/image.asp?n=6&Case=34 Hyaline globules (webpathology.com)]. | |||
*[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://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== | |||
[[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> | |||
*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> | |||
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> | |||
*[[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== | |||
*[[Germ cell tumours]]. | |||
*[[Genitourinary pathology]]. | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||
[[Category:Germ cell tumours]] | |||
[[Category:Genitourinary pathology]] |
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