Case 6

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Clinical history

22 year old man, testicular mass.

Primary image

Choriocarcinoma - intermed mag.jpg
Very low magnification. H&E stain.
Very high magnification 
Choriocarcinoma - very high mag.jpg
Very high magnification. H&E stain.
Very high magnification 
Choriocarcinoma -2- very high mag.jpg
Very high magnification. H&E stain.

Differential diagnosis

Differential diagnosis 
germ cell tumour - choriocarcinoma, mixed germ cell tumour

Additional tests

More history

More history 
Discovered testicular mass on self-exam. Serum hCG elevated.

Ask a friend

Ask a friend 
Can't help think about chorionic villi. Did you try a hCG IHC?

Stains

Alcian blue/PAS to Bilirubin
Test Result
Alcian blue/PASDr T would ask why!
Alican blue pH 1.0Dr T would ask why!
Alcian blue pH 2.5Dr T would ask why!
AuramineDr T would ask why!
BielchowskyDr T would ask why!
BilirubinDr T would ask why!
Colloidal iron to Fontana-Masson
Test Result
Colloidal ironDr T would ask why!
Congo redDr T would ask why!
Cresyl violetDr T would ask why!
DieterleDr T would ask why!
Diff QuikDr T would ask why!
Fontana-MassonDr T would ask why!
Gallyas to Gremelius
Test Result
GallyasDr T would ask why!
GiemsaDr T would ask why!
GMSDr T would ask why!
Gomori's trichromeDr T would ask why!
GramDr T would ask why!
GremeliusDr T would ask why!
JMS to Mucicarmine
Test Result
JMSDr T would ask why!
JonesDr T would ask why!
KinyounDr T would ask why!
Luxol fast blueDr T would ask why!
Masson trichromeDr T would ask why!
M-MASDr T would ask why!
MovatDr T would ask why!
MucicarmineDr T would ask why!
Oil red O to Prussian blue
Test Result
Oil red ODr T would ask why!
OreceinDr T would ask why!
PASDr T would ask why!
PASDDr T would ask why!
PASFDr T would ask why!
PTAHDr T would ask why!
Prussian blueDr T would ask why!
Reticulin to Ziehl-Neelsen
Test Result
ReticulinDr T would ask why!
Sudan black BDr T would ask why!
Toluidine blueDr T would ask why!
VerhoeffDr T would ask why!
Von KossaDr T would ask why!
Warthin-StarryDr T would ask why!
Ziehl-NeeslenDr T would ask why!

IHC

Alpha-1 AT to Cathepsin K
Test Result
alpha-1 AT Dr T would ask why!
ACTH Dr T would ask why!
AE1/AE1Dr T would ask why!
alpha-fetoprotein Dr T would ask why!
Alk-I Dr T would ask why!
AMACRDr T would ask why!
ARDr T would ask why!
ATRXDr T would ask why!
Beta2-microglobulin Dr T would ask why!
B72.3 Dr T would ask why!
Beta-cateninDr T would ask why!
BCL2 Dr T would ask why!
BCL6 Dr T would ask why!
BCLxL Dr T would ask why!
C3 comp Dr T would ask why!
CA9Dr T would ask why!
Calcitonin Dr T would ask why!
Calponin Dr T would ask why!
Calretinin Dr T would ask why!
CAM5.2Dr T would ask why!
Cathepsin KDr T would ask why!
CD10 to Chromogranin
Test Result
CD10 Dr T would ask why!
CD117 Dr T would ask why!
CD138Dr T would ask why!
CD15 Dr T would ask why!
CD1a Dr T would ask why!
CD20 Dr T would ask why!
CD21 Dr T would ask why!
CD23 Dr T would ask why!
CD3 Dr T would ask why!
CD30 Dr T would ask why!
CD31 Dr T would ask why!
CD34 Dr T would ask why!
CD35 Dr T would ask why!
CD4 Dr T would ask why!
CD43 Dr T would ask why!
CD45 (LCA)Dr T would ask why!
CD5 Dr T would ask why!
CD56 Dr T would ask why!
CD57Dr T would ask why!
CD68 Dr T would ask why!
CD7 Dr T would ask why!
CD79a Dr T would ask why!
CD8 Dr T would ask why!
CD99 Dr T would ask why!
CDX2Dr T would ask why!
CEA-m Dr T would ask why!
Chromogranin Dr T would ask why!
CK17 to Glypican 3
Test Result
CK17Dr T would ask why!
CK19POSITIVE
CK20 Dr T would ask why!
CK34betaE12 Dr T would ask why!
CK5/6Dr T would ask why!
CK7 Dr T would ask why!
CMV Dr T would ask why!
c-MYC Dr T would ask why!
Cyclin D1 Dr T would ask why!
D2-40Dr T would ask why!
Desmin Dr T would ask why!
DOG1Dr T would ask why!
EBV Dr T would ask why!
EMADr T would ask why!
ER and PR Dr T would ask why!
Factor VIII Dr T would ask why!
Factor XIIIa Dr T would ask why!
Fascin Dr T would ask why!
FHDr T would ask why!
FSH Dr T would ask why!
Gastrin Dr T would ask why!
GATA3POSITIVE nuclear staining
GCDFP-15 (BRST2)Dr T would ask why!
GFAPDr T would ask why!
GH Dr T would ask why!
Glucagon Dr T would ask why!
Glypican-3POSITIVE
HBME-1 to IgM
Test Result
HBME-1 Dr T would ask why!
HBV core Dr T would ask why!
HBV surface Dr T would ask why!
H-caldesmonDr T would ask why!
HCG POSITIVE
HelicobacterDr T would ask why!
Hepatocyte Dr T would ask why!
HER2/neu Dr T would ask why!
HHV-8Dr T would ask why!
HMB-45Dr T would ask why!
HNF1betaDr T would ask why!
HPV Dr T would ask why!
HSV-I Dr T would ask why!
HSV-II Dr T would ask why!
IDH-1Dr T would ask why!
Inhibin Dr T would ask why!
INI1 (BAF47)Dr T would ask why!
Insulin Dr T would ask why!
Kappa Dr T would ask why!
Ki-67 40%
Lambda Dr T would ask why!
Leu 7 Dr T would ask why!
IgA Dr T would ask why!
IgG Dr T would ask why!
IgM Dr T would ask why!
LH to PDGFR
Test Result
LH Dr T would ask why!
LIN28 Dr T would ask why!
Lysozyme Dr T would ask why!
mammoglobinDr T would ask why!
MAP2Dr T would ask why!
MCVDr T would ask why!
Melanin A Dr T would ask why!
MHC class I Dr T would ask why!
MITFDr T would ask why!
MUM1Dr T would ask why!
Myeloperoxidase Dr T would ask why!
MYO D1 Dr T would ask why!
MyoglobinDr T would ask why!
NapsinDr T would ask why!
NFDr T would ask why!
NKX3.1Dr T would ask why!
NSE Dr T would ask why!
OCT3/4Dr T would ask why!
p16Dr T would ask why!
P501SDr T would ask why!
p53 Dr T would ask why!
p57Dr T would ask why!
p63 Dr T would ask why!
PankeratinDr T would ask why!
PAX2Dr T would ask why!
PAX5Dr T would ask why!
PAX8Dr T would ask why!
PCNA Dr T would ask why!
PDGFRDr T would ask why!
PLAP to WT1
Test Result
PLAP Dr T would ask why!
PNL-2C Dr T would ask why!
Prolactin Dr T would ask why!
PSA Dr T would ask why!
PSAPDr T would ask why!
RCCDr T would ask why!
S-100Dr T would ask why!
SALL4Dr T would ask why!
Smooth muscle actin Dr T would ask why!
Somatostatin Dr T would ask why!
STAT6 Dr T would ask why!
Synaptophysin Dr T would ask why!
TdT Dr T would ask why!
TFE3Dr T would ask why!
TFEBDr T would ask why!
Thyroglobulin Dr T would ask why!
Toxoplasma Dr T would ask why!
TSH Dr T would ask why!
TTF-1 Dr T would ask why!
Ubiquitin Dr T would ask why!
UCHL1 (PGP9.5)Dr T would ask why!
Ulex Europaeus Dr T would ask why!
VimentinDr T would ask why!
VIP Dr T would ask why!
VZV Dr T would ask why!
WT-1Dr T would ask why!


Chromosomal translocations

Translocations Chr 1-10
Test Result
t(1;13) PAX7-FKHR Dr Torres would ask why!
t(2,13) PAX3-FKHR Dr Torres would ask why!
t(8;14) MYC-IGHDr Torres would ask why!
t(9;22) BCR-ABL Dr Torres would ask why!
t(9;22) CHN-EWS Dr Torres would ask why!
Translocations Chr 11-13
Test Result
t(11;14) CCND1-IGH Dr Torres would ask why!
t(11;22) EWS-WT1 Dr Torres would ask why!
t(11;22) FLI1-EWS Dr Torres would ask why!
t(12;15) ETV6-NTRK3 Dr Torres would ask why!
t(12;16) FUS-ATF1 Dr Torres would ask why!
t(12;16) CHOP-TLS Dr Torres would ask why!
t(12;22) EWS-ATF1 Dr Torres would ask why!
Translocations Chr 14-22
Test Result
t(14,18) IGH-BCL2 Dr Torres would ask why!
t(15;17) PML-RARA Dr Torres would ask why!
t(16;21) FUS-ERG Dr Torres would ask why!
t(17;22) COLA1-PDGFB Dr Torres would ask why!
t(21;22) EWS-ERG Dr Torres would ask why!
Translocations Chr X & Y
Test Result
t(X;1) PRCC-TFE3Dr Torres would ask why!
t(X;17) TFE3-ASPL Dr Torres would ask why!
t(X;18) SYT-SSX Dr Torres would ask why!


Diagnosis

Diagnosis 
Choriocarcinoma


Comment:
Histology is important for this diagnosis. CK19 is positive in yolk sac tumour (YST) and choriocarcinoma.[1] Glypican 3 is can be positive in choriocarcinoma; it is usually positive in YST.

Reference

  1. Bremmer, F.; Ströbel, P.; Hubertus, H.; Strecker, J.; Gaisa, N.; Strauß, A.; Schweyer, S.; Radzun, H-J. et al. (2015). [www.diagnosticpathology.org/content/10/1/7‎Cached "CK19 is a sensitive marker for yolk sac tumours of the testis."]. Diagnostic Pathology 10 (7). doi:10.1186/s13000-015-0243-y. www.diagnosticpathology.org/content/10/1/7‎Cached.


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