Embryonal carcinoma

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Embryonal carcinoma
Diagnosis in short

Embryonal carcinoma. H&E stain.
LM vesicular nuclei, nuclear overlap, necrosis (common), mitoses, variable architecture (tubulopapillary, glandular, solid, embryoid bodies)
LM DDx seminoma, mixed germ cell tumour, yolk sac tumour, other carcinomas
IHC OCT3 +ve, CD30 +ve, AE1/AE3 +ve, CD117 -ve
Grossing notes orchiectomy grossing
Staging testicular cancer staging
Site testis, ovary, mediastinum
Signs testicular mass, pelvic mass
Prevalence pure embryonal uncommon
Clin. DDx typically other testicular tumours

Embryonal carcinoma is a type of germ cell tumour. It is commonly as a component of mixed germ cell tumours.

General

Gross

Microscopic

Features:[3]

  1. Nucleoli - key feature.
  2. Vesicular nuclei (clear, empty appearing nuclei) - key feature.
  3. Nuclei overlap.
  4. Necrosis - common.
    • Not commonly present in seminoma.
  5. Indistinct cell borders
  6. Mitoses - common.
  7. Variable architecture:[1]
    • Solid (predominant in ~55% of cases).
    • Glandular (predominant in ~17% of cases).
    • Papillary (predominant in ~11% of cases).
    • Nested.
    • Micropapillary.
    • Anastomosing glandular.
    • Sieve-like glandular.
    • Pseudopapillary.
    • Blastocyst-like.
    • Embryoid bodies - ball of cells in surrounded by empty space on three sides.

Notes:

  • Cytoplasmic staining variable (eosinophilic to basophilic).
  • Syncytiotrophoblasts commonly seen (~40-50% of cases[1]).

DDx:

Images

  • Embryonal carcinoma - very high mag. - cropped (WC/Nephron)

  • Embryonal carcinoma - high mag. (WC/Nephron)

  • Embryonal carcinoma - high mag. (WC/Nephron)

  • Embryonal carcinoma - intermed. mag. (WC/Nephron)

  • Embryonal carcinoma - low mag. (WC/Nephron)

IHC

ISUP consensus

General panel:[4]

  • OCT4 +ve.
    • Choriocarcinoma, yolk sac tumour and spermatocytic seminoma all -ve.
  • CD30 +ve.
  • CD117 -ve.[5]

Additional notes

  • CK19 -ve.[6]
  • AE1/AE3 +ve.
  • OCT3/4 +ve.[7]
  • D2-40 -ve.[7]
    • Iczkowski et al. suggest it is useful for discriminating from seminoma. This is somewhat disputed by Lau et al.[5]
  • PLAP +ve.[8]
  • CK7 +ve/-ve (~50% have weak staining).[9]
    • Seminoma -ve, choriocarcinoma +ve.

See also

References

  1. ↑ 1.0 1.1 1.2 Kao, CS.; Ulbright, TM.; Young, RH.; Idrees, MT. (May 2014). "Testicular embryonal carcinoma: a morphologic study of 180 cases highlighting unusual and unemphasized aspects.". Am J Surg Pathol 38 (5): 689-97. doi:10.1097/PAS.0000000000000171. PMID 24503753.
  2. ↑ Yalçın, B.; Demir, HA.; Tanyel, FC.; Akçören, Z.; Varan, A.; Akyüz, C.; Kutluk, T.; Büyükpamukçu, M. (Oct 2012). "Mediastinal germ cell tumors in childhood.". Pediatr Hematol Oncol 29 (7): 633-42. doi:10.3109/08880018.2012.713084. PMID 22877235.
  3. ↑ Zhou, Ming; Magi-Galluzzi, Cristina (2006). Genitourinary Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 549. ISBN 978-0443066771.
  4. ↑ 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.
  5. ↑ 5.0 5.1 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.
  6. ↑ 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.
  7. ↑ 7.0 7.1 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.
  8. ↑ Jacobsen, GK.; Nørgaard-Pedersen, B. (Sep 1984). "Placental alkaline phosphatase in testicular germ cell tumours and in carcinoma-in-situ of the testis. An immunohistochemical study.". Acta Pathol Microbiol Immunol Scand A 92 (5): 323-9. PMID 6209917.
  9. ↑ Wegman SJ, Parwani AV, Zynger DL (February 2019). "Cytokeratin 7, inhibin, and p63 in testicular germ cell tumor: superior markers of choriocarcinoma compared to β-human chorionic gonadotropin". Hum Pathol 84: 254–261. doi:10.1016/j.humpath.2018.10.007. PMID 30359635.
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