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Difference between revisions of "Seminoma"
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{{ Infobox diagnosis | |||
| Name = {{PAGENAME}} | |||
| Image = Seminoma_high_mag.jpg | |||
| Width = | |||
| Caption = Seminoma. [[H&E stain]]. | |||
| Micro = fried egg-like cells (clear or eosinophilic cytoplasm, central nucleus), lymphocytic infiltrate (common), +/-[[syncytiotrophoblast]]s (rare), +/-granulomas (uncommon) | |||
| Subtypes = | |||
| LMDDx = [[embryonal carcinoma]], [[ITGCN]], [[mixed germ cell tumour]], granulomatous orchitis | |||
| Stains = | |||
| IHC = OCT3/4 +ve, PLAP +ve, D2-40 +ve, CD30 -ve | |||
| EM = | |||
| Molecular = | |||
| IF = | |||
| Gross = | |||
| Grossing = | |||
| Site = [[testis]] | |||
| Assdx = [[ITGCN]] | |||
| Syndromes = | |||
| Clinicalhx = | |||
| Signs = testicular mass, +/-retroperitoneal lymphadenopathy | |||
| Symptoms = | |||
| Prevalence = | |||
| Bloodwork = +/-beta-hCG elevated | |||
| Rads = | |||
| Endoscopy = | |||
| Prognosis = good | |||
| Other = | |||
| ClinDDx = other [[testis|testicular tumours]] ([[germ cell tumour]]s, [[lymphoma) | |||
}} | |||
'''Seminoma''' is a common [[testis|testicular]] [[germ cell tumour]]. | |||
It should ''not'' be confused with the unrelated tumour called ''[[spermatocytic seminoma]]''. | |||
===General=== | |||
*Male counterpart of the [[dysgerminoma]], which arise in the [[ovary]]. | |||
*Most common [[germ cell tumour]] of the testis. | |||
Clinical: | |||
*Elevated serum LDH. | |||
*Normal serum alpha fetoprotein. | |||
*Usually normal beta-hCG. | |||
Note: | |||
*Rarely, it may present a retroperitoneal mass.<ref name=pmid21424055>{{Cite journal | last1 = Preda | first1 = O. | last2 = Nicolae | first2 = A. | last3 = Loghin | first3 = A. | last4 = Borda | first4 = A. | last5 = Nogales | first5 = FF. | title = Retroperitoneal seminoma as a first manifestation of a partially regressed (burnt-out) testicular germ cell tumor. | journal = Rom J Morphol Embryol | volume = 52 | issue = 1 | pages = 193-6 | month = | year = 2011 | doi = | PMID = 21424055 }}</ref> | |||
====Epidemiology & etiology==== | |||
*Arises from ''[[intratubular germ cell neoplasia]]'' (ITGCN). | |||
===Microsopic=== | |||
Features: | |||
*Cells with fried egg appearance - '''key feature''': | |||
**Clear cytoplasm. | |||
**Central nucleus, with prominent nucleolus. | |||
***Nucleus may have "corners", i.e. it is ''not'' round. | |||
*+/-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> | |||
**Large + irregular, vesicular nuclei. | |||
**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> | |||
*+/-Florid granulomatous reaction. | |||
Memory device: 3 Cs - clear cytoplasm, central nucleus, corners on the nuclear membrane. | |||
DDx: | |||
*[[Embryonal carcinoma]]. | |||
*Solid variant of [[yolk sac tumour]]. | |||
**Lacks fibrous septae and lymphocytes.<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> | |||
*[[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> | |||
*Granulomatous orchitis - if [[granuloma]]s are present. | |||
====Images==== | |||
<gallery> | |||
Image:Seminoma_high_mag.jpg |Seminoma - high 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: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) | |||
</gallery> | |||
===IHC=== | |||
*D2-40 +ve ~100% of cases.<ref name=pmid17277761>{{Cite journal | last1 = Lau | first1 = SK. | last2 = Weiss | first2 = LM. | last3 = Chu | first3 = PG. | title = D2-40 immunohistochemistry in the differential diagnosis of seminoma and embryonal carcinoma: a comparative immunohistochemical study with KIT (CD117) and CD30. | journal = Mod Pathol | volume = 20 | issue = 3 | pages = 320-5 | month = Mar | year = 2007 | doi = 10.1038/modpathol.3800749 | PMID = 17277761 }}</ref> | |||
*CD117 +ve (ckit) ~92% of cases.<ref name=pmid17277761/> | |||
*CD30 -ve.<ref name=pmid16867864>{{Cite journal | last1 = Cossu-Rocca | first1 = P. | last2 = Jones | first2 = TD. | last3 = Roth | first3 = LM. | last4 = Eble | first4 = JN. | last5 = Zheng | first5 = W. | last6 = Karim | first6 = FW. | last7 = Cheng | first7 = L. | title = Cytokeratin and CD30 expression in dysgerminoma. | journal = Hum Pathol | volume = 37 | issue = 8 | pages = 1015-21 | month = Aug | year = 2006 | doi = 10.1016/j.humpath.2006.02.018 | PMID = 16867864 }}</ref> | |||
**Done to r/o [[embryonal carcinoma]]. | |||
*Cytokeratins usu. -ve, may have weak focal positivity.<ref name=pmid16867864/> | |||
*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> | |||
===Sign out=== | |||
<pre> | |||
RETROPERITONEAL SOFT TISSUE, RIGHT, CORE BIOPSY: | |||
- SEMINOMA. | |||
</pre> | |||
====Micro==== | |||
The sections show large atypical, discohesive cells with prominent nucleoli, central | |||
nuclei and moderate clear cytoplasm, intermixed with mature lymphocytes. Mitotic | |||
activity is present. | |||
====Small biopsy==== | |||
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 | |||
present. Correlation with serology and consideration of re-biopsy is suggested. | |||
==See also== | |||
*[[Testis]]. | |||
*[[Genitourinary pathology]]. | |||
*[[Dysgerminoma]]. | |||
*[[Germinoma]]. | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||