Difference between revisions of "Yolk sac tumour"

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#redirect [[Germ cell tumours#Yolk sac tumour]]
{{ 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
| EM        =
| Molecular  =
| IF        =
| Gross      = white/yellow mucinous infiltrative mass
| Grossing  =
| 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 afflicits 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.
*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 - most common according to ''webpathology.com''.<ref name=webpath_case34>URL: [http://webpathology.com/image.asp?case=34&n=1 http://webpathology.com/image.asp?case=34&n=1]. Accessed on: March 8, 2010.</ref> 
*#*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 ''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]].
*[[Mixed germ cell tumour]].
 
====Images====
<gallery>
Image:Mixed_germ_cell_tumour_-_very_high_mag.jpg|Yolk sac tumour. (WC/Nephron)
</gallery>
www:
*[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/CCJRoot/v11n6/pdf/374.pdf Yolk sac tumour (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===
*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>
*Alpha-1 AT +ve.
*Cytokeratin +ve.{{fact}}
 
Negative stains:<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 - positive in [[seminoma]] and embryonal carcinoma.
*CD30 - positive in [[embryonal carcinoma]].
 
==See also==
*[[Germ cell tumours]].
*[[Genitourinary pathology]].
 
==References==
{{Reflist|2}}


[[Category:Diagnosis]]
[[Category:Diagnosis]]
[[Category:Germ cell tumours]]
[[Category:Genitourinary pathology]]
Michael
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