Difference between revisions of "Germ cell tumor classification"

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Germ cell tumors can be classified based on their histologic findings and differentiation into:
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Revision as of 16:07, 17 September 2019

Germ cell tumors can be classified based on their histologic findings and differentiation into:


 
 
 
 
 
 
 
 
Germ cell tumors
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Germinomatous/Undifferentiated/Immature
 
 
 
 
 
 
 
 
Nongerminomatous/Differentiated/Embryonal
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Dysgerminoma(Ovary)
 
 
 
Seminoma(Testis)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Embryonal carcinoma
 
 
 
 
 
 
embryonic tissue
 
 
 
 
Extraembryonic tissue
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Teratoma
 
 
Yolk sac tumor
 
Choriocarcinoma
 
 

Germ cell tumors also can be classifies based on their location regardless to the histolgic finding:

 
 
 
 
 
 
 
 
Germ cell tumors
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Gonadal
 
 
 
 
 
 
 
 
Extragonadal
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Located in the gonads
 
 
 
 
 
 
 
 
Located in the midline of the body including:
  • CNS
  • Mediastinum
  • Retroperitoneum
  • Coccyx
  •  
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     


    Types Subtypes Signs and Symptoms Histopathology Lab finding Prognosis
    Germinomatous

    /Undifferentiated

    Seminoma (Testis)

    Gross: pale gray to yellow nodules that are uniform or slightly lobulated and often bulge from the cut surface
    • Complete blood count and blood chemistry tests.
    • Abnormal serum tumor marker levels (LDH, HCG).
    • CT: Metastases to the para-aortic, inguinal, or iliac lymph nodes. Visceral metastasis may also be seen.
    • Pelvic MRI: may be diagnostic. multinodular tumors of uniform signal intensity
    • Hypo- to isointense on T2-weighted images and inhomogenous enhancement on contrast enhanced T1-weighted images.
    • Other diagnostic studies for seminoma include biopsy, FDG-PET scan, and bone scan.

    Dysgerminoma

    (Ovary)

    • Chemotherapy: except those with stage 1a, stage 1a, 1b dysgerminoma
    • Radiotherapy:

    ** Dysgerminoma is radiosensitive.

    ** Radiotherapy is not anymore the first option of treatment for dysgerminoma considering its association with ovarian failuredevelopment.

    • Surgery: for diagnostic grading and therapy depending on if the patient prefers to preserve the ovary or not.


    Germinomatous/

    Differentiated

    Embryonic

    Teratoma

    • AFP
    • MSAFP
    • CT scans are often used to diagnose teratoma.


    • For malignant teratomas, usually, surgery is followed by chemotherapy.
    • Teratomas that are in surgically inaccessible locations, or are very complex, or are likely to be malignant (due to late discovery and/or treatment) sometimes are treated first with chemotherapy.

    Extraembryonic

    Choriocarcinoma(Gestational Trophoblastic Neoplasia)[1][2][3][4][5][6][7][8]

    Early Symptoms:

    Rare Symptoms:

    Late Symptoms

    Gross pathological:

    Microscopic histopathological:


    Human chorionic gonadotropin (HCG or b-HCG) is the most common tumor marker test used to diagnose GTD

    HCG is markedly elevated (usu. >10,000 IU



    Poor prognosis of gestational trophoblastic neoplasia (GTN) can be determined by the following factors:

    Yolk sac tumor

    (Endodermal sinus tumor)

    Symptoms:[9][10]


      • On gross pathology:
      • Encaptulated, firm, smooth, round, globular, solid gray-white with a gelatinous, myxoid, or mucoid appearance, necrosis, cystic changes, and hemorrhage are characteristic findings of endodermal sinus tumor.
      • On microscopic histopathological analysis:
      • Schiller-Duval bodies (invaginated papillary structures with central vessel) is a characteristic finding of endodermal sinus tumor. The tumors are composed of irregular space lined by flattened to cuboidal cells and recticular stroma
    • An elevated concentration of serum alpha feto-protein is diagnostic of endodermal sinus tumor. [12]
    • AFP is very important for diagnosis, disease monitoring and early metastasis
    • Endodermal sinus tumor may also be diagnosed using biopsy and measurement of GATA-4, a transcription factor[13]

    References

    1. Signs and symptoms of gestational trophoblastic disease. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/gestational-trophoblastic-disease/signs-and-symptoms/?region=ns Accessed on October 10, 2015
    2. Ober, William B.; Edgcomb, John H.; Price, Edward B. (1971). "THE PATHOLOGY OF CHORIOCARCINOMA". Annals of the New York Academy of Sciences. 172 (10 Physiology a): 299–426. doi:10.1111/j.1749-6632.1971.tb34943.x. ISSN 0077-8923.
    3. Smith, Harriet O.; Kohorn, Ernest; Cole, Laurence A. (2005). "Choriocarcinoma and Gestational Trophoblastic Disease". Obstetrics and Gynecology Clinics of North America. 32 (4): 661–684. doi:10.1016/j.ogc.2005.08.001. ISSN 0889-8545.
    4. Cellular Classification of Gestational Trophoblastic Disease. National Cancer Institute. http://www.cancer.gov/types/gestational-trophoblastic/hp/gtd-treatment-pdq/#section/_5 Accessed on October 8, 2015
    5. Young RH, Scully RE (March 1984). "Placental-site trophoblastic tumor: current status". Clin Obstet Gynecol. 27 (1): 248–58. PMID 6200262.
    6. Allison KH, Love JE, Garcia RL (December 2006). "Epithelioid trophoblastic tumor: review of a rare neoplasm of the chorionic-type intermediate trophoblast". Arch. Pathol. Lab. Med. 130 (12): 1875–7. doi:10.1043/1543-2165(2006)130[1875:ETTROA]2.0.CO;2. PMID 17149967.
    7. Diagnosing gestational trophoblastic disease. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/gestational-trophoblastic-disease/diagnosis/?region=ns Accessed on October 13, 2015
    8. Choriocarcinoma. librepathology.org. http://librepathology.org/wiki/index.php/Choriocarcinoma Accessed on October 8, 2015
    9. Hoffman, Barbara (2012). Williams gynecology. New York: McGraw-Hill Medical. ISBN 9780071716727.
    10. Gershenson DM, Del Junco G, Herson J, Rutledge FN (1983). "Endodermal sinus tumor of the ovary: the M. D. Anderson experience". Obstet Gynecol. 61 (2): 194–202. PMID 6185892.
    11. Hoffman, Barbara (2012). Williams gynecology. New York: McGraw-Hill Medical. ISBN 9780071716727.
    12. Talerman A, Haije WG, Baggerman L (1980). "Serum alphafetoprotein (AFP) in patients with germ cell tumors of the gonads and extragonadal sites: correlation between endodermal sinus (yolk sac) tumor and raised serum AFP". Cancer. 46 (2): 380–5. doi:10.1002/1097-0142(19800715)46:2<380::aid-cncr2820460228>3.0.co;2-u. PMID 6155988.
    13. Siltanen S, Anttonen M, Heikkilä P, Narita N, Laitinen M, Ritvos O; et al. (1999). "Transcription factor GATA-4 is expressed in pediatric yolk sac tumors". Am J Pathol. 155 (6): 1823–9. doi:10.1016/S0002-9440(10)65500-9. PMC 1866939. PMID 10595911.
    14. 14.0 14.1 Jung SE, Lee JM, Rha SE, Byun JY, Jung JI, Hahn ST (2002). "CT and MR imaging of ovarian tumors with emphasis on differential diagnosis". Radiographics. 22 (6): 1305–25. doi:10.1148/rg.226025033. PMID 12432104.
    15. Hung JH, Shen SH, Hung J, Lai CR (2007). "Ultrasound and magnetic resonance images of endodermal sinus tumor". J Chin Med Assoc. 70 (11): 514–8. doi:10.1016/S1726-4901(08)70052-2. PMID 18063508.
    16. Kato N, Tamura G, Fukase M, Shibuya H, Motoyama T (2003). "Hypermethylation of the RUNX3 gene promoter in testicular yolk sac tumor of infants". Am J Pathol. 163 (2): 387–91. doi:10.1016/S0002-9440(10)63668-1. PMC 1868235. PMID 12875960.
    17. 17.0 17.1 17.2 "Definition of endodermal sinus tumor - NCI Dictionary of Cancer Terms - National Cancer Institute".
    18. Stage Information for Ovarian Germ Cell Tumors. http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_8. URL Accessed on November 5, 2015

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