Primary mediastinal germ cell tumor with intratubular germ cell neoplasia of the testis--further support for germ cell origin of these tumors: a case report.
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The histogenesis of extragonadal germ cell tumors remains an enigma. The majority of patients with retroperitoneal tumors are male, and careful histologic evaluation reveals preinvasive intratubular germ cell neoplasia (ITGCN) or scars in the testis suggesting a so-called "burnt out" germ cell tumor. However, in the testes of patients with primary mediastinal germ cell tumors, no ITGCN has been described in the literature to date. The authors report the first case of simultaneous germ cell neoplasia in the mediastinum and the testis, providing further insights into the biology and origin of these lesions.The authors report the pathologic features and cytogenetic findings in an adult male with a mediastinal germ cell tumor and asymmetric testis. This patient died shortly after diagnosis.A locally invasive mediastinal nonseminomatous germ cell tumor was associated with ITGCN in one testis. Metastases were not present clinically or on autopsy during a detailed and systematic examination of retroperitoneal lymph nodes and other viscera. Neither an invasive germ cell tumor nor a scar was found in either testis (both testes were serially sectioned and entirely examined histologically).The findings of this study suggest that the mediastinal tumor is a primary neoplasm with concomitant in situ lesion in one testis, suggesting a more generalized defect of germ cell and thus providing new information about the unresolved issue of the histogenesis of extragonadal germ cell tumors. This article presents a review of the literature concerning the issues highlighted by this case and discusses the hypotheses regarding the development of extragonadal germ cell tumors.Keywords:
Histogenesis
Mediastinal tumor
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One hundred-ninety nine cases of testicular tumours, of which 189 (94,9%) germ cell tumours, have been studied by histological methods. Seminoma with its two subtypes (anaplastic and spermatocytic) is the most frequent tumour (110 cases i.e. 55,2%), followed by embryonal carcinoma (30 cases: 15,3%), teratocarcinoma (25 cases: 13,2%), teratoma (12 cases: 6,3%) and choriocarcinoma (5 cases: 2,6%). Tumours showing more than one histologic pattern are frequent. The distinctive histologic features have studied, with emphasis of those useful for diagnostic and prognostic purposes. The ages mostly involved by various tumours are stressed. The rarest tumours are briefly described. Histologic data suggest that germinal tumours are originated by the same primordial germ cell which is able to develop various degrees of differentiation. Histologic and histogenetic features of limphomas and tumours of specialized gonadal stroma are also discussed.
Teratocarcinoma
Embryonal carcinoma
Dysgerminoma
Histogenesis
Anaplastic carcinoma
Histology
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Embryonal carcinoma
Neoplasm
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The Mixed germ cell tumors of the mediastinum are very quite rare. The Prognosis is generally dominated by the most aggressive component, which is represented by a choriocarcinoma, an endodermal sinus tumor, an embryonal carcinoma, and a seminoma, in descending order of in the degree of malignancy. We experienced one a case of a mixed germ cell tumor at the anterior mediastinum. The patient was 27-year-old male, who complained of hemoptysis and cough. The Chest X-ray showed a well-defined lobulated mediastinal mass in the left upper lung field. The operation was done and The mass was excised surgically. A Biopsy showed elements of mature tissues, immature neuronal components, and seminoma components.
Mediastinal tumor
Embryonal carcinoma
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Thoracotomy
Mediastinal tumor
Anterior mediastinum
Primary tumor
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Observations differ on the pre‐invasive malignant lesions associated with the various categories of testicular germ cell tumours. Such lesions have been found to be similar in appearance and are assumed to be composed of multipotent cells, or conversely a distinctive pre‐invasive stage has been reported in association with each form of germ cell neoplasm. This study was undertaken to see whether distinctive morphological and immunohistochemical features of carcinoma in situ adjacent to various categories of germ cell tumours could be established. Carcinoma in situ adjacent to seminomas, teratomas and mixed germ cell tumours in 18 adults was indistinguishable morphologically. Placental alkaline phosphatase was demonstrated immunohistochemically but vimentin and low molecular weight cytokeratins were uniformly absent in these abnormal germ cells from all three groups. These findings support the concept of a multipotent pre‐invasive malignant cell for both seminoma and teratoma in the adult. Carcinoma in situ was not seen adjacent to 1 5 spermatocytic seminomas, nor was placental alkaline phosphatase demonstrated in tubules adjacent to these tumours. These negative findings are additional evidence that spermatocytic seminoma differs from classical seminoma in its histogenesis. Carcinoma in situ, as defined morphologically and immunohistochemically in adults, was not identified adjacent to yolk sac tumours and differentiated teratomas in 20 prepubertal testes. The possibility that pre‐invasive malignancy in children may not resemble that in adults must be considered when assessing the malignant potential of cryptorchid testes on biopsies taken during orchidopexy.
Histogenesis
Carcinoma in situ
Rete testis
Placental alkaline phosphatase
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Fine needle aspiration cytology was performed on six patients with malignant mediastinal germ cell tumor: 1 pure seminoma, 1 pure embryonal carcinoma, 1 pure yolk sac tumor and 3 mixed germ cell tumors containing teratoma. Their cytologic features were compared with each other and with the cytologic features of thymoma, which arises commonly in the anterior mediastinum. A definitive cytologic diagnosis could be made only in the cases of seminoma because of its characteristic cytologic features. Cytochemical staining for germ cell alkaline phosphatase was helpful in diagnosing seminoma in the cytologic examination, while the presence of hyaline globule or alpha-fetoprotein immunostaining as the cytologic diagnostic feature of yolk sac tumor were not necessarily found in fine needle aspiration cytology. All epithelial, lymphocytic and mixed type thymomas were easily differentiated from the four types of germ cell tumor examined.
Endodermal sinus tumor
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The histogenesis of extragonadal germ cell tumors remains an enigma. The majority of patients with retroperitoneal tumors are male, and careful histologic evaluation reveals preinvasive intratubular germ cell neoplasia (ITGCN) or scars in the testis suggesting a so-called "burnt out" germ cell tumor. However, in the testes of patients with primary mediastinal germ cell tumors, no ITGCN has been described in the literature to date. The authors report the first case of simultaneous germ cell neoplasia in the mediastinum and the testis, providing further insights into the biology and origin of these lesions.The authors report the pathologic features and cytogenetic findings in an adult male with a mediastinal germ cell tumor and asymmetric testis. This patient died shortly after diagnosis.A locally invasive mediastinal nonseminomatous germ cell tumor was associated with ITGCN in one testis. Metastases were not present clinically or on autopsy during a detailed and systematic examination of retroperitoneal lymph nodes and other viscera. Neither an invasive germ cell tumor nor a scar was found in either testis (both testes were serially sectioned and entirely examined histologically).The findings of this study suggest that the mediastinal tumor is a primary neoplasm with concomitant in situ lesion in one testis, suggesting a more generalized defect of germ cell and thus providing new information about the unresolved issue of the histogenesis of extragonadal germ cell tumors. This article presents a review of the literature concerning the issues highlighted by this case and discusses the hypotheses regarding the development of extragonadal germ cell tumors.
Histogenesis
Mediastinal tumor
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Autopsy findings in 20 cases of clinical extragonadal germ-cell tumors arising in the anterior mediastinum are presented. The histologic types were: 2 choriocarcinomas, 3 seminomas, 3 malignant teratomas, 3 embryonal carcinomas, and 9 mixed germ-cell tumors. All of the patients were men, and the ages ranged from 14 to 45 years, with a mean of 32.5 years. The mean survival for these patients after diagnosis was 10.9 months. Local recurrence was characteristic of non-seminomatous tumors. In patients with seminoma, local control of the disease was good, but distant metastases were the cause of death. The most frequent sites of metastases were lungs, bones and liver. In all 20 cases, the testes were carefully step-sectioned. Occult tumor was found in only one case of embryonal carcinoma and a well-defined testicular scar with calcification in a patient with choriocarcinoma. Both patients had lower retroperitoneal metastases. These findings support the premise that, in the majority of cases, these tumors had a primary extragonadal origin.
Occult
Embryonal carcinoma
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Most testicular sarcomas arise from germ cell tumors (GCTs) viz. teratoma or spermatocytic seminoma. Pure intratesticular sarcomas are very rare. We present an autopsy report of non-germ cell primary intratesticular sarcoma with synchronous mediastinal sarcoma and lung metastasis in a young male who presented with symptoms of mediastinal compression and simultaneously had a significant gradually enlarging testicular mass.
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An autopsy case of embryonal carcinoma in the anterior mediastinum developing in a 49‐year‐old male is reported. The tumor showed a great variety of histological patterns, all of which can be regarded as tumor of germ cell origin. Wide‐spread hematogenous metastasis was found especially in the right lung. Specific histological features of Teilum's endodermal sinus tumors may enable their proper identification from thymoma or other types of neoplasm in the mediastinum. The histogenesis of extragonadal germ cell tumors was also discussed. ACTA PATH. JAP. 19: 409˜418, 1969.
Anterior mediastinum
Primary (astronomy)
Embryonal carcinoma
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