A Case of Mixed Germ Cell Tumor of the Mediastinum
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Abstract:
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.Keywords:
Mediastinal tumor
Embryonal carcinoma
The clinical and pathological features of two patients with testicular germ cell tumour are described. The cases illustrate the area of gross and histological overlap between seminoma and solid embryonal carcinoma, for which there are useful distinguishing features which might aid diagnosis.
Embryonal carcinoma
Dysgerminoma
Testicle
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Classical seminoma and embryonal carcinoma are two points in the spectrum of histologic differentiation in testicular germ cell tumors. The validity of an intermediate category, ie, atypical seminoma (AS) is questionable. Histopathologic and clinical data on 42 patients treated for primary testicular germ cell tumor from 1975 to 1985 were reviewed. Twenty-seven cases were identified as classical seminoma and nine were embryonal carcinoma. The remaining six cases were somewhat problematic to classify, combining the growth pattern of seminoma with cytologic features of embryonal carcinoma. Immunocytochemically, four of these tumors suggested some progression towards the embryonal carcinoma phenotype on the basis of cytokeratin expression. Survival for classical seminoma, AS, and embryonal carcinoma were 90%, 80%, and 63% respectively (mean follow-up, 8.6 years). Although the survival differences were not statistically significant, when considered with morphologic and selected immunocytochemical data, they tend to support the concept of an AS as an intermediate lesion between classical seminoma and embryonal carcinoma.
Embryonal carcinoma
Carcinoma in situ
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Embryonal carcinoma
CD117
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The clinical and pathologic features of 30 ovarian mixed germ cell tumors (neoplasms containing combinations of malignant germ cell elements) were studied to determine their behavior and to compare them with pure forms of malignant germ cell tumors. Dysgerminoma was the most common constituent, found in 24 (80%), followed by endodermal sinus tumor in 21 (70%), teratoma in 16 (53%), choriocarcinoma in 6 (20%), and embryonal carcinoma in 5 (16%). The actuarial survival for the entire group was 46%, and for patients with Stage I tumors it was 50%. The most important factors in predicting the prognosis for patients with Stage I disease was the size and the histologic composition of the neoplasm. If more than one-third of a Stage I neoplasm was composed of endodermal sinus tumor, choriocarcinoma, or Grade 3 teratoma, the prognosis was poor, whereas if the tumor contained less than one-third of these components or contained combinations of dysgerminoma, embryonal carcinoma, or Grade 1 or 2 teratoma, the prognosis was excellent. All patients whose neoplasm was less than 10 cm in maximum diameter survived, regardless of the composition of the tumor. Positive pregnancy tests in nonpregnant patients reflected the presence of either frank choriocarcinoma or scattered syncytiotrophoblastic giant cells. The latter did not appear to alter the prognosis. The finding of elevated serum levels of human chorionic gonadotropin (hCG) in 38% of the nonpregnant patients suggested that serial serum assays for hCG might be useful in staging and monitoring the response to treatment in these patients.
Dysgerminoma
Embryonal carcinoma
Immature teratoma
Endodermal sinus tumor
Neoplasm
Human chorionic gonadotropin
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The classic testicular tumor marker alpha-fetoprotein (AFP) is associated with nonseminomatous germ cell tumors, including embryonal carcinoma, yolk sac tumor, and teratoma. AFP is not considered to be produced by pure seminoma. However, postmortem studies have demonstrated that 30 to 45% of patients who died of seminoma initially diagnosed harbored nonseminomatous metastases and had an elevated serum AFP. We analyzed AFP expression by immunohistochemistry and by nested reverse transcription-polymerase chain reaction (RT-PCR) in 10 seminomas, 3 embryonal carcinomas, and 1 immature teratoma, diagnosed by traditional clinical methods. Positive immunohistochemical staining was observed in all embryonal carcinomas and in the teratoma but not in the seminomas. AFP mRNA, however, was found in 6 of 10 seminomas, in all embryonal carcinomas, and in the teratoma. The nucleotide sequence of PCR products was identical with that of the AFP gene. We conclude that the analysis of AFP gene expression by nested RT-PCR would be useful for detecting minute quantities of nonseminomatous germ cell elements in classic seminoma. Moreover, the existence of AFP mRNA suggests the possibility that seminoma cells can differentiate into nonseminomatous germ cells.
Embryonal carcinoma
Alpha-fetoprotein
Testicle
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Embryonal carcinoma
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Positive cases of serum human chorionic gonadotropin (hCG) have been increased in patients with pure seminoma due to the progress of methods of measuring serum hCG. But the positive ratio and the value of serum hCG in pure seminoma cases are lower than those of non-seminoma cases. The relationship between the pathological type of testicular tumor and the hCG levels in both serum and tumor tissue was investigated, and clinical usefulness of the serum hCG levels as a tumor marker of pure seminoma was discussed. The materials were 19 pure seminomas, 14 non-seminomas and 11 normal testes as controls.HCG and hCG-β in tumor tissue extracts and in the serum of blood from the spermatic and peripheral veins were measured by radioimmunoassay (RIA). The tissue content of hCG and hCG-β were 276.7±136.1mIU/g·tissue and 16.5±3.20ng/g·tissue, respectively, in pure seminoma; 224, 376±91, 619mIU/g·tissue and 4, 608±1, 817ng/g·tissue, respectively, in non-seminoma including choriocarcinoma component; 1, 807±1, 428mIU/g·tissue, and 37.0±11.2ng/g·tissue, respectively, in non-seminoma including seminoma component but not including choriocarcinoma component; 20.4±3.1mIU/g·tissue and 1.27±0.38ng/g·tissue, respectively, in normal testes, (each M±SE).The tissue content of hCG-β in pure seminoma is significantly higher than that in normal testis (p<0.01) and significantly lower than that in non-seminoma including choriocarcinoma component. There was no significant difference in hCG and hCG-β in tumor tissue extracts between pure seminoma and non-seminoma including seminoma component, but not including choriocarcinoma component, and between normal control and non-seminoma (yolk sac tumor, mature treatoma, epidermoid cyst) excluding both seminoma and choriocardinoma component. In all patients with pure seminoma, serum hCG or hCG-β of the spermatic vein was higher than those of the peripheral vein.These results strongly suggest that all pure seminomas produce hCG-β like substances. With more precision in measuring hCG, serum hCG may be a clinically useful tumor marker of all pure seminoma. Furthermore, measurement of hCG in the tumor tissue may assist pathological diagnosis of testicular tumors.
Human chorionic gonadotropin
Testicle
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Testicular germ cell tumors represent about 95% of all testicular tumors. They are often composed of many different components. Seminoma usually has a favorable course but the prognosis of mixed germ cell tumors is depending on the type and proportion of different histologic components. The aim of this study was to determine the proportion and histologic type of various components of testicular germ cell tumors diagnosed in the period 1992-2000. In this period there were 131 testicular germ cell tumors with 72 (55.0%) nonseminomatous and 59 (45.0%) seminomatous tumors. Of all nonseminomatous tumors, 4 were composed of one component only, and 68 contained different components. Nonseminomatous tumors contained most commonly embryonal carcinoma (91.7%), teratoma (70.8%) and yolk sac tumor (33.3%) components. The most frequent combination of mixed germ cell tumors was composed of teratoma and embryonal carcinoma in 28 (41.2%) cases. Seminoma was found in 59 cases as pure seminoma and in 19 (26.4%) additional cases represented a component of testicular mixed germ cell tumor. Analysis of deeper sections by means of HE stained slides and immunohistochemistry (cytokeratin, CD30, alpha-fetoprotein, beta-HCG, PLAP and hPL) revealed 20 cases with components that were not described in original biopsy findings. We may conclude that the analysis of many sections using immunohistochemistry is necessary to identify all tumor components.
Embryonal carcinoma
Immature teratoma
Teratocarcinoma
Germinoma
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Two hundred and eight cases of germ cell tumors of the testis were thoroughly studied. Fifty-one (24.5%) were embryonal carcinoma, 115 (55.3%) were seminoma, and 42 (20.2%) contained both embryonal carcinoma and seminoma. The average age of the patients with embryonal carcinoma, seminoma, and combined tumors was 27.6, 38.3, and 30.3 years. Furthermore, in the patients with combined tumors, those having a predominance of embryonal carcinoma had an average age of 28.3 years, while those having a predominance of seminoma had an average age of 33.4 years. This study supports the concept that the malignant potential of germ cells in younger patients is embryonal carcinoma, the malignant potential of germ cells in older patients is seminoma, and that in intermediate-aged patients the germ cells are capable of developing varying amounts of embryonal carcinoma and seminoma in the same tumor.
Embryonal carcinoma
Teratocarcinoma
Dysgerminoma
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Embryonal carcinoma
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