Diffuse embryoma with intratubular germ-cell neoplasia
- [Show abstract] [Hide abstract] ABSTRACT: The variety of morphologic patterns of different entities of the genitourinary tract can present a diagnostic dilemma for the pathologist. This is especially true in cases of mimics of cancer, a cancer of unknown primary, or poorly differentiated tumors, in which it is hard to assign histogenesis needed to plan the correct therapy for the patient. Immunohistochemistry offers a better capacity than hematoxylin-eosin staining alone to differentiate human tissue types. Also, in the past decades, several techniques had been developed to differentiate between benign and malignant processes with morphologic overlap. By using immunohistochemistry in selected cases, the rate of false-negative and false-positive diagnoses can be reduced, and some patients are afforded the opportunity to get more specific or effective therapy as a result. For each subgroup of genitourinary system tumors, common diagnostic problems are reviewed, and immunohistochemical markers useful in addressing these problems are discussed, along with expected patterns of immunoreactivity. The pertinent literature, with focus on immunohistochemical staining of tumors of the genitourinary tract. The addition of immunohistochemistry to the diagnostic armamentarium for genitourinary pathologic diagnosis has increased the sensitivity and specificity of diagnoses and aided in the selection of optional therapeutic regimens in selected cases.
- [Show abstract] [Hide abstract] ABSTRACT: Diffuse embryoma of the testis is a very rare, distinct form of mixed germ cell tumor. I report here on a case of diffuse embryoma in a 22-year-old male who presented with painful scrotal swelling. The resected testis was entirely occupied by a non-encapsulated tumor mass. The cut surface of the tumor was grey or whitish pink, soft and granular with foci of hemorrhage and necrosis. Microscopically, the tumor was characterized by a diffuse, orderly arrangement of embryonal carcinoma and yolk sac tumor in almost equal proportions. The yolk sac tumor component was diffusely wrapped around the embryonal carcinoma. Syncytiotrophoblasts were scattered throughout the tumor. Minor foci of immature teratoma, seminoma and intratubular germ cell neoplasia were observed. The yolk sac tumor (YST) component was emphasized by immunoreactivity for alpha fetoprotetn, whereas the embryonal carcinoma was reactive for CD30. The strong reactivity for cytokeratin in the YST component formed an outstanding contrast to the weak cytokeratin reactivity in the embryonal carcinoma.
- [Show abstract] [Hide abstract] ABSTRACT: Diagnostic work-up when a testicular cancer is suspected includes a clinical examination, determination of risk factors, imaging and serum tumours markers. Tumour markers are useful in the diagnosis and staging of disease, for monitor the therapeutic response and to detect tumour recurrence. The alpha- fetoprotein (AFP) and beta-human chorionic gonadotropin (beta-hCG) are well established as serum markers for GCTs of the testis, lactate dehydrogenase (LDH) and placental-like alkaline phosphatase (PLAP) may be alternative serological markers with less specifity. However, these markers are increased in only about 60 per cent of patients with testicular cancer. Therefore, additional tumour markers would facilitate clinical diagnosis and treatment in these patients. In this review we have evaluated the clinical application of several markers of testis cancers in serum, semen and tissue samples. Immunohistochemistry detection of some of these being solid new markers in addition to the routinely used but none have been shown to be superior to the classical markers in serum and semen samples. Further research is need in this context for the detection of new markers.
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