Germ cell tumor pathophysiology: Difference between revisions
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* Accounts for about a third of all [[testicular]] [[Germ cell neoplasm|germ cell]] [[malignancies]] and is one of the most treatable [[cancers]] with a survival rate of 98% to 99% in early-stage disease | * Accounts for about a third of all [[testicular]] [[Germ cell neoplasm|germ cell]] [[malignancies]] and is one of the most treatable [[cancers]] with a survival rate of 98% to 99% in early-stage disease | ||
* Originates in the [[germinal epithelium]] of the [[seminiferous tubules]] as a result from the proliferation of immature [[spermatogonia]] | * Originates in the [[germinal epithelium]] of the [[seminiferous tubules]] as a result from the proliferation of immature [[spermatogonia]] | ||
*On gross [[pathology]], [[seminoma]] is characterized by pale gray to yellow [[nodules]] that are uniform or slightly lobulated and often bulge from the cut surface. | *On gross [[pathology]], [[seminoma]] is characterized by pale gray to yellow [[nodules]] that are uniform or slightly lobulated and often bulge from the cut surface<ref name="pathologyoftesticularseminoma1">Pathology of testicular seminoma. Dr Marcin Czarniecki and Dr Andrew Dixon et al. Radiipaedia 2016. http://radiopaedia.org/articles/testicular-seminoma-1. Accessed on February 29, 2016</ref> | ||
*[[Microscopic]] [[Pathology]]: | *[[Microscopic]] [[Pathology]]: | ||
** On [[microscopic]] [[pathology]], [[seminoma]] is characterized by | ** On [[microscopic]] [[pathology]], [[seminoma]] is characterized by<ref name="pathologyofseminoma1">Microscopic pathology of seminoma. Libre pathology 2016. http://librepathology.org/wiki/Seminoma. Accessed on March 3, 2016</ref> | ||
*:* Cells with [[fried egg]] appearance - '''key feature''' | *:* Cells with [[fried egg]] appearance - '''key feature''' | ||
*::* Clear [[cytoplasm]] | *::* Clear [[cytoplasm]] | ||
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* On microscopic histopathological analysis, uniform cells that resemble [[primordial germ cells]], consisting of large, round cells with vesicular nuclei and clear or finely granular cytoplasm that is eosinophilic are characteristic findings of germinoma. | * On microscopic histopathological analysis, uniform cells that resemble [[primordial germ cells]], consisting of large, round cells with vesicular nuclei and clear or finely granular cytoplasm that is eosinophilic are characteristic findings of germinoma. | ||
* Pure germinomas are composed of large polygonal undifferentiated cells with abundant cytoplasm arranged in nests separated by bands of connective tissue | * Pure germinomas are composed of large polygonal undifferentiated cells with abundant cytoplasm arranged in nests separated by bands of connective tissue | ||
* The histologic appearance of NGGCTs varies depending upon the specific cell types present<ref name="pmid17618441" /> | * The histologic appearance of NGGCTs varies depending upon the specific cell types present<ref name="pmid17618441" /> | ||
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* Genes involved in the pathogenesis of germinoma include gains of 1p, 8p, and 12q and losses of 13q and 18q, duplication of the short arm of chromosome 12, loss of 1p and 6q, alterations in sex chromosomes in children, alterations of the ''p14'' gene, mutations of the ''c-kit'' gene, aberrations of ''CCND2'' (12P13), and ''RB1'', and gain-of-function mutations of ''KIT''. | * Genes involved in the pathogenesis of germinoma include gains of 1p, 8p, and 12q and losses of 13q and 18q, duplication of the short arm of chromosome 12, loss of 1p and 6q, alterations in sex chromosomes in children, alterations of the ''p14'' gene, mutations of the ''c-kit'' gene, aberrations of ''CCND2'' (12P13), and ''RB1'', and gain-of-function mutations of ''KIT''. | ||
* The progression to germinoma usually involves the mutations of the ''KIT/RAS'' signalling or ''AKT1''/mtor pathways and cyclin/''CDK-RB-E2F'' pathway if ''CCND2''(12P13) and ''RB1'' genes are aberrated | * The progression to germinoma usually involves the mutations of the ''KIT/RAS'' signalling or ''AKT1''/mtor pathways and cyclin/''CDK-RB-E2F'' pathway if ''CCND2''(12P13) and ''RB1'' genes are aberrated | ||
== '''Infantile testis teratomas''' == | == '''Infantile testis teratomas''' == | ||
Revision as of 19:10, 13 August 2019
- Germ cells are the cells that develop in the embryo and they make up the reproductive system in males and females.
- After the development of germ cells, they follow the body midline path and descend into the pelvis as ovarian cells or into the scrotal sac as testicular cells.
- Th ovaries and testes are called gonads and many ovarian and testicular tumors have germ cell origin.
- The pathophysiology of germ cell tumors is different based on the classification of germ cell tumors
- Each of the distinct entities of germ cell tumor has a different pathogenesis
Dysgerminoma
- It is understood that ovarian germ cell tumors are the result of the pathologic transformation of primordial germ cells during different stages of the development.
- The pathophysiology of ovarian germ cell tumors depends on the histological subtype.
- Their common origin is believed to be from the primordial germ cells that transformed pathologically in different stages of development.
- Dysgerminoma arises from primordial germ cells, which are gonadal cells that are normally involved in the gametogenesis.
- The majority of dysgerminomas in women present in the stage 1A.
- Bilateral invovlement occurs in 10% to 15% of the cases.
- In < 15% of the affected cases, elements of other germ cell tumors can also be found.
- It is difficult to distinguish subtypes of ovarian germ cell tumor on gross pathology alone.
- The majority of ovarian germ cell tumors have a solid and cysticappearance with areas of hemorrhage and necrosis
- On microscopic pathology, ovarian germ cell tumors may be characterized by a uniform “fried egg” appearance (dysgerminoma), presence of Schiller-Duval bodies (yolk sac tumor), presence of embryonic-like neural, gastrointestinal, and/or cartilaginous tissue (teratoma), or mixed histopathological features (embryonal cell carcinoma).
Testicular Seminoma
- Accounts for about a third of all testicular germ cell malignancies and is one of the most treatable cancers with a survival rate of 98% to 99% in early-stage disease
- Originates in the germinal epithelium of the seminiferous tubules as a result from the proliferation of immature spermatogonia
- On gross pathology, seminoma is characterized by pale gray to yellow nodules that are uniform or slightly lobulated and often bulge from the cut surface[1]
- Microscopic Pathology:
- On microscopic pathology, seminoma is characterized by[2]
- Cells with fried egg appearance - key feature
- Lymphocytes - interspersed (common)
- Syncytiotrophoblasts, present in 10-20% of seminoma
- Large, irregular, vesicular nuclei
- Eosinophilic vacuolated cytoplasm (contains hCG)
- Florid granulomatous reaction
- Approximately 24% of Stage I seminomas have lymphovascular invasion for stage I (Tx, N0, M0).
- Intertubular seminoma may not form a discrete mass and mimic a benign testis.
Germinoma
- On microscopic histopathological analysis, uniform cells that resemble primordial germ cells, consisting of large, round cells with vesicular nuclei and clear or finely granular cytoplasm that is eosinophilic are characteristic findings of germinoma.
- Pure germinomas are composed of large polygonal undifferentiated cells with abundant cytoplasm arranged in nests separated by bands of connective tissue
- The histologic appearance of NGGCTs varies depending upon the specific cell types present[3]
- Infiltrating small lymphocytes are often present and can obscure the diagnosis, especially in small biopsy specimens[3]
- Genes involved in the pathogenesis of germinoma include gains of 1p, 8p, and 12q and losses of 13q and 18q, duplication of the short arm of chromosome 12, loss of 1p and 6q, alterations in sex chromosomes in children, alterations of the p14 gene, mutations of the c-kit gene, aberrations of CCND2 (12P13), and RB1, and gain-of-function mutations of KIT.
- The progression to germinoma usually involves the mutations of the KIT/RAS signalling or AKT1/mtor pathways and cyclin/CDK-RB-E2F pathway if CCND2(12P13) and RB1 genes are aberrated
Infantile testis teratomas
Yolk sac tumors
References
- ↑ Pathology of testicular seminoma. Dr Marcin Czarniecki and Dr Andrew Dixon et al. Radiipaedia 2016. http://radiopaedia.org/articles/testicular-seminoma-1. Accessed on February 29, 2016
- ↑ Microscopic pathology of seminoma. Libre pathology 2016. http://librepathology.org/wiki/Seminoma. Accessed on March 3, 2016
- ↑ 3.0 3.1