Testis and epididymis
Germ cell tumors
Embryonal carcinoma

Author: Turki Al-Hussain, M.D. (see Authors page)

Revised: 3 July 2017, last major update January 2013

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed Search: Embryonal carcinoma [title] testis

Cite this page: Embryonal carcinoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/testisembryonal.html. Accessed July 21st, 2017.
Definition / general
  • Usually age 20 - 30's
  • Pure tumors represent 2% of germ cell tumors but 85% of NSGCT have embryonal carcinoma component
  • 65% have metastases at diagnosis, often with associated symptoms (back pain, dyspnea, neurologic symptoms)
Treatment
  • Treatment is controversial; as 97% of stage I are disease free after orchiectomy; some recommend watchful waiting, others retroperitoneal lymph node dissection and chemotherapy if nodal metastases are present
  • For advanced disease, give cisplatin based chemotherapy and remove residual masses
Gross description
  • Usually doesn't replace entire testes
  • Variegated or pale gray, poorly demarcated with hemorrhage and necrosis
  • Usually invades tunica albuginea, mean size 2.5 cm
Gross images

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Pure embryonal carcinoma

Gray white mottled appearance

Embryonal carcinoma and teratoma

Microscopic (histologic) description
  • Solid, pseudoglandular, alveolar, tubular or papillary patterns
  • Primitive epithelial type cells with minimal features of differentiation
  • High grade features of large, epithelioid, anaplastic cells with prominent nucleoli, indistinct cell borders with nuclear overlapping, pleomorphism, frequent mitoses
  • Also giant cells with granular, pink, amphophilic cytoplasm
  • Often mixed with other nonseminomatous germ cell tumors
  • No distinct fibrous septa
  • Intratubular embryonal carcinoma often present adjacent to invasive lesion, often with calcifications
  • Stromal component suggests presence of teratoma
  • Vascular invasion may be artifactual (loosely cohesive cells that don't conform to shape of vessel); true vascular invasion (groups of cells that conform to shape of vessel or are adherent by thrombus) is a poor prognostic factor and should be reported
Microscopic (histologic) images

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Sheets of blue cells

Primitive, anaplastic cells

Coagulative necrosis

Papillary pattern

Abundant cytoplasm

Solid sheets of anaplastic cells


Syncytio-trophoblast

Immature stroma

Intratubular

Intratubular - CD30+

CD30+

Positive stains
Negative stains
Electron microscopy description
  • Poorly differentiated adenocarcinoma with long tight junctions, prominent Golgi complex, cytoplasmic inclusions, irregular nucleus with large complex nucleolus
Differential diagnosis
  • Extratesticular site: poorly differentiated carcinoma (EMA+, PLAP-, mucin+)