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Table of Contents
Definition / general | Treatment | Gross description | Gross images | Microscopic (histologic) description | Microscopic (histologic) images | Positive stains | Negative stains | Electron microscopy description | Differential diagnosisCite this page: Embryonal carcinoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/testisembryonal.html. Accessed July 15th, 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
Images hosted on other servers:
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
Images hosted on other servers:
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
- Cytokeratin, CD30, PLAP, Oct3 / 4, SALL4, SOX2 (Am J Surg Pathol 2007;31:836)
- hCG or AFP in mixed tumors
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+)
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