Testis & epididymis
Nonseminomatous germ cell tumors-general


Topic Completed: 1 January 2013

Minor changes: 6 July 2020

Copyright: 2002-2019, PathologyOutlines.com, Inc.

PubMed Search: Nonseminomatous germ cell tumors [title] (NSGCT)

Sepideh Nikki Asadbeigi, M.D.
Oudai Hassan, M.D.
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Cite this page: Asadbeigi S, Hassan O. Nonseminomatous germ cell tumors-general. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/testisnsgctgeneral0.html. Accessed October 29th, 2020.
Definition / general
  • A group of germ cell tumors different than seminoma
  • More aggressive than seminoma
  • It is recommended to list components with percentage involvement
  • Do not overlook yolk sac tumor (YST) foci or nongerm cell component
Essential features
  • Modal age of NSGCT is a decade earlier than seminoma
  • More aggressive than seminoma
  • Variegated appearance grossly, since usually a mixture of different components
  • Differential diagnosis includes: seminoma, sex cord stromal tumor, lymphoma and metastatic carcinoma
Terminology
  • Malignant mixed germ cell tumor, embryonal carcinoma, yolk sac tumor (YST), teratoma postpubertal type, choriocarcinoma, nonchoriocarcinomatous trophoblastic tumors
ICD coding
  • ICD-10: C62.90 - malignant neoplasm of unspecified testis, unspecified whether descended or undescended
Epidemiology
  • Testicular germ cell tumors account for 1% of all male cancers worldwide (Andrology 2015;3:4)
  • Majority of male GCT are seminomas and mixed seminoma and NSGCT
  • Modal age of NSGCT is a decade earlier than seminoma
  • Nonseminomatous germ cell tumors constitutes slightly less than half of testicular germ cell tumors (Andrology 2015;3:4)
  • Embryonal carcinoma (EC) is the second most common pure testicular GCT, represent 10.8% of pure germ cell tumors (Andrology 2018 Dec 21 [Epub ahead of print])
  • YST 75% to 80% of all childhood testicular neoplasms
  • Choriocarcinoma present in 7 - 8% of mixed GCT
Sites
  • Testis, ovaries, mediastinum and brain
Etiology and Pathophysiology
Clinical features
Laboratory
  • Elevated LDH, α Fetoprotein and β HCG
Radiology description
  • Cystic and solid intratesticular mass
  • Teratoma tend to be well circumscribed with complex architecture due to different components
Prognostic factors
  • Poor prognostic factors include: higher age, retroperitoneal primary disease, mediastinal primary disease, bone metastases, liver metastases, pulmonary metastases and increased levels of tumor markers (Eur Urol 2017;71:290)
Case reports
Treatment
  • Surgery plus chemotherapy
Gross description
  • Variegated appearance since usually a mixture of different components
  • May have areas of hemorrhage and necrosis in choriocarcinoma
  • May be focally cystic and may have mucinous cut surface in YST
Gross images

Images hosted on other servers:

Embryonal carcinoma and mature teratoma

Seminoma and immature teratoma

Mixed germ cell tumor

Large areas of necrosis

Soft yellow areas

Microscopic (histologic) description
  • Embryonal carcinoma: solid sheets, tubular papillary architecture, primitive cells with indistinct cell borders, marked nuclear atypia
  • Yolk sac tumor: simultaneous presence of a myriad of histologic patterns, microcystic / reticular pattern is the most common, myxoid stroma, Schiller-Duval bodies, extracellular and intracellular hyaline globules
  • Choriocarcinoma: plexiform admixture of syncitiotrophoblasts, cytotrophoblasts and intermediate trophoblasts
  • Teratoma, postpubertal type: virtually any epithelial or mesenchymal component can be seen; degrees of cytologic atypia is allowed in both epithelial and mesenchymal component and does not mean somatic malignant transformation
Microscopic (histologic) images

Contributed by Oudai Hassan, M.D.
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Teratoma, postpubertal type

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YST, microcystic pattern

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Embryonal carcinoma (EC) intermixed with YST

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YST, reticular and microcystic patterns

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Choriocarcinoma

Positive stains
Negative stains
Molecular / cytogenetics description
Sample pathology report
  • Testes, right, orcchiectomy:
    • Malignant mixed germ cell tumor, consisting of teratoma (70%), yolk sac tumor(20%) and embryonal carcinoma (10%).
    • Tumor measures 5 cm in greatest dimension.
    • Surgical resection margins are negative.
    • The tumor is organ confined.
    • No lymph-vascular space invasion is identified.
    • Gem cell neoplasia in situ.
    • Please see cancer checklist below for more details.
Differential diagnosis
Board review style question #1

    A 26 year old man presents with hemoptysis. A physical examination highlights the presence of a right testicular mass. Serum Β-HCG titer was 4650 mIU/mL. The orchiectomy specimen shows a hemorrhagic tumor which consists of a mixture of multinucleated cells and small mononuclear cuboidal cells. Which marker highlights the mononuclear cells?

  1. CD30
  2. GATA3
  3. OCT 3/4
  4. P63
Board review answer #1
B. GATA3

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Board review style question #2
    Invasion of which of the following structures is compatible with pathologic stage 1 in germ cell tumors?

  1. Epididymis
  2. Hilar soft tissue
  3. Lymph vascular spaces
  4. Rete testis
Board review answer #2
D. Rete testis

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