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.
Page views in 2020: 1,204
Page views in 2021 to date: 388
Cite this page: Asadbeigi S, Hassan O. Nonseminomatous germ cell tumors-general. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/testisnsgctgeneral0.html. Accessed January 23rd, 2021.
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
  • 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
  • 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
  • Testis, ovaries, mediastinum and brain
Etiology and Pathophysiology
Clinical features
  • 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
  • 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.
Missing Image Missing Image

Teratoma, postpubertal type

Missing Image

YST, microcystic pattern

Missing Image

Embryonal carcinoma (EC) intermixed with YST

Missing Image

YST, reticular and microcystic patterns

Missing Image


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 style answer #1

Comment Here
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 style answer #2
D. Rete testis

Comment Here
Back to top
Image 01 Image 02