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Comparative Study
, 8 (5), 5650-7
eCollection

Extragonadal Malignant Germ Cell Tumors: A Clinicopathological and Immunohistochemical Analysis of 48 Cases at a Single Chinese Institution

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Comparative Study

Extragonadal Malignant Germ Cell Tumors: A Clinicopathological and Immunohistochemical Analysis of 48 Cases at a Single Chinese Institution

Yuping Gao et al. Int J Clin Exp Pathol.

Abstract

Primary extragonadal malignant germ cell tumors (EMGCTs) are rare and characterized by the location in the midline of the body, including mediastinum, CNS, retroperitoneum and coccyx. EMGCTs present with different clinical and biologic characteristics in different tumor locations. Accurately diagnosing MEGCTs would be very difficult by performing on HE staining alone, and requires immunohistochemical verification. This study was to investigate the biological feature of EMGCTs and diagnostic value of immunohistochemical markers OCT3/4, CD117, PLAP, AFP, β-HCG and CD30 in EMGCTs. A retrospective study was performed on 48 patients with EMGCTs. EMGCTs were found to occur predominantly in males, especially for mediastinal MGCTs. The tumor locations included mediastinum, CNS and retroperitoneum. The mediastinum and CNS were the most common sites of EMGCTs. Seminoma/germinomas (64.6%) was the most common histological subtypes of EMGCTs. Chest pain, dyspnea, cough and fever were the most common clinical presentations in mediastinal MGCTs. Headache, visual disturbances, endocrine abnormalities, and signs of increased intracranial pressure were common clinical symptoms in CNS MGCTs. Abdominal mass with or without pain, backache and weight loss were common clinical presentations in retroperitoneal MGCTs. PLAP, CD117 and OCT3/4 were highly expressed in seminomas/gernimomas. CD30, EMA and CK AE1/3 staining were positive in embryonal carcinoma. AFP and β-HCG positive staining are characteristic in yolk sac tumors and choriocarcinoma, respectively. Patients with seminomas/germinomas had a better prognosis than those with NS/G-GCTs. Our finding suggests that the accurate diagnosis of EMGCTs is critical not only for predicting the tumor progression but also for patient management. Immunohistochemical markers have become an important tool in the diagnosis and differential diagnosis of EMGCTs.

Keywords: Extragonada malignant germ cell tumors; diagnosis; immunohistochemistry; prognosis.

Figures

Figure 1
Figure 1
Histological features: A: Germinomas (CNS) are recognized for tumor cells with abundant clear cytoplasm, sheet growth pattern, lymphocytic infiltrating along fibrovascular stroma (HE×200). B: Yolk sac tumors (mediastinum) are composed of clear, columnar epithelial cells arranged in sheets, cords and tubules structures. “Schiller-Duval bodies” is a hallmark of YST (HE×400). C: Embryonal carcinomas (CNS) are characterized by tumors cells organized in sheets, cord, or gland-like structures (HE×200). D: Choriocarcinomas (CNS) are composed of two characteristic cell types: cytotrophoblastic cells and syncytiotrophoblastic giant cells (HE×200). E: Immunostaining for PLAP in serminoma (retroperitoneum) (×200). F: Immunohistochemistry for CD117 showing positive staining in the tumor cells of the germinoma (CNS) (×200). G: Immunohistochemistry for OCT3/4 showing positive staining in the tumor cells of the germinoma (CNS) (×200). H: Immunostaining for AFP in yolk sac tumor (mediastinum) (×200).

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