Difference between revisions of "Germ cell neoplasia in situ"

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| Image      = Intratubular germ cell neoplasia - 2 - very high mag.jpg
| Image      = Intratubular germ cell neoplasia - 2 - very high mag.jpg
| Width      =
| Width      =
| Caption    = ITGCN (left of image). [[H&E stain]].
| Caption    = GCNIS (left of image). [[H&E stain]].
| Synonyms  =
| Synonyms  =
| Micro      = "large" round or polygonal nuclei, prominent nucleoli, clear cytoplasm, +/-cells (completely) fill the tubule  
| Micro      = "large" round or polygonal nuclei, prominent nucleoli, clear cytoplasm, +/-cells (completely) fill the tubule  
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*Not all germ cell tumours (GCTs) arise from ''intratubular germ cell neoplasia''.  
*Not all germ cell tumours (GCTs) arise from ''intratubular germ cell neoplasia''.  


The following testicular GCTs do not arise from ITGCN:
The following testicular GCTs do not arise from GCNIS:
*[[Spermatocytic seminoma]].<ref>{{cite journal |author=Müller J, Skakkebaek NE, Parkinson MC |title=The spermatocytic seminoma: views on pathogenesis |journal=Int. J. Androl. |volume=10 |issue=1 |pages=147–56 |year=1987 |month=February |pmid=3583416 |doi= |url=}}</ref>
*[[Spermatocytic tumour]].<ref name=pmid2837162>{{cite journal |author=Müller J, Skakkebaek NE, Parkinson MC |title=The spermatocytic seminoma: views on pathogenesis |journal=Int. J. Androl. |volume=10 |issue=1 |pages=147–56 |year=1987 |month=February |pmid=3583416 |doi= |url=}}</ref>
*[[Yolk sac tumour]]s (endodermal sinus tumour).<ref>{{cite journal |author=Manivel JC, Simonton S, Wold LE, Dehner LP |title=Absence of intratubular germ cell neoplasia in testicular yolk sac tumors in children. A histochemical and immunohistochemical study |journal=Arch. Pathol. Lab. Med. |volume=112 |issue=6 |pages=641–5 |year=1988 |month=June |pmid=2837162 |doi= |url=}}</ref>
*[[Yolk sac tumour]]s (endodermal sinus tumour).<ref>{{cite journal |author=Manivel JC, Simonton S, Wold LE, Dehner LP |title=Absence of intratubular germ cell neoplasia in testicular yolk sac tumors in children. A histochemical and immunohistochemical study |journal=Arch. Pathol. Lab. Med. |volume=112 |issue=6 |pages=641–5 |year=1988 |month=June |pmid=2837162 |doi= |url=}}</ref>
*Teratoma.{{Fact}}
*Teratoma.{{Fact}}
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====Case 1====
====Case 1====
<gallery>
<gallery>
Image: Intratubular germ cell neoplasia - intermed mag.jpg | ITGCN - intermed. mag.
Image: Intratubular germ cell neoplasia - intermed mag.jpg | GCNIS (ITGCN) - intermed. mag.
Image: Intratubular germ cell neoplasia - high mag.jpg | ITGCN - high mag.
Image: Intratubular germ cell neoplasia - high mag.jpg | GCNIS (ITGCN) - high mag.
Image: Intratubular germ cell neoplasia - very high mag.jpg | ITGCN - very high mag.
Image: Intratubular germ cell neoplasia - very high mag.jpg | GCNIS (ITGCN) - very high mag.
Image: Intratubular germ cell neoplasia - 2 - very high mag.jpg | ITGCN - very high mag.
Image: Intratubular germ cell neoplasia - 2 - very high mag.jpg | GCNIS (ITGCN) - very high mag.
</gallery>
</gallery>
====Case 2====
====Case 2====
<gallery>
<gallery>
Image:Intratubular_germ_cell_neoplasia_high_mag_cropped.jpg | ITGCN - cropped. (WC/Nephron)
Image:Intratubular_germ_cell_neoplasia_high_mag_cropped.jpg | GCNIS (ITGCN) - cropped. (WC/Nephron)
Image:Intratubular_germ_cell_neoplasia_high_mag.jpg | ITGCN. (WC/Nephron)
Image:Intratubular_germ_cell_neoplasia_high_mag.jpg | GCNIS (ITGCN). (WC/Nephron)
</gallery>
</gallery>
====Case 3====
====Case 3====
<gallery>
<gallery>
Image: ITGCN and Sertoli cells only -- intermed mag.jpg | ITGCN & SCO - intermed. mag.
Image: ITGCN and Sertoli cells only -- intermed mag.jpg | GCNIS (ITGCN) & SCO - intermed. mag.
Image: ITGCN and Sertoli cells only -- high mag.jpg | ITGCN & SCO - high mag.
Image: ITGCN and Sertoli cells only -- high mag.jpg | GCNIS (ITGCN) & SCO - high mag.


Image: ITGCN and Sertoli cells only - PLAP -- intermed mag.jpg | ITGCN & SCO - intermed. mag.
Image: ITGCN and Sertoli cells only - PLAP -- intermed mag.jpg | GCNIS (ITGCN) & SCO - intermed. mag.
Image: ITGCN and Sertoli cells only - PLAP -- high mag.jpg | ITGCN & SCO - high mag.
Image: ITGCN and Sertoli cells only - PLAP -- high mag.jpg | GCNIS (ITGCN) & SCO - high mag.
Image: ITGCN and Sertoli cells only - PLAP -- very high mag.jpg | ITGCN & SCO - very high mag.
Image: ITGCN and Sertoli cells only - PLAP -- very high mag.jpg | GCNIS (ITGCN) & SCO - very high mag.
</gallery>
</gallery>
====www====
====www====
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==IHC==
==IHC==
===ISUP consensus===
===ISUP consensus===
ITGCN versus atypical intratubular germ cells:<ref name=pmid25025364>{{Cite journal  | last1 = Amin | first1 = MB. | last2 = Epstein | first2 = JI. | last3 = Ulbright | first3 = TM. | last4 = Humphrey | first4 = PA. | last5 = Egevad | first5 = L. | last6 = Montironi | first6 = R. | last7 = Grignon | first7 = D. | last8 = Trpkov | first8 = K. | last9 = Lopez-Beltran | first9 = A. | title = Best practices recommendations in the application of immunohistochemistry in urologic pathology: report from the international society of urological pathology consensus conference. | journal = Am J Surg Pathol | volume = 38 | issue = 8 | pages = 1017-22 | month = Aug | year = 2014 | doi = 10.1097/PAS.0000000000000254 | PMID = 25025364 }}</ref>
GCNIS (ITGCN) versus atypical intratubular germ cells:<ref name=pmid25025364>{{Cite journal  | last1 = Amin | first1 = MB. | last2 = Epstein | first2 = JI. | last3 = Ulbright | first3 = TM. | last4 = Humphrey | first4 = PA. | last5 = Egevad | first5 = L. | last6 = Montironi | first6 = R. | last7 = Grignon | first7 = D. | last8 = Trpkov | first8 = K. | last9 = Lopez-Beltran | first9 = A. | title = Best practices recommendations in the application of immunohistochemistry in urologic pathology: report from the international society of urological pathology consensus conference. | journal = Am J Surg Pathol | volume = 38 | issue = 8 | pages = 1017-22 | month = Aug | year = 2014 | doi = 10.1097/PAS.0000000000000254 | PMID = 25025364 }}</ref>
*OCT4 +ve.
*OCT4 +ve.


Alternates:
Alternates:
*[[PLAP]] +ve.<ref>{{Cite journal  | last1 = Schreiber | first1 = L. | last2 = Lifschitz-Mercer | first2 = B. | last3 = Paz | first3 = G. | last4 = Yavetz | first4 = H. | last5 = Elliott | first5 = DJ. | last6 = Kula | first6 = K. | last7 = Slowikowska-Hilczer | first7 = J. | last8 = Maymon | first8 = BB. | title = Double immunolabeling by the RBM and the PLAP markers for identifying intratubular (in situ) germ cell neoplasia of the testis. | journal = Int J Surg Pathol | volume = 11 | issue = 1 | pages = 17-20 | month = Jan | year = 2003 | doi =  | PMID = 12598912 }}</ref>
*[[PLAP]] +ve.<ref name=pmid12598912>{{Cite journal  | last1 = Schreiber | first1 = L. | last2 = Lifschitz-Mercer | first2 = B. | last3 = Paz | first3 = G. | last4 = Yavetz | first4 = H. | last5 = Elliott | first5 = DJ. | last6 = Kula | first6 = K. | last7 = Slowikowska-Hilczer | first7 = J. | last8 = Maymon | first8 = BB. | title = Double immunolabeling by the RBM and the PLAP markers for identifying intratubular (in situ) germ cell neoplasia of the testis. | journal = Int J Surg Pathol | volume = 11 | issue = 1 | pages = 17-20 | month = Jan | year = 2003 | doi =  | PMID = 12598912 }}</ref>
*D2-40 +ve.
*D2-40 +ve.


Revision as of 23:10, 15 March 2016

Germ cell neoplasia in situ
Diagnosis in short

GCNIS (left of image). H&E stain.
LM "large" round or polygonal nuclei, prominent nucleoli, clear cytoplasm, +/-cells (completely) fill the tubule
Subtypes undifferentiated, differentiated (intratubular seminoma, intratubular embyronal carcinoma)
LM DDx seminoma, embryonal carcinoma, Sertoli cell-only syndrome
IHC OCT4, PLAP +ve, D2-40 +ve
Site testis
Prognosis premalignant
Treatment radiotherapy (?)

Germ cell neoplasia in situ, abbreviated GCNIS, is a premalignant lesion of the testis.

It was previously known previously known as intratubular germ cell neoplasia (abbreviated ITGCN) and testicular intraepithelial neoplasia.[1][2]

General

  • Considered the precursor lesion for germ cell tumours.
  • Not all germ cell tumours (GCTs) arise from intratubular germ cell neoplasia.

The following testicular GCTs do not arise from GCNIS:

Classification:[5]

  • Undifferentiated ITGCN.
  • Differentiated ITGCN.[6]
    • Intratubular embryonal carcinoma.
    • Intratubular seminoma.

Treatment:

  • Radiotherapy.[1]

Microscopic

Features:[7][8]

  • "Large" round or polygonal nuclei.
    • Size in relation to normal often not defined.
      • Rakheja et al. say >= 5x a lymphocyte for intratubular embryonal carcinoma.[5]
    • Polygonal nuclei = squared-off nuclear membrane.
  • Prominent nucleoli - key feature.
  • Clear cytoplasm - important.
  • +/-Cells fill the tubule.

Note:

  • Sertoli cells may have a nucleolus... but they have eosinophilic ctyoplasm.[citation needed]

DDx:

  • Sertoli cell-only syndrome - Sertoli cells also have nucleoli, wind swept appearance.[9]
  • Seminoma - especially intratubular predominant growth pattern.
  • Embryonal carcinoma.

Images

Case 1

  • GCNIS (ITGCN) - intermed. mag.

  • GCNIS (ITGCN) - high mag.

  • GCNIS (ITGCN) - very high mag.

  • GCNIS (ITGCN) - very high mag.

Case 2

  • GCNIS (ITGCN) - cropped. (WC/Nephron)

  • GCNIS (ITGCN). (WC/Nephron)

Case 3

  • GCNIS (ITGCN) & SCO - intermed. mag.

  • GCNIS (ITGCN) & SCO - high mag.

  • GCNIS (ITGCN) & SCO - intermed. mag.

  • GCNIS (ITGCN) & SCO - high mag.

  • GCNIS (ITGCN) & SCO - very high mag.

www

IHC

ISUP consensus

GCNIS (ITGCN) versus atypical intratubular germ cells:[10]

  • OCT4 +ve.

Alternates:

Others

  • CD117 +ve.
    • Disputed: doesn't differentiate neoplastic from non-neoplastic according to Biermann et al.[12]
  • OCT3/4 +ve.

See also

References

  1. ↑ 1.0 1.1 Dieckmann, KP.; Wilken, S.; Loy, V.; Matthies, C.; Kleinschmidt, K.; Bedke, J.; Martinschek, A.; Souchon, R. et al. (May 2013). "Treatment of testicular intraepithelial neoplasia (intratubular germ cell neoplasia unspecified) with local radiotherapy or with platinum-based chemotherapy: a survey of the German Testicular Cancer Study Group.". Ann Oncol 24 (5): 1332-7. doi:10.1093/annonc/mds628. PMID 23293116.
  2. ↑ Berney, DM.; Looijenga, L.; Idrees, M.; Oosterhuis, JW.; Rajpert-De Meyts, E.; Ulbright, TM.; Skakkebaek, NE. (Feb 2016). "Germ Cell Neoplasia In Situ (GCNIS). Evolution of the Current Nomenclature for Testicular Pre-invasive Germ Cell Malignancy.". Histopathology. doi:10.1111/his.12958. PMID 26918959.
  3. ↑ Müller J, Skakkebaek NE, Parkinson MC (February 1987). "The spermatocytic seminoma: views on pathogenesis". Int. J. Androl. 10 (1): 147–56. PMID 3583416.
  4. ↑ Manivel JC, Simonton S, Wold LE, Dehner LP (June 1988). "Absence of intratubular germ cell neoplasia in testicular yolk sac tumors in children. A histochemical and immunohistochemical study". Arch. Pathol. Lab. Med. 112 (6): 641–5. PMID 2837162.
  5. ↑ 5.0 5.1 5.2 Rakheja, D.; Hoang, MP.; Sharma, S.; Albores-Saavedra, J. (Apr 2002). "Intratubular embryonal carcinoma.". Arch Pathol Lab Med 126 (4): 487-90. doi:10.1043/0003-9985(2002)1260487:IEC2.0.CO;2. PMID 11900581. http://www.archivesofpathology.org/doi/full/10.1043/0003-9985(2002)126%3C0487:IEC%3E2.0.CO;2.
  6. ↑ Lau, SK.; Weiss, LM.; Chu, PG. (Jul 2007). "Association of intratubular seminoma and intratubular embryonal carcinoma with invasive testicular germ cell tumors.". Am J Surg Pathol 31 (7): 1045-9. doi:10.1097/PAS.0b013e31802b8712. PMID 17592271.
  7. ↑ URL: http://www.webpathology.com/image.asp?case=30&n=1. Accessed on: 18 May 2010.
  8. ↑ Gondos, B.; Migliozzi, JA. (Nov 1987). "Intratubular germ cell neoplasia.". Semin Diagn Pathol 4 (4): 292-303. PMID 3328244.
  9. ↑ URL: http://www.webpathology.com/image.asp?n=3&Case=28. Accessed on: 25 March 2013.
  10. ↑ Amin, MB.; Epstein, JI.; Ulbright, TM.; Humphrey, PA.; Egevad, L.; Montironi, R.; Grignon, D.; Trpkov, K. et al. (Aug 2014). "Best practices recommendations in the application of immunohistochemistry in urologic pathology: report from the international society of urological pathology consensus conference.". Am J Surg Pathol 38 (8): 1017-22. doi:10.1097/PAS.0000000000000254. PMID 25025364.
  11. ↑ Schreiber, L.; Lifschitz-Mercer, B.; Paz, G.; Yavetz, H.; Elliott, DJ.; Kula, K.; Slowikowska-Hilczer, J.; Maymon, BB. (Jan 2003). "Double immunolabeling by the RBM and the PLAP markers for identifying intratubular (in situ) germ cell neoplasia of the testis.". Int J Surg Pathol 11 (1): 17-20. PMID 12598912.
  12. ↑ Biermann, K.; Stoop, H.; Looijenga, L. (May 2012). "c-KIT protein expression does not discriminate neoplastic from non-neoplastic intratubular germ cells.". Histopathology 60 (6): 1017-9. doi:10.1111/j.1365-2559.2011.04157.x. PMID 22340755.
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