Difference between revisions of "Yolk sac tumour"

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#redirect [[Germ cell tumours#Yolk sac tumour]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Mixed_germ_cell_tumour_-_very_high_mag.jpg
| Width      =
| Caption    = Yolk sac tumour. [[H&E stain]].
| Micro      = Schiller-Duval bodies (glomerulerus-like structures), variable architecture - usually reticular or microcystic
| Subtypes  =
| LMDDx      = [[embryonal carcinoma]], [[mixed germ cell tumour]]
| Stains    =
| IHC        = AFP +ve
| EM        =
| Molecular  =
| IF        =
| Gross      = white/yellow mucinous infiltrative mass
| Grossing  =
| Site      = [[testis]], other
| Assdx      =
| Syndromes  =
| Clinicalhx =
| Signs      =
| Symptoms  =
| Prevalence = rare
| Bloodwork  = alpha fetoprotein (AFP) elevated
| Rads      =
| Endoscopy  =
| Prognosis  = poor
| Other      =
| ClinDDx    = other [[germ cell tumours]]
}}
'''Yolk sac tumour''' is an uncommon [[germ cell tumour]] that primarily afflicits infants and young boys.  It may be seen as part of [[mixed germ cell tumour]].  It is abbreviated '''YST'''.
 
It may be referred to as '''endodermal sinus tumour'''.
===General===
*Rare.
*Aggressive - especially extragonadal tumours.<ref name=pmid18767035/>
 
Epidemiology:
*Most common GCT in infants and young boys.
*Bimodal age distribution:<ref name=pmid18767035>{{Cite journal  | last1 = Shah | first1 = JP. | last2 = Kumar | first2 = S. | last3 = Bryant | first3 = CS. | last4 = Ali-Fehmi | first4 = R. | last5 = Malone | first5 = JM. | last6 = Deppe | first6 = G. | last7 = Morris | first7 = RT. | title = A population-based analysis of 788 cases of yolk sac tumors: A comparison of males and females. | journal = Int J Cancer | volume = 123 | issue = 11 | pages = 2671-5 | month = Dec | year = 2008 | doi = 10.1002/ijc.23792 | PMID = 18767035 }}</ref>
**<4 years.
**10-30 years.
 
Clinical:
*Elevated AFP.
 
===Gross===
*White/yellow mucinous infiltrative mass.<ref name=Ref_PCPBoD8_510>{{Ref PCPBoD8|510}}</ref>
 
===Microscopic===
Classic feature:<ref name=Ref_PCPBoD8_510>{{Ref PCPBoD8|510}}</ref>
*Schiller-Duval bodies.
**Look like glomerulus - central blood vessel surrounded by epithelial-like cells a space and more epithelial-like cells
*Architecure - variable.
*#Reticular - most common according to WMSP.<ref name=Ref_WMSP369>{{Ref WMSP|369}}</ref>
*#Microcystic - most common according to ''webpathology.com''.<ref name=webpath_case34>URL: [http://webpathology.com/image.asp?case=34&n=1 http://webpathology.com/image.asp?case=34&n=1]. Accessed on: March 8, 2010.</ref> 
*#*Lace-like pattern.
*#Endodermal sinus-like - has Schiller-Duval bodies.
*#Solid.
*#Papillary.
*#Glandular.
*#Alveolar.
*#Enteric.
*#Polyvesicular vitelline.
*#Hepatoid.
*+/-Eosinophilic hyaline globules (contain alpha-fetoprotein).
 
Notes:
*Has a loose stroma/vaguely discohesive -- unlike embryonal carcinoma.
*How to remember patterns ''REM PS GAPEH'' = reticular, endodermal sinus, microcystic, papillary, solid, glandular, alveolar, polyvesicular vitelline, enteric, hepatoid.
*Yolk sac tumours in adults are essentially always a component of a [[mixed germ cell tumour]], i.e. if one sees a pure yolk sac tumour in an adult, it is probably under sampled.<ref name=pmid1203848>{{Cite journal  | last1 = Talerman | first1 = A. | title = The incidence of yolk sac tumor (endodermal sinus tumor) elements in germ cell tumors of the testis in adults. | journal = Cancer | volume = 36 | issue = 1 | pages = 211-5 | month = Jul | year = 1975 | doi =  | PMID = 1203848 }}</ref>
 
Variants:
*Hepatoid pattern.<ref>URL: [http://webpathology.com/image.asp?case=34&n=6 http://webpathology.com/image.asp?case=34&n=6]. Accessed on: March 8, 2010.</ref>
**Vaguely resembles liver.
***[[Hyaline globules]] (light red well-circumscribed globs).
***Bile canaculi.
*Solid pattern.<ref>URL: [http://webpathology.com/image.asp?case=34&n=8 http://webpathology.com/image.asp?case=34&n=8]. Accessed on: March 8, 2010.</ref>
**Vaguely resembles ''seminoma''.
 
DDx:
*[[Embryonal carcinoma]].
*[[Mixed germ cell tumour]].
 
====Images====
<gallery>
Image:Mixed_germ_cell_tumour_-_very_high_mag.jpg|Yolk sac tumour. (WC/Nephron)
</gallery>
www:
*[http://webpathology.com/image.asp?case=34&n=6 Hepatoid Pattern (webpathology.com)].
*[http://www.webpathology.com/image.asp?case=34&n=5 Schiller-Duval body (webpathology.com)].
*[http://www.webpathology.com/image.asp?n=6&Case=34 Hyaline globules (webpathology.com)].
*[http://path.upmc.edu/cases/case152.html Yolk sac tumour - case 1 - several images (upmc.edu)].
*[http://path.upmc.edu/cases/case492.html Yolk sac tumour - case 2 - several images (upmc.edu)].
*[http://www.moffitt.org/CCJRoot/v11n6/pdf/374.pdf Yolk sac tumour (moffitt.org)].<ref name=pmid15625525>{{Cite journal  | last1 = Sesterhenn | first1 = IA. | last2 = Davis | first2 = CJ. | title = Pathology of germ cell tumors of the testis. | journal = Cancer Control | volume = 11 | issue = 6 | pages = 374-87 | month =  | year =  | doi =  | PMID = 15625525 }}</ref>
 
===IHC===
*AFP +ve.
*Glypican 3 +ve.
**More sensitive than AFP.<ref name=pmid20438407>{{Cite journal  | last1 = Emerson | first1 = RE. | last2 = Ulbright | first2 = TM. | title = Intratubular germ cell neoplasia of the testis and its associated cancers: the use of novel biomarkers. | journal = Pathology | volume = 42 | issue = 4 | pages = 344-55 | month = Jun | year = 2010 | doi = 10.3109/00313021003767355 | PMID = 20438407 }}</ref>
*Alpha-1 AT +ve.
*Cytokeratin +ve.{{fact}}
 
Negative stains:<ref name=pmid19396148>{{Cite journal  | last1 = Gopalan | first1 = A. | last2 = Dhall | first2 = D. | last3 = Olgac | first3 = S. | last4 = Fine | first4 = SW. | last5 = Korkola | first5 = JE. | last6 = Houldsworth | first6 = J. | last7 = Chaganti | first7 = RS. | last8 = Bosl | first8 = GJ. | last9 = Reuter | first9 = VE. | title = Testicular mixed germ cell tumors: a morphological and immunohistochemical study using stem cell markers, OCT3/4, SOX2 and GDF3, with emphasis on morphologically difficult-to-classify areas. | journal = Mod Pathol | volume = 22 | issue = 8 | pages = 1066-74 | month = Aug | year = 2009 | doi = 10.1038/modpathol.2009.66 | PMID = 19396148 }}</ref>
*OCT3/4 - positive in [[seminoma]] and embryonal carcinoma.
*CD30 - positive in [[embryonal carcinoma]].
 
==See also==
*[[Germ cell tumours]].
*[[Genitourinary pathology]].
 
==References==
{{Reflist|2}}


[[Category:Diagnosis]]
[[Category:Diagnosis]]
[[Category:Germ cell tumours]]
[[Category:Genitourinary pathology]]

Revision as of 11:44, 10 July 2013

Yolk sac tumour
Diagnosis in short

Yolk sac tumour. H&E stain.
LM Schiller-Duval bodies (glomerulerus-like structures), variable architecture - usually reticular or microcystic
LM DDx embryonal carcinoma, mixed germ cell tumour
IHC AFP +ve
Gross white/yellow mucinous infiltrative mass
Site testis, other
Prevalence rare
Blood work alpha fetoprotein (AFP) elevated
Prognosis poor
Clin. DDx other germ cell tumours

Yolk sac tumour is an uncommon germ cell tumour that primarily afflicits infants and young boys. It may be seen as part of mixed germ cell tumour. It is abbreviated YST.

It may be referred to as endodermal sinus tumour.

General

  • Rare.
  • Aggressive - especially extragonadal tumours.[1]

Epidemiology:

  • Most common GCT in infants and young boys.
  • Bimodal age distribution:[1]
    • <4 years.
    • 10-30 years.

Clinical:

  • Elevated AFP.

Gross

  • White/yellow mucinous infiltrative mass.[2]

Microscopic

Classic feature:[2]

  • Schiller-Duval bodies.
    • Look like glomerulus - central blood vessel surrounded by epithelial-like cells a space and more epithelial-like cells
  • Architecure - variable.
    1. Reticular - most common according to WMSP.[3]
    2. Microcystic - most common according to webpathology.com.[4]
      • Lace-like pattern.
    3. Endodermal sinus-like - has Schiller-Duval bodies.
    4. Solid.
    5. Papillary.
    6. Glandular.
    7. Alveolar.
    8. Enteric.
    9. Polyvesicular vitelline.
    10. Hepatoid.
  • +/-Eosinophilic hyaline globules (contain alpha-fetoprotein).

Notes:

  • Has a loose stroma/vaguely discohesive -- unlike embryonal carcinoma.
  • How to remember patterns REM PS GAPEH = reticular, endodermal sinus, microcystic, papillary, solid, glandular, alveolar, polyvesicular vitelline, enteric, hepatoid.
  • Yolk sac tumours in adults are essentially always a component of a mixed germ cell tumour, i.e. if one sees a pure yolk sac tumour in an adult, it is probably under sampled.[5]

Variants:

  • Hepatoid pattern.[6]
    • Vaguely resembles liver.
  • Solid pattern.[7]
    • Vaguely resembles seminoma.

DDx:

Images

  • Yolk sac tumour. (WC/Nephron)

www:

IHC

  • AFP +ve.
  • Glypican 3 +ve.
    • More sensitive than AFP.[9]
  • Alpha-1 AT +ve.
  • Cytokeratin +ve.[citation needed]

Negative stains:[10]

See also

References

  1. ↑ 1.0 1.1 Shah, JP.; Kumar, S.; Bryant, CS.; Ali-Fehmi, R.; Malone, JM.; Deppe, G.; Morris, RT. (Dec 2008). "A population-based analysis of 788 cases of yolk sac tumors: A comparison of males and females.". Int J Cancer 123 (11): 2671-5. doi:10.1002/ijc.23792. PMID 18767035.
  2. ↑ 2.0 2.1 Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 510. ISBN 978-1416054542.
  3. ↑ Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 369. ISBN 978-0781765275.
  4. ↑ URL: http://webpathology.com/image.asp?case=34&n=1. Accessed on: March 8, 2010.
  5. ↑ Talerman, A. (Jul 1975). "The incidence of yolk sac tumor (endodermal sinus tumor) elements in germ cell tumors of the testis in adults.". Cancer 36 (1): 211-5. PMID 1203848.
  6. ↑ URL: http://webpathology.com/image.asp?case=34&n=6. Accessed on: March 8, 2010.
  7. ↑ URL: http://webpathology.com/image.asp?case=34&n=8. Accessed on: March 8, 2010.
  8. ↑ Sesterhenn, IA.; Davis, CJ.. "Pathology of germ cell tumors of the testis.". Cancer Control 11 (6): 374-87. PMID 15625525.
  9. ↑ Emerson, RE.; Ulbright, TM. (Jun 2010). "Intratubular germ cell neoplasia of the testis and its associated cancers: the use of novel biomarkers.". Pathology 42 (4): 344-55. doi:10.3109/00313021003767355. PMID 20438407.
  10. ↑ Gopalan, A.; Dhall, D.; Olgac, S.; Fine, SW.; Korkola, JE.; Houldsworth, J.; Chaganti, RS.; Bosl, GJ. et al. (Aug 2009). "Testicular mixed germ cell tumors: a morphological and immunohistochemical study using stem cell markers, OCT3/4, SOX2 and GDF3, with emphasis on morphologically difficult-to-classify areas.". Mod Pathol 22 (8): 1066-74. doi:10.1038/modpathol.2009.66. PMID 19396148.
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