Home Translating Report News Physicians Diseases Body Sites Lab tests Search
Home Diseases and Health Information

Background

Seminomas comprise 50% of all testicular germ cell tumors and are most common at 40 years of age. Patients usually present with testicular swelling and pain. Testicular tumors often have elevated serum hCG (human chorionic gonadotropin) in 10% of patients and elevated serum PLAP (placental-like alkaline phosphatase) in 50% of cases. These tumors typically have a cream to yellow cut surface with a buldging fleshy consistency.

INCIDENCE 50% of all testicular tumors
AGE RANGE-MEDIAN Average age 40.5 years
Rare <10 years

 

EPIDEMIOLOGIC ASSOCIATIONS CHARACTERIZATION
Very tall men  
Increased HLA DR5 and Bw41  

 

DISEASE ASSOCIATIONS CHARACTERIZATION
AIDS and immunosuppresion  

 

PATHOGENESIS CHARACTERIZATION
Isochromosome 12p Most common abnormality
May lead to K-ras-2 protoncogene activation

 

LABORATORY/RADIOLOGIC/
OTHER TESTS

CHARACTERIZATION
Laboratory Markers  
Serum hCG
7-25% with mild elevation
10% in stage I patients
25% or more in patients with metastatic disease
Serum LDH
Elevated in 82% of patients with metastatic disease
Serum PLAP
Elevated in 33-91% of stage I patients
Elevated in 40-75% of patients with metastatic disease
Flow cytometry Mean diploid value of 1.6-1.8 times normal

 

GROSS APPEARANCE/
CLINICAL VARIANTS
CHARACTERIZATION
General Right>Left testis
Tumors average 5 cm
Solid well circumscribed and bulge above the surrounding parenchyma
Cut surface tan to cream colored
VARIANTS  
Paraneoplastic hypercalcemia Rarely
Exophthalmos Sceondary to paraendocrine abnormality
Current or surgically corrected cryptorchidism 10-30%

 

HISTOLOGICAL TYPES CHARACTERIZATION
General

There are two cellular elements. There are sheets of seminoma cells with central nuclei, eosinophilic to clear cytoplasm, and large nucleoli. Well defined intercellular borders are present. The second component are numerous lymphocytes occasionally associated with granulomas in 50-60%

About 20% of tumors may have large trophoblast cells, which are immunopositive for HCG. Intermixed with the tumor are broad fibrous bands and septae often infiltrated by lymphocytes.

Necrosis is common

VARIANTS  
Tubular variant Closely packed solid tubules

 

SPECIAL STAINS/IMMUNOPEROXIDASE/
OTHER
CHARACTERIZATION
Special stains Glycogen PAS positive
Immunoperoxidase

Positive for PLAP, LDH, ferritin, and NSE
hCG positive in 7-25%
Negative for CD30 and EMA

Necrotic Seminoma of the Testis
Establishing the Diagnosis With Masson Trichrome Stain and Immunostains


Barbara D. Florentine, MD, Arno A. Roscher, MD, Jerry Garrett, MD, and Nancy E. Warner, MD

From the Keck School of Medicine, University of Southern California, Los Angeles, Calif (Drs Florentine, Roscher, and Warner); and Henry Mayo Newhall Memorial Hospital, Newhall, Calif (Drs Florentine, Roscher, and Garrett)

Arch Pathol Lab Med 2002;Vol. 126, No. 2, pp. 205–206. Abstract quote

We describe an infarcted mass in the testis containing “ghost” cells suspicious for neoplasm. The entire lesion was necrotic.

A Masson trichrome stain greatly improved nuclear and cytologic detail, confirming the suspicion of neoplasm.

Placental alkaline phosphatase revealed specific membrane staining of the neoplastic cells and established a diagnosis of seminoma. Masson trichrome plus selected immunostains offer a promising approach to the diagnosis of certain necrotic neoplasms.

 

DIFFERENTIAL DIAGNOSIS KEY DIFFERENTIATING FEATURES
CHARACTERIZATION SPERMATOCYTIC SEMINOMA TYPICAL SEMINOMA
Proportion of germ cell tumors 1-2% 40-50%
Sites Testis only Testis, ovary, mediastinum, pineal, retroperitoneum
Bilaterality 9% 2%
Association with other forms of germ cell tumor No Yes
Association with IGCNU No Yes
Intercellular edema Common Uncommon
Composition 3 cell types, with denser cytoplasm, round nuclei 1 cell type, often clear cytoplasm, less regular nuclei
Stroma Scanty Prominent
Lymphoid reaction Rare to absent Prominent
Granulomas Extremely rare Often prominent
Sarcomatous transformation Occasional Absent
Glycogen Absent to scant Abundant
PLAP staining Absent to scant Prominent
hCG staining Absent Present in 10%
Metastases Extremely rare Common
ADDITIONAL DIFFERENTIAL DIAGNOSIS KEY DIFFERENTIATING FEATURES
Solid embryonal carcinoma  
Solid yolk sac tumor  
Choriocarcinoma  
Malignant lymphoma  
Sertoli cell tumors  

 

PROGNOSIS AND TREATMENT CHARACTERIZATION
Prognostic Factors

The tumor stage is the most important prognostic factor for these tumors with tumors limited to the testis having a survival of >95%.

75% present with disease limited to the testis
20% have retroperitoneal involvement
5% have supradiaphragmatic or organ metastases

Poor prognostic factors:

Vascular invasion-possible
Size>6 cm
Lacking lymphoid stroma
Elevated serum hCG

Survival >95% survival for tumors confined to testis following orchiectomy and radiation
Recurrence Unusual, most occur outside radiated fields in mediastinum, cervical lymph nodes, or lungs
Metastasis 2.5% present with metastases
Treatment

Seminomas are very radiosensitive and respond well to chemotherapy.
Radiation to ipsilateral inguinal and iliac nodes and periaortic and pericaval lymph nodes

Tumors metastatic to retroperitoneum are treated with radiation and may receive platinum based chemotherapy

Tumors of the Testis, Adnexa, Spermatic cord, and scrotum in Atlas of Tumor Pathology. Third Series. Fascicle 25. 1999.


Commonly Used Terms

Testis


Internet Links


Last Updated 3/4/2002

Send mail to psdermpath@earthlink.net with questions or comments about this web site.
Copyright 2002
The Doctor's Doctor