Types of Germ Cell Tumors (GCT)

00:02 Testicular tumor.

00:03 We’ll take a look at the parameters or the categories.

00:07 Tumor, morphology, marker, prognosis, remark.

00:11 Our first major germ cell tumor is a seminoma.

00:15 Take a look at the picture here. A cut section.

00:17 Do you see any blood in here? And very important – none whatsoever.

00:22 Seminoma versus a non-seminomatous germ cell tumors are non-hemorrhagic.

00:29 Sometimes referred to as being a walnut.

00:32 Okay. So if you cut open a walnut, maybe perhaps this is what it looks like on the inside.

00:36 That area that you’re seeing within the testicle, that is more whitish would be the actual tumor within the testicle.

00:43 Morphology here: Fried-egg appearance.

00:46 And by fried egg, literally means as though if you break open an egg, the yolk falls in the middle, around it will be the albumin.

00:53 The white.

00:54 That’s a fried-egg appearance.

00:56 The nucleus will be in the middle.

00:57 Fried egg is a non-specific morphology or description.

01:01 You’ve heard of oligodendroglioma, and that is a brain tumor in which there once again, the appearance – With the morphology would be fried egg.

01:10 Serum marker here, you’re going to be using what’s known as your human chorionic gonadotropin.

01:16 And you have something called placental alkaline phosphatase.

01:22 Prognosis is excellent.

01:24 Here, if you’re thinking metastasis, it will be through lymphatic.

01:28 Where is it going? Para-aortic and it is important that you pay attention to how incredibly sensitive it is to radiotherapy.

01:38 What you’re also doing is comparing this seminoma, which is the most common of all of your germ cell tumors versus the non-seminomatous, which we’ll get into next.

01:49 Embryonal: Well, the main thing here about embryonal is you take a look at the section here and you find at this section -- and you’ll find it to be hemorrhagic.

02:00 Hemorrhagic versus if you take a look at seminoma, it looks like it’s non-hemorrhagic.

02:08 Yolk sac tumor: Also call it endodermal sinus tumor (EST).

02:13 Endodermal sinus tumor But guess what? We did this for ovarian tumor as well.

02:20 And with the ovarian tumor, remember once again, ovarian tumor, this is not the most common family of tumors.

02:26 What family are we doing? Germ cell tumors.

02:30 For which gender? Males.

02:34 EST stands for endodermal sinus tumor.

02:37 Here with the yolk sac, do you remember when we had a discussion and if you haven’t quite gotten into it, that’s okay.

02:43 But the fact that glomeruli, if you have these primitive glomerular-like structures that you would find with yolk sac tumor, you call this Schiller–Duval bodies, glomerular-like.

02:54 Here, a yolk sac, the type of tumor marker you would expect to find would be alpha fetoprotein to be elevated.

03:01 Once you start getting away from seminomatous, this obviously will be a non-seminomatous testicular tumor, extremely aggressive, and here, the most common testicular tumor in a boy less than 5 years of age would be yolk sac tumor.

03:19 Something else that I wish to bring to your attention.

03:22 When we get into ovarian tumor, remember that a seminoma is then referred to as being -- or it’s equivalent in a female ovarian tumor is called a dysgerminoma.

03:33 And these are thing that we’ll discuss in ovarian tumor.

03:36 But you know me, I like to reinforce information over and over again.

03:41 I want you to think.

03:43 This is choriocarcinoma.

03:45 Choriocarcinoma would be found in two different locations and that’s how you need to approach the choriocarcinoma.

03:50 Pay attention.

03:51 Choriocarcinoma could be either gestational or could be non-gestational.

03:56 Either case, what do we mean gestational? Well, you might have heard of choriocarcinoma being an issue with the cancer of the placenta.

04:04 True.

04:05 For example, hydatidiform mole, complete mole, may then give rise to choriocarcinoma.

04:11 But that’s gestational cancer.

04:13 Where are you now? A gonad.

04:16 Which gender? The male, so testicles.

04:19 So this is testicular, non-gestational choriocarcinoma.

04:23 Therefore, morphology, you would expect to find placental tissue.

04:27 Trophoblastic.

04:28 "But Dr. Raj, we’re in the testicle?" Yes, but this is cancer. It can do whatever it wants.

04:33 Just like you would with any type of placental disorder or in general placentas involved, pregnancy, placenta involved.

04:42 And you’ve heard of the pregnancy test, beta hCG.

04:45 Aggressive.

04:47 Here, once you start getting away from your seminomatous, the non-seminomatous will be hemorrhagic, hemorrhagic and spread also would be hematogenous.

05:00 Hyperthyroidism can develop in man with non-seminomatous germ cell tumors, who have marketly elevated serum beta HCD-levels.

05:07 This is due to ligand receptor cross reactivity between the HCG and thyroid-stimulating hormones or TSH.

05:15 Do no forget these features of choriocarcinoma.

05:19 Teratoma.

05:21 Really, the only thing that I wish to bring to your attention because we’ll be dealing with teratoma quite a bit in a female.

05:26 And a teratoma in female is known as a cystic teratoma.

05:31 And with a female, we’ll be looking at the mature teratoma more so, which is benign in a female.

05:37 In a male, quite different.

05:39 A teratoma is going to be all three germ layers, so we have our endoderm, ectoderm and our mesoderm.

05:47 And the immature form will be extremely aggressive, malignant, and your next step of management here will be to resect the tumor.

05:55 Benign in children, tends to be a teratoma.

05:57 And in addition, keep in mind that teratoma can be anywhere from head to toe or head to basically the testicle.

06:05 So if it’s a child, you're most likely thinking about the sacrococcygeal.

06:09 Can you picture that? Or it could be in the midline.

06:12 And we had this discussion when we did our neoplasia.

06:15 By midline, I mean that it could be part of your pineal gland or maybe perhaps in your mediastinum.

06:20 Things that you want to pay attention to teratoma.

06:23 At this point, we have finished our discussion of germ cell tumors.

06:28 The most common family of all testicular tumors, your focus definitely should be on seminoma and some salient points about each one these other types of testicular germ cell tumors.