Bahrami Armita, Ro Jae Y, Ayala Alberto G
Department of Pathology, Baylor College of Medicine, Houston, TX, USA.
Arch Pathol Lab Med. 2007 Aug;131(8):1267-80. doi: 10.5858/2007-131-1267-AOOTGC.
More than 90% of testicular neoplasms originate from germ cells. Testicular germ cell tumors (GCTs) are a heterogeneous group of neoplasms with diverse histopathology and clinical behavior.
To help the readers distinguish various subtypes of GCTs, to highlight the clinical manifestations and pathologic features of these tumors, and to review several newly developed immunohistochemical markers for GCTs.
Review of the pertinent literature and our experience.
The etiology of GCTs is largely unknown. Cytogenetic studies suggest a different pathogenesis for each group of infantile/prepubertal GCTs, postpubertal GCTs, and spermatocytic seminoma. Unclassified intratubular germ cell neoplasia is the precursor of all GCTs, excluding spermatocytic seminoma and infantile/prepubertal GCTs. Seminoma, the most common GCT in adults, does not occur before 5 years of age. Spermatocytic seminoma, a tumor of elderly men, typically has an indolent clinical behavior, but rarely it undergoes sarcomatous transformation associated with an aggressive behavior. Embryonal carcinoma is the most common component in mixed GCTs. Eighty percent or more of embryonal carcinoma component and vascular invasion are recognized predictors of occult metastasis for clinical stage I mixed GCTs. Most patients with prepubertal yolk sac tumor, the most common pediatric GCT, have stage I disease at presentation. Most choriocarcinomas present with metastatic symptoms because of the propensity for rapid hematogenous dissemination. Teratomas in children regardless of maturity and dermoid cysts in adults are benign; in contrast, teratomas in adults have a malignant behavior. With appropriate therapy, the majority of testicular GCTs are curable.
超过90%的睾丸肿瘤起源于生殖细胞。睾丸生殖细胞肿瘤(GCT)是一组异质性肿瘤,具有不同的组织病理学和临床行为。
帮助读者区分GCT的各种亚型,突出这些肿瘤的临床表现和病理特征,并综述几种新开发的GCT免疫组化标志物。
相关文献综述及我们的经验。
GCT的病因大多不明。细胞遗传学研究表明,婴儿期/青春期前GCT、青春期后GCT和精母细胞性精原细胞瘤各有不同的发病机制。未分类的管内生殖细胞肿瘤是所有GCT(不包括精母细胞性精原细胞瘤和婴儿期/青春期前GCT)的前体。精原细胞瘤是成人中最常见的GCT,5岁前不会发生。精母细胞性精原细胞瘤是老年男性的肿瘤,通常临床行为惰性,但很少发生与侵袭性行为相关的肉瘤样转化。胚胎癌是混合性GCT中最常见的成分。胚胎癌成分占80%或更多以及血管侵犯是临床I期混合性GCT隐匿转移的公认预测指标。大多数青春期前卵黄囊瘤(最常见的儿童GCT)患者初诊时为I期疾病。大多数绒毛膜癌因易于快速血行播散而表现为转移症状。儿童的畸胎瘤无论成熟程度如何以及成人的皮样囊肿都是良性的;相反,成人的畸胎瘤具有恶性行为。通过适当治疗,大多数睾丸GCT可治愈。