Ulbright T M, Roth L M
Department of Pathology, Indiana University School of Medicine, Indianapolis.
Semin Diagn Pathol. 1987 Nov;4(4):304-19.
This article describes some of the recent developments in the pathology of germ cell tumors of the testis. Many germ cell tumors show different types of differentiation. Two different explanations for this phenomenon include the differentiation of other germ cell elements from totipotential embryonal carcinoma cells or the direct differentiation of neoplasms from a malignant intratubular germ cell. Although the concept that there is a subset of seminomas having a poorer prognosis still exists, the histologic identification of such "anaplastic seminoma" remains an unachieved goal, and we, therefore, do not recommend the use of the term anaplastic seminoma at present. A recent analysis of spermatocytic seminomas has failed to demonstrate that they are capable of meiotic division. They are composed of cells differentiating in the direction of spermatocytes, but they have not achieved that stage. The prognosis, in general, remains excellent, although recently sarcomas have been reported in association with spermatocytic seminomas with metastasis of the sarcomatous elements. The presence of human chorionic gonadotropin-producing syncytiotrophoblastic giant cells in otherwise pure seminomas does not appear to adversely affect the prognosis. Yolk sac tumors have a varied histology that many pathologists do not recognize. The presence of intercellular basement membrane (parietal differentiation) is useful in the recognition of yolk sac tumor. Sometimes solid foci of yolk sac tumor may be mistaken for seminoma, and alpha-fetoprotein and cytokeratin stains may be useful in this situation, although the presence of basement membrane, hyaline globules, and focal microcysts by light microscopy may obviate the need to use them. Hepatic and enteric (or endometrioid) differentiation may occur in yolk sac tumors and cause diagnostic confusion. The development most "non-germ" cell malignancies in patients with germ cell tumors appears to occur by transformation of aneuploid teratomatous elements at the primary or metastatic site. The identification of such malignancies depends on the recognition of invasion by the elements rather than on high-grade cytologic atypia. Unusual patterns of choriocarcinoma and yolk sac tumor may be encountered following chemotherapy, and there is circumstantial evidence that some sarcomas and carcinomas occurring in patients with testis cancer may develop directly from yolk sac tumor.
本文描述了睾丸生殖细胞肿瘤病理学的一些最新进展。许多生殖细胞肿瘤表现出不同类型的分化。对此现象的两种不同解释包括全能胚胎癌细胞分化为其他生殖细胞成分，或肿瘤由恶性曲细精管内生殖细胞直接分化而来。尽管存在预后较差的精原细胞瘤亚群这一概念仍然存在，但对这种“间变性精原细胞瘤”的组织学鉴定仍是一个未实现的目标，因此，我们目前不建议使用间变性精原细胞瘤这一术语。最近对精母细胞性精原细胞瘤的分析未能证明它们能够进行减数分裂。它们由向精母细胞方向分化的细胞组成，但尚未达到那个阶段。总体而言，预后仍然良好，尽管最近有报道称精母细胞性精原细胞瘤伴有肉瘤成分转移。在其他方面为纯精原细胞瘤中出现产生人绒毛膜促性腺激素的合体滋养层巨细胞似乎不会对预后产生不利影响。卵黄囊瘤具有多种组织学表现，许多病理学家并不认识。细胞间基底膜（壁层分化）的存在有助于识别卵黄囊瘤。有时卵黄囊瘤的实性病灶可能被误诊为精原细胞瘤，在这种情况下，甲胎蛋白和细胞角蛋白染色可能会有所帮助，尽管通过光学显微镜观察到基底膜、透明小球和局灶性微囊肿的存在可能无需使用它们。卵黄囊瘤可能发生肝和肠（或子宫内膜样）分化并导致诊断混淆。生殖细胞肿瘤患者中大多数“非生殖”细胞恶性肿瘤似乎是由原发或转移部位的非整倍体畸胎瘤成分转化而来。此类恶性肿瘤的鉴定取决于对这些成分浸润的识别，而非高度的细胞学异型性。化疗后可能会遇到不寻常的绒毛膜癌和卵黄囊瘤模式，有间接证据表明睾丸癌患者中发生的一些肉瘤和癌可能直接由卵黄囊瘤发展而来。
