Perry A, Wiley E L, Albores-Saavedra J
Department of Pathology, University of Texas Southwestern Medical Center, Dallas 75235-9072.
Hum Pathol. 1994 Mar;25(3):235-9. doi: 10.1016/0046-8177(94)90193-7.
Intratubular germ cell neoplasia (ITGCN) is now considered to be the preinvasive phase of testicular germ cell tumors with the exceptions of spermatocytic seminoma, pure yolk sac tumor, and mature teratoma. Pagetoid spread of ITGGN into rete testis is a common yet unpublished finding in these cases. We reviewed 100 cases of testicular germ cell tumors from the Surgical Pathology service of Parkland Memorial Hospital (Dallas, TX) to evaluate the frequency of this pattern of spread. Additional sections were obtained from selected cases and were stained with anti-placental alkaline phosphatase, anti-low molecular weight keratin (clone AE1), and various lectins to highlight the process. Pagetoid spread of ITGCN into rete testis was identified in 24 of 60 cases (40%) in which histologic sections contained both ITGCN and rete testis. The incidence of pagetoid ITGCN involvement of the rete testis was lower in pure seminoma (seven of 25 cases [28%]) than in testes containing nonseminomatous germ cell tumors (17 of 35 cases [49%]). AE1 stained the epithelial cells of the rete testis but not the cells of the ITGCN, whereas placental alkaline phosphatase stained the neoplastic cells but not the epithelial cells of the rete testis. These stains were useful in delineating two cases in which the pagetoid involvement was so extensive that they were misdiagnosed as invasive seminomas. Pagetoid spread of ITGCN is a relatively common finding in testicular germ cell tumors and rarely can be mistaken for invasive seminoma. Immunohistochemistry can be helpful in distinguishing florid pagetoid spread from invasive seminoma.
除精母细胞性精原细胞瘤、单纯卵黄囊瘤和成熟畸胎瘤外，管内生殖细胞瘤（ITGCN）现被认为是睾丸生殖细胞肿瘤的浸润前阶段。ITGGN向睾丸网的派杰样扩散在这些病例中是一个常见但未发表的发现。我们回顾了帕克兰纪念医院（得克萨斯州达拉斯）外科病理科的100例睾丸生殖细胞肿瘤病例，以评估这种扩散模式的发生率。从选定病例中获取额外切片，并用抗胎盘碱性磷酸酶、抗低分子量角蛋白（克隆AE1）和各种凝集素染色以突出该过程。在60例组织切片同时包含ITGCN和睾丸网的病例中，有24例（40%）发现ITGCN向睾丸网的派杰样扩散。单纯精原细胞瘤中睾丸网受派杰样ITGCN累及的发生率（25例中有7例[28%]）低于含有非精原细胞性生殖细胞肿瘤的睾丸（35例中有17例[49%]）。AE1可染色睾丸网的上皮细胞，但不能染色ITGCN的细胞，而胎盘碱性磷酸酶可染色肿瘤细胞，但不能染色睾丸网的上皮细胞。这些染色有助于鉴别两例派杰样累及非常广泛以至于被误诊为浸润性精原细胞瘤的病例。ITGCN的派杰样扩散在睾丸生殖细胞肿瘤中是一个相对常见的发现，很少会被误诊为浸润性精原细胞瘤。免疫组织化学有助于区分弥漫性派杰样扩散与浸润性精原细胞瘤。
