Ulbright T M
Department of Pathology, Indiana University School of Medicine, Indianapolis.
Am J Surg Pathol. 1993 Nov;17(11):1075-91. doi: 10.1097/00000478-199311000-00001.
Testicular germ cell neoplasia, a disease predominantly of young men, is, for unknown reasons, increasing in incidence. Cryptorchidism, a prior testicular germ cell tumor, a family history of testicular germ cell tumors, and somatosexual ambiguity syndromes remain well-established risk factors. Intratubular germ cell neoplasia of the unclassified type represents the common precursor to the great majority of testicular germ cell tumors, and its identification in testicular biopsies reliably identifies those patients who will often progress to an invasive lesion. Seminoma appears to represent the invasive derivative of intra-tubular germ cell of neoplasia of the unclassified type; problematic variants include seminomas with tubular, granulomatous, and edematous patterns. Spermatocytic seminoma is an essentially nonmetastasizing neoplasm unless complicated by the rare development of a sarcomatous component. Embryonal carcinomas usually occur admixed with other germ cell tumor types. The combination of positivity for placental alkaline phosphatase and negativity for epithelial membrane antigen can assist in the distinction of embryonal carcinomas from somatic carcinomas. The treatment of clinical stage I patients with nonseminomatous germ cell tumor with "surveillance only" may be contraindicated depending on features that include the proportion of embryonal carcinoma and the presence of lymphovascular invasion in the orchiectomy specimen. It is important to be aware that pure, mature teratomas in postpubertal patients may be associated with metastases of teratomatous or nonteratomatous type Yolk sac tumor is characterized by numerous patterns including glandular, myxomatous, sarcomatoid, hepatoid, and parietal variants. Choriocarcinomas classically have a biphasic pattern of syncytiotrophoblast and cytotrophoblast; trophoblastic proliferations lacking a biphasic pattern also occur but are difficult to classify unless this category is broadened. Mixed germ cell tumors, consisting of two or more different elements, are quite common. The polyembryoma is a distinctive, well-organized form of mixed germ cell tumor consisting of embryonal carcinoma and yolk sac tumor.
睾丸生殖细胞肿瘤主要发生于年轻男性，其发病率出于未知原因正在上升。隐睾、既往睾丸生殖细胞肿瘤、睾丸生殖细胞肿瘤家族史以及性发育异常综合征仍是公认的危险因素。未分类型管内生殖细胞肿瘤是绝大多数睾丸生殖细胞肿瘤的常见前驱病变，在睾丸活检中识别出该病变可可靠地确定那些常进展为浸润性病变的患者。精原细胞瘤似乎是未分类型管内生殖细胞肿瘤的浸润性衍生物；有问题的变体包括具有小管状、肉芽肿性和水肿性模式的精原细胞瘤。精母细胞性精原细胞瘤本质上是一种非转移性肿瘤，除非合并罕见的肉瘤成分。胚胎癌通常与其他类型的生殖细胞肿瘤混合出现。胎盘碱性磷酸酶阳性和上皮膜抗原阴性的组合有助于将胚胎癌与体细胞癌区分开来。对于临床I期非精原细胞瘤性生殖细胞肿瘤患者，根据包括胚胎癌比例和睾丸切除标本中是否存在淋巴管浸润等特征，“仅观察”的治疗方式可能是禁忌的。需要注意的是，青春期后患者的纯成熟畸胎瘤可能与畸胎瘤性或非畸胎瘤性转移有关。卵黄囊瘤具有多种模式，包括腺管状、黏液样、肉瘤样、肝样和壁层变体。绒毛膜癌典型地具有合体滋养层和细胞滋养层的双相模式；也会出现缺乏双相模式的滋养层增殖，但除非扩大这一类别，否则难以分类。由两种或更多不同成分组成的混合性生殖细胞肿瘤很常见。多胚瘤是一种独特的、组织良好的混合性生殖细胞肿瘤，由胚胎癌和卵黄囊瘤组成。
