Albores-Saavedra J, Huffman H, Alvarado-Cabrero I, Ayala A G
Department of Pathology, University of Texas Southwestern Medical Center, Dallas 75235-9072, USA.
Hum Pathol. 1996 Jul;27(7):650-5. doi: 10.1016/s0046-8177(96)90393-7.
Four examples of spermatocytic seminoma with a predominant anaplastic component occurred in men 33 to 43 years of age, without histories of cyptorchidism. The seminomas presented with painless testicular masses recognized 3 to 18 months before orchiectomy. Preoperative serum measurements of human chorionic gonadotropin and alpha-fetoprotein were negative. All tumors contained areas (10% to 30% of the tumor) in which the three cell types characteristic of conventional spermatocytic seminoma could be identified under light microscopy. The predominant anaplastic component also contained the three cell types, but the nuclei had prominent nucleoli with granular and filamentous chromatin. In addition, sheets of cells with vesicular nuclei and prominent nucleoli superficially resembling embryonal carcinoma were found. There were numerous large mononuclear and multinucleated giant cells with bizarre nuclei and prominent nucleoli, but no sarcomatous elements. Many normal and abnormal mitotic figures were present. Tunical and vascular invasion and extensive necrosis were constant features. Immunohistochemistry documented p53 protein overexpression in two tumors, but neoplastic cells were negative with immunostains for placenta-like alkaline phosphatase, leukocyte common antigen, neuron-specific enolase, alpha-fetoprotein, human chorionic gonadotropin, vimentin, and cytokeratins. Ultrastructural examination of the anaplastic component showed large rope-like nucleoli, but the cytoplasmic features were similar to those of conventional spermatocytic seminoma. Despite the presence of a major anaplastic component, no patient has developed metastasis. Larger series and longer follow-up are needed to understand the natural history of these neoplasms.
4例以间变成分占主导的精母细胞性精原细胞瘤发生于33至43岁男性，无隐睾病史。这些精原细胞瘤表现为无痛性睾丸肿块，在睾丸切除术前3至18个月被发现。术前血清人绒毛膜促性腺激素和甲胎蛋白检测均为阴性。所有肿瘤均含有区域（占肿瘤的10%至30%），在光学显微镜下可识别出传统精母细胞性精原细胞瘤的三种特征性细胞类型。主要的间变成分也含有这三种细胞类型，但细胞核有明显的核仁，染色质呈颗粒状和丝状。此外，还发现成片的细胞核呈泡状、核仁明显的细胞，表面上类似胚胎癌。有许多具有怪异细胞核和明显核仁的大单核和多核巨细胞，但无肉瘤成分。存在许多正常和异常的有丝分裂象。包膜和血管侵犯以及广泛坏死是常见特征。免疫组织化学显示2例肿瘤中有p53蛋白过度表达，但肿瘤细胞对胎盘样碱性磷酸酶、白细胞共同抗原、神经元特异性烯醇化酶、甲胎蛋白、人绒毛膜促性腺激素、波形蛋白和细胞角蛋白的免疫染色均为阴性。间变成分的超微结构检查显示有大的绳状核仁，但细胞质特征与传统精母细胞性精原细胞瘤相似。尽管存在主要的间变成分，但尚无患者发生转移。需要更大规模的系列研究和更长时间的随访来了解这些肿瘤的自然病程。
