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mediastinal germinoma
Monday 23 January 2012
Primary mediastinal seminoma; mediastinal dysgerminoma
Digital cases
JRC:258 : Ovarian dysgerminoma. JRC:1231 : Mediastinum, anterior: Germinoma with multilocular thymic cyst . JRC:19001 : Mediastinum, anterior: thymic germinoma. JRC:19005 : Thymic seminoma with marked cystic changes, superior mediastinum. JRC:7861 : Mediastinum: Germinoma with yolk sac component. JRC:7851 : Mediastinum: Germinoma (embryonal). JRC:7852 : Mediastinum: Germinoma. JRC:7853 : Mediastinum: Germinoma. JRC:7862 : Mediastinum: Germinoma.
Definition: a primitive germ cell tumor, similar to testicular seminoma.
Synopsis
90% are apparently unilateral, but occult foci of dysgerminoma can be detected by biopsy of the contralateral ovary in 10% of cases monotonous proliferation of primitive germ cells connective tissue septa containing variable amounts of chronic inflammatory cells
Immunohistochemistry
most are vimentin + and PLAP + (placental-like alkaline phosphatase) CD117 (c-kit) + inconstant + to : cytokeratins, desmin, GFAP, CEA and S-100 protein
Etiology and evolution
the vast majority have no precursor lesion may arise from gonadoblastoma may be a precursor to other primitive germ cell tumors
Accurate diagnosis of mediastinal seminoma is critical because of its favorable response to radiation therapy and/or cisplatin-based chemotherapy.
Immunohistochemical staining for OCT4 has recently been validated as a powerful tool for detecting gonadal seminoma.
However, discrepancies between the genetic alterations and immunoprofiles of mediastinal and testicular seminomas have been reported, raising the question of whether techniques that are useful in the diagnosis of gonadal seminoma are applicable to its mediastinal counterpart.
The intense staining pattern of OCT4 and the high sensitivity of FISH make them superior to other auxiliary diagnostic utilities for detecting seminoma.
References
Primary mediastinal seminoma: a comprehensive assessment integrated with histology, immunohistochemistry, and fluorescence in situ hybridization for chromosome 12p abnormalities in 23 cases. Sung MT, Maclennan GT, Lopez-Beltran A, Zhang S, Montironi R, Cheng L. Am J Surg Pathol. 2008 Jan;32(1):146-55. PMID: #18162782#
