The core four - A panel of immunohistochemistry markers to diagnose and subtype testicular germ cell tumors

Abstract

Context: Immunohistochemistry (IHC) to differentiate germ cell tumors. Aims: The aim of the study is to differentiate seminomatous and nonseminomatous germ cell tumors (GCTs) with morphological overlap using a minimal and affordable panel of IHC markers. Settings and Design: This is a retrospective observational study. Subjects and Methods: All testicular GCTs (TGCT) which were diagnosed on biopsies and/or resection specimens (prechemotherapy) between January 2014 and June 2019. The demographic, clinical, and imaging findings were noted from the medical records. Hematoxylin and eosin (H and E)-stained sections were reviewed for morphology. The IHC markers constituted Octamer-binding transcription factor (OCT) 3/4, glypican 3 (GPC3), CD117, CD30, placental-like alkaline phosphatase, Sal-like protein 4, and β-human chorionic gonadotropin (HCG). IHC markers were performed in various combinations depending on the morphology, and a panel constituting OCT 3/4, CD117, GPC3, and CD30 was performed on cases with diagnostic dilemma and morphological overlaps. Statistical Analysis Used: Sensitivity, specificity, positive (PPV), and negative predictive value (NPV) were calculated for suggested panel of IHC OCT 3/4, CD117, GPC3, and CD30. Results: The study included 36 patients with TGCT with a mean age of 27 (15–58) years. Nonseminomatous tumors were the most common (86%). The concise panel was performed in 20/36 (56%) tumors to resolve the diagnosis. The sensitivity, specificity, PPV, and NPV for OCT3/4 were 80%, 55%, 31%, and 92% in seminomas and 65%, 100%, 100%, and 46% in embryonal carcinomas (EC), for CD117 was 89%, 82%, 73%, and 93% in seminomas and 60%, 77%, 60%, and 77% in yolk sac tumors (YST), for GPC3 was 95%, 90%, 95%, and 90% in YST, CD30 96%, 100%, 100%, and 91% in ECs, respectively. Conclusions: Designing a novel concise and affordable IHC panel constituting OCT 3/4, CD117, GPC3, and CD30 has good sensitivity and specificity in differentiating seminomas, YST, and EC, respectively. Additional markers, namely β-HCG, can be used in identifying the choriocarcinoma component.

A Rare Case of a Non-seminomatous Testicular Cancer Metastasis to the Duodenum: A Case Report

“…A definitive diagnosis requires a radical inguinal orchiectomy to perform a histopathological examination and immunohistochemical staining. Embryonal carcinoma staining is positive for OCT 3/4, CD30, and SALL4 [ 8 , 9 ]. Additionally, all patients should undergo contrast-enhanced CT of the abdomen and pelvis to rule out possible metastasis [ 4 ].…”

What You See Is Not What You Get: Germ Cell Tumor Mimicking Disseminated Coccidioidomycosis

“…Immunohistochemical stains revealed strong positivity of cytokeratin AE1/AE3 and SALL4, consistent with either an embryonal carcinoma or a yolk sac tumor. 3 The L1 vertebral bone biopsy demonstrated osteoblastic bone formation ( Figure 5 ).…”

Testicular Germ Cell Tumor Tissue Biomarker Analysis: A Comparison of Human Protein Atlas and Individual Testicular Germ Cell Tumor Component Immunohistochemistry

“…Specific subtypes of TGCT can morphologically overlap, such as areas with architecture typical of YST but with atypical cytological features, atypical areas within or adjacent to SE, which suggest transformation to EC, and the interface of EC and YST with cytological features unlike YST. These cases require IHC for proper diagnosis [32,71]. In our patient cohort, we have had multiple such instances, with the interface of YST and EC only being resolved with IHC analysis.…”

“…In our patient cohort, we have had multiple such instances, with the interface of YST and EC only being resolved with IHC analysis. Accurate diagnosis is essential for proper treatment selection, such as diagnosing the presence of EC within the TGCT [71]. All this makes knowing the protein landscape of TGCT histological components and the healthy testis essential for accurate TGCT management.…”