Malignant germ cell tumor

Lymphoblastic leukemia has been described after treatment of a malignant germ cell tumor it was suggested that this was related to the etoposide component of the treatment, and that development of secondary leukemia after etoposide may not be confined to the myeloid cell lineage (82). 

Knapp RH, Hurt RD, Payne WS, et al. Malignant germ cell tumors of the mediastinum. J Thorac Cardiovasc Surg. 1985 89 82-89. 

FLAP can be positive in most types of malignant germ cell tumors, but it also can stain epithelial neoplasms. 

Cytokeratin AE1/AE3 stains many malignant germ cell tumors, and the pattern of staining can help with classification. 

EMA is negative in most malignant germ cell tumors. 

In addition to the sex-cord stromal tumors, a variety of other benign and primary and metastatic malignant ovarian tumors may have a functioning stroma with estrogenic or androgenic production. However, these elevations will remain commonly subclinical. These tumors include mucinous tumors, rarely endometrioid carcinoma, malignant germ cell tumors, and mucinous metastatic carcinomas [37]. 

Brammer HM, Buck JL, Hayes WS et al (1990) Malignant germ cell tumors of the ovary radiologic-pathologic correlation. Radiographics 10 715-724... 

Malignant germ cell tumors comprise, in order of decreasing frequency, dysgerminomas, immature teratomas, endodermal sinus tumors, and embryonal and nongestational choriocarcinomas. The latter three are extremely rare. In these patients, tumor markers may be helpful for assessing response and tumor recmrence. Endodermal sinus tumors secrete AFP. Embryonal carcinomas can secrete both AFP and HCG, whereas pure choriocarcinomas secrete only HCG [4]. 

Patients with malignant disease show increased LD activity in serum up to 70% of patients with fiver metastases and 20% to 60% of patients with other nonhepatic metastases have elevated total LD activity. Notably elevated LD-1 is observed in germ cell tumors (61% of cases), such as teratoma, seminoma of the testis, and dysgerminoma of the ovary. Patients with seminoma have a raised LD-1 m 63% of cases compared with 60% in nonseminoma cases. The percent of patients with increased LD-1 depended on the stage of the disease. LD-1 appeared to be a useful predictor of outcome in patients with testicular germ cell tumors. 

Serum AFP levels are elevated in hepatocellular carcinomas and malignancies involving ovaries and testes. Yolk sac tumors, which occur more frequently in the ovaries of young women, and girls, and in the testes of boys, raise serum levels of AFP. Serum hCG measurement is also helpful in the diagnosis and management of germ cell tumors. Thus, hCG and AFP are also used as tumor markers. 

Gershenson DM. Update on malignant ovarian germ cell tumors. Cancer 1993 71 1581-1590. 

In addition to epithelial neoplasms, a number of sarcomas, CNS tumors, small round cell tumors, and a few germ cell tumors may be positive with EMA. These tumors include malignant nerve sheath tumors, synovial sarcoma, leiomyosarcoma, malignant fibrous histiocytoma, epithelioid sarcoma, and chordoma. With the exception of the last two tumors mentioned, EMA immunostaining is focal. 

Burke AP, Mostofi EK. Placental alkaline phosphatase immunohistochemistry of intratubular malignant germ cells and associated testicular germ cell tumors. Hum Pathol. 1988 19 663-670. 

Bailey D, Marks A, Stratis M, Baumal R. Immunohistochemical staining of germ cell tumors and intratubular malignant germ cells of the testis using antibody to placental alkaline phosphatase and a monoclonal anti-seminoma antibody. Mod Pathol. 1991 4 167-171. 

The common non-epithelial neoplasms that cause malignant effusions include malignant melanomas, lymphomas, sarcomas, germ cell tumors, and some pediatric malignant tumors. The determination of origin of non-epithelial malignancies on purely cytomorphologic... 

Germ cell neoplasms are common in pediatric patients as well as young adults. Seminomas are occasionally found in malignant effusions in pleura, peritoneum, and hydrocele sac." Dysgerminoma is the female counterpart of the seminoma and rarely presents in effusions. These tumors can occur as pure tumors or as mixed tumors with other germ cell tumors, and they have potential to metastasize. Cell blocks have been proven to be a useful tool in the immunohistochemical studies performed to diagnose and differentiate components of mixed germ cell tumors. 

Bleomycin is highly effective against germ cell tumors of the testis and ovary. In testicular cancer it is curative when used with cisplatin and vinblastine or cisplatin and etoposide. It is used as a component of the standard ABVD regimen for Hodgkin s disease. Bleomycin also is given intrapleurally (60 U)for malignant pleural effusions. 

The probability of malignancy is also related to the patient s age. In girls less than 9 years of age, 80% of ovarian masses are malignant, with the majority consisting of germ cell tumors. In women of reproductive age, the overall chance that an ovarian tumor will be malignant is 1 in 15 compared to 1 in 3 by 45 years of age [35]. 

In patients with a family history of breast and ovarian cancer, ovarian cancers occur up to 10 years earlier. In females younger than 20 years of age, germ cell tumors account for more than two-thirds of malignant ovarian tumors. 

Malignant germ cell and malignant stromal neoplasm are responsible for 7% each. Germ cell tumors represent two-thirds of malignancies in females less than 20 years of age. 

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