Skip to main content
NCBI home page
Journal of Clinical Pathology logoLink to Journal of Clinical Pathology
. 1996 Mar;49(3):223–225. doi: 10.1136/jcp.49.3.223

Germ cell tumour as a diagnostic pitfall of metastatic carcinoma.

T W Shek 1, S T Yuen 1, I S Luk 1, M P Wong 1
PMCID: PMC500402  PMID: 8675733

Abstract

AIM: Testicular germ cell tumours may present as metastases in cervical lymph nodes, yet the primary tumours remain clinically occult. The aim of the study is to alert pathologists and clinicians to this uncommon but important presentation and highlight the clues and the diagnostic adjuncts to its correct diagnosis. METHODS: The clinical, cytological, histological, and immunohistochemical features of two patients with germ cell tumour initially presenting as cervical lymphadenopathy were described and analysed. RESULTS: Both patients were young adult males, who were found to have metastatic undifferentiated carcinoma on fine needle aspiration of the enlarged cervical lymph nodes. The tumour cells in both cases were positive for placental alkaline phosphatase (PLAP) and negative for epithelial membrane antigen (EMA). CONCLUSIONS: Clinicians and pathologists should be aware of the possibility of germ cell tumour when encountering a young adult male with metastatic poorly differentiated carcinoma. Positivity for PLAP and negativity for EMA are helpful adjuncts in arriving at the correct diagnosis.

Full text

PDF
223

Images in this article

224Image
on p.224
224Image
on p.224
225Image
on p.225

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Atkin N. B., Baker M. C. i(12p): specific chromosomal marker in seminoma and malignant teratoma of the testis? Cancer Genet Cytogenet. 1983 Oct;10(2):199–204. doi: 10.1016/0165-4608(83)90125-5. [DOI] [PubMed] [Google Scholar]
  2. Burke A. P., Mostofi F. K. Placental alkaline phosphatase immunohistochemistry of intratubular malignant germ cells and associated testicular germ cell tumors. Hum Pathol. 1988 Jun;19(6):663–670. doi: 10.1016/s0046-8177(88)80172-2. [DOI] [PubMed] [Google Scholar]
  3. Castedo S. M., de Jong B., Oosterhuis J. W., Seruca R., te Meerman G. J., Dam A., Schraffordt Koops H. Cytogenetic analysis of ten human seminomas. Cancer Res. 1989 Jan 15;49(2):439–443. [PubMed] [Google Scholar]
  4. Fleury-Feith J., Bellot-Besnard J. Criteria for aspiration cytology for the diagnosis of seminoma. Diagn Cytopathol. 1989;5(4):392–395. doi: 10.1002/dc.2840050410. [DOI] [PubMed] [Google Scholar]
  5. Hainsworth J. D., Greco F. A. Poorly differentiated carcinoma and germ cell tumors. Hematol Oncol Clin North Am. 1991 Dec;5(6):1223–1231. [PubMed] [Google Scholar]
  6. Highman W. J., Oliver R. T. Diagnosis of metastases from testicular germ cell tumours using fine needle aspiration cytology. J Clin Pathol. 1987 Nov;40(11):1324–1333. doi: 10.1136/jcp.40.11.1324. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Kline T. S., Kannan V., Kline I. K. Lymphadenopathy and aspiration biopsy cytology. Review of 376 superficial nodes. Cancer. 1984 Sep 15;54(6):1076–1081. doi: 10.1002/1097-0142(19840915)54:6<1076::aid-cncr2820540624>3.0.co;2-w. [DOI] [PubMed] [Google Scholar]
  8. Kubosawa H., Nagao K., Kondo Y., Ishige H., Inaba N. Coexistence of adenocarcinoma and choriocarcinoma in the sigmoid colon. Cancer. 1984 Sep 1;54(5):866–868. doi: 10.1002/1097-0142(19840901)54:5<866::aid-cncr2820540518>3.0.co;2-u. [DOI] [PubMed] [Google Scholar]
  9. Lee R. E., Valaitis J., Kalis O., Sophian A., Schultz E. Lymph node examination by fine needle aspiration in patients with known or suspected malignancy. Acta Cytol. 1987 Sep-Oct;31(5):563–572. [PubMed] [Google Scholar]
  10. Oliva E., Andrada E., Pezzica E., Prat J. Ovarian carcinomas with choriocarcinomatous differentiation. Cancer. 1993 Oct 15;72(8):2441–2446. doi: 10.1002/1097-0142(19931015)72:8<2441::aid-cncr2820720823>3.0.co;2-n. [DOI] [PubMed] [Google Scholar]
  11. Oosterhuis J. W., Castedo S. M., de Jong B., Cornelisse C. J., Dam A., Sleijfer D. T., Schraffordt Koops H. Ploidy of primary germ cell tumors of the testis. Pathogenetic and clinical relevance. Lab Invest. 1989 Jan;60(1):14–21. [PubMed] [Google Scholar]
  12. Oyasu R., Nan L., Smith D. P., Kawamata H. Human chorionic gonadotropin beta-subunit synthesis by undifferentiated urothelial carcinoma with syncytiotrophoblastic differentiation. Arch Pathol Lab Med. 1994 Jul;118(7):715–717. [PubMed] [Google Scholar]
  13. Pallesen G., Hamilton-Dutoit S. J. Ki-1 (CD30) antigen is regularly expressed by tumor cells of embryonal carcinoma. Am J Pathol. 1988 Dec;133(3):446–450. [PMC free article] [PubMed] [Google Scholar]
  14. Sporn J. R., Greenberg B. R. Empiric chemotherapy in patients with carcinoma of unknown primary site. Am J Med. 1990 Jan;88(1):49–55. doi: 10.1016/0002-9343(90)90127-y. [DOI] [PubMed] [Google Scholar]
  15. Wick M. R., Swanson P. E., Manivel J. C. Placental-like alkaline phosphatase reactivity in human tumors: an immunohistochemical study of 520 cases. Hum Pathol. 1987 Sep;18(9):946–954. doi: 10.1016/s0046-8177(87)80274-5. [DOI] [PubMed] [Google Scholar]
  16. Yakeishi Y., Mori M., Enjoji M. Distribution of beta-human chorionic gonadotropin-positive cells in noncancerous gastric mucosa and in malignant gastric tumors. Cancer. 1990 Aug 15;66(4):695–701. doi: 10.1002/1097-0142(19900815)66:4<695::aid-cncr2820660418>3.0.co;2-n. [DOI] [PubMed] [Google Scholar]
  17. Young R. H., Eble J. N. Unusual forms of carcinoma of the urinary bladder. Hum Pathol. 1991 Oct;22(10):948–965. doi: 10.1016/0046-8177(91)90003-8. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Clinical Pathology are provided here courtesy of BMJ Publishing Group

RESOURCES