1
|
Bansal C, Singh A, Kapoor D, Nayyar C, Shaikh MN, Swami PC. Cytodiagnostic Dilemma in a Lung Mass as the First Presentation of Testicular Mixed Germ Cell Tumor Metastasis. Indian J Surg Oncol 2024; 15:168-171. [PMID: 38511017 PMCID: PMC10948662 DOI: 10.1007/s13193-023-01850-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 11/11/2023] [Indexed: 03/22/2024] Open
Abstract
Testicular mixed germ cell tumors (TMGCTs) are rare malignant tumors comprising of two or more types of germ cell tumors. Their onset may be undetectable and the patient may first present with symptoms of metastasis. We hereby report a case of a young male who presented with respiratory discomfort and had no symptoms of primary testicular tumor. CT-guided FNAC lung revealed mainly necrotic, keratinous debris with a focus of chondromyxoid stroma. Differential diagnoses of components of teratoma, squamous cell carcinoma and inclusion cyst was considered. FNAC was reported out for the possible presence of teratoma components. Retrospectively, physical examination and subsequent USG revealed testicular tumor. The case led to a diagnostic dilemma as the patient presented with no prior history suggestive of metastasis from testicular mixed germ cell tumor. The aim of the current case report is to alert the pathologists and clinicians about this uncommon clinical presentation and diagnostic relevance of FNA. It highlights that FNA lung revealing keratinous material should always be searched for the possibility of teratoma component.
Collapse
Affiliation(s)
- Cherry Bansal
- Department of Pathology, Dr S S Tantia Medical College, Hospital & Research Center, Sri Ganganagar, Rajasthan India
| | - Amanpreet Singh
- Department of Pathology, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab India
| | - Dimple Kapoor
- Department of Pathology, Dr S S Tantia Medical College, Hospital & Research Center, Sri Ganganagar, Rajasthan India
| | - Charu Nayyar
- Department of Microbiology, Dr S S Tantia Medical College, Hospital & Research Center, Sri Ganganagar, Rajasthan India
| | - Mohammed Nadeem Shaikh
- Department of Biochemistry, Dr S S Tantia Medical College, Hospital & Research Center, Sri Ganganagar, Rajasthan India
| | - P. C. Swami
- Department of Oral & Maxillofacial Surgery, Dr S S Tantia Medical College, Hospital & Research Center, Sri Ganganagar, Rajasthan India
| |
Collapse
|
2
|
Kundu U, Gan Q, Donthi D, Sneige N. The Utility of Fine Needle Aspiration (FNA) Biopsy in the Diagnosis of Mediastinal Lesions. Diagnostics (Basel) 2023; 13:2400. [PMID: 37510144 PMCID: PMC10378189 DOI: 10.3390/diagnostics13142400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 06/22/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023] Open
Abstract
Fine needle aspiration is a minimally invasive, low-morbidity, and cost-efficient technique for the sampling of mediastinal lesions. Additionally, ancillary testing on FNA samples can be used for the refinement of diagnoses and for treatment-related purposes (flow cytometry, cytogenetics, immunohistochemistry, and molecular diagnostics). Mediastinal lesions, however, can show a variety of lineages and morphologic features, giving rise to diagnostic dilemmas. As a result, the differential diagnosis can vary widely and becomes especially challenging due to the smaller sample size on FNA and the variability in component sampling. For appropriate patient management and to determine the correct treatment strategies, accurate pathologic diagnoses are paramount. In this review, we present the cytomorphologic features together with the immunophenotypic findings of mediastinal lesions, with emphasis on the diagnostic challenges and pitfalls in FNA cytology samples, including smears and cell block sections.
Collapse
Affiliation(s)
- Uma Kundu
- Section of Cytopathology, Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Qiong Gan
- Section of Cytopathology, Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Deepak Donthi
- Section of Cytopathology, Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Nour Sneige
- Section of Cytopathology, Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| |
Collapse
|
3
|
Reynolds JP, Liu S. Fine needle aspiration of mediastinal germ cell tumors. Semin Diagn Pathol 2020; 37:174-178. [PMID: 32444243 DOI: 10.1053/j.semdp.2020.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 12/23/2022]
Abstract
Germ cell tumors in the mediastinum are rare and often occur in young patients but may occur in older patients. Seminoma, embryonal carcinoma, yolk sac tumor, choriocarcinoma and teratoma have distinct morphologic features with high grade nuclei. They are the primary diagnostic consideration in young males but may be lower on the list in older patients, where they may be misdiagnosed as carcinomas. Review of the history, use of immunohistochemistry stains and recognition of morphologic features will help to make the diagnosis of germ cell tumor of the mediastinum. These tumors have a good to intermediate prognosis, depending on when they are detected.
Collapse
Affiliation(s)
- Jordan P Reynolds
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH.
| | - Shiguang Liu
- Department of Pathology and Laboratory Medicine University of Florida-Jacksonville, Jacksonville, FL
| |
Collapse
|
4
|
Jaggi S, Kundu R, Binji S, Handa U, Saini V. Germ cell tumor causing pleural effusion: A diagnostic dilemma. Indian J Tuberc 2018; 65:80-83. [PMID: 29332656 DOI: 10.1016/j.ijtb.2017.08.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 08/01/2017] [Indexed: 11/26/2022]
Abstract
Straw colored pleural fluid with raised adenosine deaminase (ADA) levels in young healthy adults usually raises suspicion of tuberculosis, sometimes leading to laxity in carrying thorough physical examination and missing out some important clues with potential disastrous consequences. A 35-year-old male was diagnosed to have left pleural effusion and anti-tubercular treatment was started on the basis of straw colored, lymphocyte-predominant pleural fluid with significantly raised ADA levels. When there was no improvement after 1 month of treatment he was investigated further and found to have a mediastinal mass along with hydro-pneumothorax. Fine needle aspiration cytology (FNAC) of the mass was done twice at different centers with different reports followed by biopsy from the mass to settle the diagnosis. Histopathological examination revealed yolk sac tumor. Testicular ultrasound showed a mass with ill-defined hypoechoic areas and lobulated margins in left testis, which was missed on clinical examination. Serum lactate dehydrogenase (LDH) and alpha fetoprotein (AFP) levels were found to be elevated. Beta-human chorionic gonadotropin (β-hCG) was normal. The final diagnosis of nonseminomatous germ cell tumor with mediastinal metastasis was made. The present case underlines the importance of good clinical examination, an art which is diminishing with availability of sophisticated investigations and a thin line of difference between potentially curable and fatal diagnosis, especially in young population, where malignancy is overlooked as a differential diagnosis. Furthermore, despite all its advantages, too much reliance on FNAC may be responsible for misdiagnosis in certain cases.
Collapse
Affiliation(s)
- Surabhi Jaggi
- Junior Resident, Department of Pulmonary Medicine, Government Medical College and Hospital, Sector 32 A, Chandigarh 160030, India
| | - Reetu Kundu
- Assistant Professor, Department of Pathology, Government Medical College and Hospital, Sector 32 A, Chandigarh 160030, India.
| | - Sanjeev Binji
- Junior Resident, Department of Pulmonary Medicine, Government Medical College and Hospital, Sector 32 A, Chandigarh 160030, India
| | - Uma Handa
- Professor, Department of Pathology, Government Medical College and Hospital, Sector 32 A, Chandigarh 160030, India
| | - Varinder Saini
- Professor, Department of Pulmonary Medicine, Government Medical College and Hospital, Sector 32 A, Chandigarh 160030, India
| |
Collapse
|
5
|
Giant Mediastinal Germ Cell Tumour: An Enigma of Surgical Consideration. Case Rep Surg 2016; 2016:7615029. [PMID: 27807495 PMCID: PMC5078647 DOI: 10.1155/2016/7615029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 09/17/2016] [Accepted: 09/21/2016] [Indexed: 12/03/2022] Open
Abstract
We present a case of 16-year-old male, who was referred from private centre for dyspnoea, fatigue, and orthopnea. The chest radiograph revealed complete opacification of left chest which was confirmed by computed tomography as a large left mediastinal mass measuring 14 × 15 × 18 cm. The diagnostic needle core biopsy revealed mixed germ cell tumour with possible combination of embryonal carcinoma, yolk sac, and teratoma. After 4 cycles of neoadjuvant BEP regime, there was initial response of tumour markers but not tumour bulk. Instead of classic median sternotomy or clamshell incision, posterolateral approach with piecemeal manner was chosen. Histology confirmed mixed germ cell tumour with residual teratomatous component without yolk sac or embryonal carcinoma component. Weighing 3.5 kg, it is one of the largest mediastinal germ cell tumours ever reported. We describe this rare and gigantic intrathoracic tumour and discuss the spectrum of surgical approach and treatment of this exceptional tumour.
Collapse
|
6
|
Copin MC. [Pathology of the mediastinum. Case 8. Seminoma]. Ann Pathol 2015; 35:251-4. [PMID: 26001352 DOI: 10.1016/j.annpat.2015.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 03/16/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Marie-Christine Copin
- Institut de pathologie, centre de biologie pathologie, université de Lille, CHU de Lille, avenue Oscar-Lambret, 59037 Lille cedex, France.
| |
Collapse
|
7
|
Peric B, Marinsek ZP, Skrbinc B, Music M, Zagar I, Hocevar M. A patient with a painless neck tumour revealed as a carotid paraganglioma: a case report. World J Surg Oncol 2014; 12:267. [PMID: 25141773 PMCID: PMC4153909 DOI: 10.1186/1477-7819-12-267] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 08/06/2014] [Indexed: 11/10/2022] Open
Abstract
Carotid paragangliomas are usually slowly enlarging and painless lateral neck masses. These mostly benign lesions are recognized due to their typical location, vessel displacement and specific blood supply, features that are usually seen on different imaging modalities. Surgery for carotid paraganglioma can be associated with immediate cerebrovascular complications or delayed neurological impairment.We are reporting the case of a 36-year-old man who presented with a painless mass on the right side of his neck 11 months after being treated for testicular cancer. After a fine-needle aspiration biopsy, he was diagnosed with a testicular cancer lymph node metastasis. Neck US and fluorine [F-18]-fluorodeoxy-D-glucose (FDG) PET-CT showed no signs of hypervascularity or vessel displacement. The patient underwent a level II to V functional neck dissection. During the procedure, suspicion of a carotid paraganglioma was raised and the tumour was carefully dissected from the walls of the carotid arteries with minimal blood loss and no cranial nerve dysfunction.The histology report revealed carotid paraganglioma with no metastasis in the rest of the lymph nodes. The patient's history of testicular germ cell tumour led to a functional neck dissection during which a previously unrecognized carotid paraganglioma was removed.Surgery for carotid PG can be associated with complications that have major impact on quality of life. A thorough assessment of the patient and neck mass must therefore be performed preoperatively in order to perform the surgical procedure under optimal conditions.
Collapse
Affiliation(s)
- Barbara Peric
- Institute of Oncology Ljubljana, Zaloska 2, Ljubljana 1000, Slovenia.
| | | | | | | | | | | |
Collapse
|
8
|
Spieler P, Rössle M. Respiratory Tract and Mediastinum. ESSENTIALS OF DIAGNOSTIC PATHOLOGY 2012. [PMCID: PMC7122295 DOI: 10.1007/978-3-642-24719-4_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Normal cytology, abnormal and atypical cells, non-cellular components, and infectious cell changes are largely described together with benign, malignant, and neuroendocrine lesions regarding exfoliative and aspiration cytology of the lung. A separate section broadly addresses diagnostic findings and differential diagnoses in bronchoalveolar washings. The section ‘Fine needle aspiration biopsy of mediastinal disorders’ covers in particular biopsy techniques, accuracy of liquid-based cytology, and the complex lesions of the thymus gland. Cytodiagnostic algorithms of the major benign and malignant pulmonary and mediastinal lesions and their respective differential diagnoses are additionally presented in synoptic setups.
Collapse
Affiliation(s)
- Peter Spieler
- Institut für Pathologie, Kantonsspital St. Gallen, Rorschacherstraße 95, 9007 St. Gallen, Switzerland
| | - Matthias Rössle
- Institut für Klinische Pathologie, UniversitätsSpital Zürich, Schmelzbergstraße 12, 8091 Zürich, Switzerland
| |
Collapse
|
9
|
Pandey A, Nandini N, Jha A, Manjunath G. Fine needle aspiration cytology and cell block in the diagnosis of seminoma testis. J Cytol 2011; 28:39-41. [PMID: 21552408 PMCID: PMC3083535 DOI: 10.4103/0970-9371.76950] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Testicular neoplasms which show a wide variety of morphologic types, comprise a small proportion of malignancies. Early identification and treatment is essential for achieving long term survival. The cytologic findings in fine needle aspiration smears from left testicular swelling of a 49 year old male suggestive of a germ cell tumor was complimented by cell block preparation as seminoma. This was confirmed by histopathologic studies. We are presenting this case to emphasize that cell block can be used for diagnosis of testicular tumors.
Collapse
Affiliation(s)
- Abhishant Pandey
- Department of Pathology, J. S. S Medical College, Mysore, Karnataka, India
| | | | | | | |
Collapse
|
10
|
Dagli AF, Pehlivan S, Cihangiroglu G, Ozercan MR. Cytology of mixed germ cell tumor with mediastinal metastasis. J Cytol 2009; 26:120-2. [PMID: 21938171 PMCID: PMC3168014 DOI: 10.4103/0970-9371.59400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Nonseminomatous germ cell tumors of the testis are common and are very aggressive malignant tumors. Most of the cases have metastases at the time of diagnosis, and involvement of the posterior mediastinum in particular is well known. A 33 year-old male patient presented with complaints of a swelling on the right side of the neck that had been growing for the last month, as well as shortness of breath and cough. His thoracic computed tomography (CT) showed a 1.5 cm lymph node on the anterior mediastinum and a mass of about 11 × 10 × 8 cm extending from the right lung apex to the right hilus, with regular contours and without contrast enhancement. The patient, who was given the preliminary diagnosis of a mixture metastatic bronchial tumor plus lymphoma, was subjected to transthoracic fine needle aspiration cytology (FNAC). His abdominal CT revealed a hypodense, heterogeneous and cystic necrotic mass of about 10 × 7 × 5 cm that was para-aortic at the infrarenal level (initially predicted as a lymphoma). The patient, who could not be typed in his cytopathological examination, was diagnosed with malignant epithelial tumor and was recommended to undergo a genitourinary system examination. Upon finding a high alpha fetoprotein (AFP) value, a scrotal ultra sonography was performed which showed a mass filling the right testis. Histopathological examination of the orchiectomy material resulted in the diagnosis of mixed germ cell tumor (60% mature teratoma and 40% yolk sac tumor). Even though metastatic lesions are mostly seen in the posterior mediastinum, our findings reveal that specimens obtained with FNAC from the anterior mediastinum bear discohesive, pleomorphic, small nuclei in epithelial cells with microvacoules in the cytoplasm. These cytopathological alterations in specimens from the anterior mediastinum might promote germ cell and yolk sac tumors.
Collapse
Affiliation(s)
- Adile Ferda Dagli
- Department of Pathology, Firat University, Medical School, Elazig, Turkey
| | | | | | | |
Collapse
|
11
|
Gupta R, Mathur SR, Arora VK, Sharma SG. Cytologic features of extragonadal germ cell tumors. Cancer 2008; 114:504-11. [DOI: 10.1002/cncr.23983] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
12
|
Anand D, Barroeta JE, Gupta PK, Kochman M, Baloch ZW. Endoscopic ultrasound guided fine needle aspiration of non-pancreatic lesions: an institutional experience. J Clin Pathol 2007; 60:1254-62. [PMID: 17220205 PMCID: PMC2095489 DOI: 10.1136/jcp.2006.045955] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Endoscopic ultrasound guided fine needle aspiration biopsy (EUS-FNA) has proven to be an effective diagnostic modality for the detection and staging of pancreatic malignancies. In recent years EUS-FNA has also been used to diagnose lesions of non-pancreatic sites such as structures in close proximity to the gut wall within the mediastinum, abdomen, pelvis and retro-peritoneum. AIMS To evaluate experience with EUS-FNA of non-pancreatic sites at a large university medical centre. METHODS The study cohort included 234 patients who underwent EUS-FNA of 246 lesions in non-pancreatic sites (122 peri-pancreatic and coeliac lymph nodes; 9 peri-pancreatic masses; other sites: mediastinum 12, gastric 25, liver 27, oesophagus 17, duodenum/colon/rectum 15, retro-peritoneum 8, lung 7, miscellaneous 4). RESULTS The cytology diagnoses were classified as non-neoplastic/reactive in 82 (33%), atypical/suspicious for malignancy in 25 (10%), malignant in 86 (35%) and non-diagnostic in 53 (22%) cases. Surgical pathology follow-up was available in 75 (31%) cases. Excluding the non-diagnostic cases there were 7 false negative and 3 false positive cases. The sensitivity, specificity and positive predictive value of EUS-FNA in the diagnosis of lesions of non-pancreatic sites was 92%, 98% and 97%, respectively. CONCLUSIONS EUS-FNA can be effectively used as a diagnostic modality in the diagnosis of lesions from non-pancreatic sites.
Collapse
Affiliation(s)
- Dipti Anand
- Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania 19104, USA
| | | | | | | | | |
Collapse
|
13
|
Castro CY, Chhieng DC. Cytology and surgical pathology of the mediastinum. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2006; 563:42-54. [PMID: 16433122 DOI: 10.1007/0-387-32025-3_6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Affiliation(s)
- Claudia Y Castro
- Immunohistochemistry Laboratory, Department of Pathology, University of Texas, Galveston, TX, USA
| | | |
Collapse
|
14
|
Mrad K, Abid L, Oubiche F, Driss M, Abbes I, Sassi S, Ben Romdhane K. Apport de la cytoponction dans le diagnostic des tumeurs germinales extragonadiques. Ann Pathol 2004; 24:356-9. [PMID: 15567952 DOI: 10.1016/s0242-6498(04)93983-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Extragonadic germinal tumors are frequently mixed tumors. When a metastatic sacrococcygeal teratoma is clinically suspected in children, a yolk-sac tumor component could be judiciously demonstrated by either an elevated serum level of alphafoetoprotein (AFP), or fine needle aspiration cytology. We report the case of a 25 month aged girl presenting a metastatic sacrococcygeal tumor (lymph node and bone metastasis) with high level of AFP (34.100 microg/ml). Fine needle aspiration cytology identified the yolk sac tumor component, characterized by papillae and glandular clusters, composed of pale isomorphic cells with vesicular and nucleolated nucleus and some intracytoplasmic hyaline globules. The yolk sac tumor component could not be identified in the sacrococcygeal surgical specimen, exclusively composed of immature teratoma.
Collapse
Affiliation(s)
- Karima Mrad
- Service d'anatomie et cytologie pathologique, Institut Salah Azaiez, Tunisie.
| | | | | | | | | | | | | |
Collapse
|