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Mixed germ cell tumor or multiple primary?

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  • Mixed germ cell tumor or multiple primary?

    Ive been reading a bit on my pathology report and havent really been clarified on what exactly my case is. I'll post the pathology report below. The question is whether or not this is a pure embryonal case, as in my eyes the pathology report contradicts itself. In one spot it says that my tumor is multifocal, by definition meaning that it would be a mixed germ cell tumor because it originated as one tumor. But in another, it says that it is multiple primary. Im under the impression that you cant have both.

    The question really is how much ec I have. If it is a multifocal tumor, then I cant possibly have 100% given the presence of seminoma aswell. However if it is multiple primary, then it is possible to have both pure ec and pure seminoma.

    Anyone had a similar case? Is there a way to get a second opinion on the makeup of my tumors?

    Here is the pathology report:

    Right testicle, radical orchiectomy: Multifocal malignant germ cell tumors, embryonal carcinoma and seminoma, classic type (see case summary and comment). CASE SUMMARY FOR MALIGNANT GERM CELL AND SEX CORD-STROMAL TUMORS OF THE TESTIS: Radical Orchiectomy Specimen laterality: Right Tumor focality: Multifocal Tumor size: 2.1 cm, greatest dimension (embryonal carcinoma) Greatest dimension of additional tumor nodules: 0.5 cm (seminoma, classic type) and 1.0 cm (seminoma, classic type) Macroscopic extent of tumor: Invades the hilar soft tissue (embryonal carcinoma) Histologic type: Multifocal malignant germ cell tumors, embryonal carcinoma and seminoma, classic type Margins: Spermatic cord margin: Negative for tumor Other margins: Negative for tumor Microscopic tumor extension: rete testis (embryonal carcinoma and seminoma classic type) Lymph-Vascular invasion: Present Pathologic staging (pTNM): TNM Descriptors: m (multiple) Primary tumor ( pT): pT2: Tumor limited to the testis and epididymis with vascular/lymphatic invasion Regional lymph nodes (pN): pNX: Cannot be assessed (no nodes submitted or found) Distant metastasis (pM): pM: Not applicable Pre-orchiectomy serum tumor markers: Serum marker studies within normal limits Post-orchiectomy serum tumor markers: Unknown Serum tumor markers (S): S0: Serum marker study levels within normal limits Additional pathologic findings: Patchy atrophic seminiferous tubules, minimal retained active spermatogenesis, extensive intratubular germ cell neoplasia, intratubular seminoma, intratubular embryonal carcinoma with extensive intratubular necrosis and dystrophic calcifications (0.9 cm subcapsular nodule), focal Leydig cell hyperplasia, epididymal cribriform epithelial hyperplasia. AJCC Staging (7th edition): pT2(m) pNX pM: Not applicable S0
    Name
    Surg Path Diagnosis
    Normal Range
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    Your Results
    M-90703
    Name
    Surg Path Comment
    Normal Range
    N/A
    Your Results
    There are at least 4 separate tumor nodules: 1) one pure embryonal carcinoma, 2.1 cm in greatest dimension which invades the rete testis and superficial hilar soft tissue associated with hilar vascular invasion, 2) one solid classic type seminoma, 1.0 cm in greatest dimension, in the superior pole, 3) one classic type seminoma, 0.5 cm in greatest dimension, inferior pole hilar predominantly intratubular with interstitial and pagetoid rete infiltration, and 4) one 0.9 cm inferior subcapsular pole nodule composed of intratubular embryonal carcinoma. Multifocal tumors and epididymal cribriform epithelial hyperplasia are associated with an increase risk for contralateral germ cell tumor formation.
    Name
    Surg Path Specimen
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    Your Results
    A. Right testicle
    Name
    Surg Path Gross
    Normal Range
    N/A
    Your Results
    A. Received in formalin, labeled with the patient's name and designated as "right testicle", is a testicle (5 x 3.2 x 2.7 cm) with attached spermatic cord (7.7 x 1.5 x 1 cm) and a small amount of attached yellow fatty tissue (3.5 x 2 x 2 cm) weighing 49 g. The margin is inked black and the remainder specimen is inked blue. The epididymis measures 6 x 1 x 0.5 cm. The testicle is bivalved and serially sectioned to reveal a cluster of tan-pink and red to grey and yellow solid firm nodules extending over an area measuring 3 x 2.1 x 1.7 cm (the nodules range in size from 0.5-2.1 cm) and one nodule separate from the cluster, 0.9 x 0.7 x 0.5 cm. The nodules are located at least 8.5 cm from the spermatic cord margin, 0.2 cm from the epididymis, and 0.2 cm from the loosely adherent tunica vaginalis. The nodules focally distort the tunica albuginea but do not grossly appear to involve it. The remaining parenchyma is tan orange and strings with ease. Representative sections are submitted in 6 cassettes. RSB6 ARD/VK 11/23/16 13:28:12 EST Cassette summary: 1. Spermatic cord margin 2-5. Cluster of nodules-representative sections including epididymis in cassettes 2 and 3 6. Nodule separate from the cluster After review of the slides, additional section of a 0.5 cm inferior pole lesion and surrounding fatty tissue is submitted in cassette 7 on 11/29/16. RSB7 ARD/MMD
    Name
    Surg Path Micro
    Normal Range
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    Your Results
    A properly controlled immunohistochemical stain for CD30 is diffusely positive in all the tumor cells present in this section confirming embryonal carcinoma. Unless designated as gross examination only, a microscopic examination has been performed and is reflected in the above diagnosis(es). If utilized, each immunohistochemical, in situ hybridization or histochemical stain documented is performed on a separate slide, unless otherwise specified. All controls stained appropriately. Some of the tests performed may have been developed and their performance characteristics determined by the Department of Pathology and Laboratory Medicine at Spectrum Health. They have not been cleared or approved by the U.S. Food and Drug Administration. The FDA has determined that such clearance or approval is not necessary. These tests are used for clinical purposes. They should not be regarded as investigational or for research. This laboratory is regulated under the Clinical Laborato ry Improvement Amendments of 1988 (CLIA) as qualified to perform high complexity clinical testing. The immunohistochemical or in situ hybridization staining tests performed are deemed medically necessary. Some of the antibodies/antigens/genes may also be evaluated by other methods such as flow cytometry or cytogenetic fluorescence in situ hybridization (FISH). Concurrent evaluation by staining on tissue sections and by these other methods may be indicated in order to correlate immunophenotype with cell morphology and to characterize a cell population of interest by flow cytometry or FISH and does not represent duplicate testing.
    Name
    Surg Path QC
    Normal Range
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    11/16- Pain/lump in R testicle 11/16- US finds multiple masses 11/16- Right I/O path multifocal largest nodule 2.1cm 100% EC with LVI/rete testis invasion. 12/16- Ct/markers normal stage 1b 12/16- Ct/markers normal 1/17- rplnd pN1 2 nodes 1.8/1.4 cm EC Stage IIA 2/20 ct/markers clear! 3/1/17 started androgel for low T 4/27/17 Relapsed. Multiple lymph nodes in mesentary and few nodes in retriperitoneum. Start 3x bep. Ct after 2nd cycle revealed all masses already resolved! Continue last cycle! 6/26/17 Finished 3x bep!
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