Difference between revisions of "Seminoma"

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| Micro      = fried egg-like cells (clear or eosinophilic cytoplasm, central nucleus), lymphocytic infiltrate (common), +/-[[syncytiotrophoblast]]s (rare), +/-granulomas (uncommon)
| Micro      = fried egg-like cells (clear or eosinophilic cytoplasm, central nucleus), lymphocytic infiltrate (common), +/-[[syncytiotrophoblast]]s (rare), +/-granulomas (uncommon)
| Subtypes  =
| Subtypes  =
| LMDDx      = [[embryonal carcinoma]], [[ITGCN]], [[mixed germ cell tumour]], [[granulomatous orchitis]]  
| LMDDx      = [[embryonal carcinoma]], [[GCNIS]], [[mixed germ cell tumour]], [[granulomatous orchitis]], [[testicular scar]], [[atrophic testis]]  
| Stains    =
| Stains    =
| IHC        = OCT3 +ve, CD117 +ve, CD30 -ve
| IHC        = OCT4 +ve, [[CD117]] +ve, CD30 -ve
| EM        =
| EM        =
| Molecular  =
| Molecular  =
| IF        =
| IF        =
| Gross      = solid, white/tan
| Gross      = solid, white/tan
| Grossing  = [[Orchiectomy grossing]]
| Grossing  = [[orchiectomy grossing]]
| Staging    = [[testicular cancer staging]]
| Site      = [[testis]]
| Site      = [[testis]]
| Assdx      = [[ITGCN]]
| Assdx      = [[GCNIS]]
| Syndromes  =
| Syndromes  =
| Clinicalhx =
| Clinicalhx =
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| Symptoms  =
| Symptoms  =
| Prevalence =
| Prevalence =
| Bloodwork  = LDH elevated, beta-hCG elevated (not common)
| Bloodwork  = LDH elevated, beta-hCG normal or slightly elevated
| Rads      =
| Rads      =
| Endoscopy  =
| Endoscopy  =
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| Other      =
| Other      =
| ClinDDx    = other [[testis|testicular tumours]] ([[germ cell tumour]]s, [[lymphoma]])
| ClinDDx    = other [[testis|testicular tumours]] ([[germ cell tumour]]s, [[lymphoma]])
| Tx        =
}}
}}
'''Seminoma''' is a common [[testis|testicular]] [[germ cell tumour]].
'''Seminoma''' is a common [[testis|testicular]] [[germ cell tumour]].


It should ''not'' be confused with the unrelated tumour called ''[[spermatocytic seminoma]]''.
It should ''not'' be confused with ''[[spermatocytic tumour]]'' (previously known as ''spermatocytic seminoma'').


==General==
==General==
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*Elevated serum LDH.
*Elevated serum LDH.
*Normal serum alpha fetoprotein.  
*Normal serum alpha fetoprotein.  
*Usually normal beta-hCG.
*Usually normal beta-hCG ''or'' slightly elevated.<ref name=pmid9311009>{{cite journal |authors=Hori K, Uematsu K, Yasoshima H, Yamada A, Sakurai K, Ohya M |title=Testicular seminoma with human chorionic gonadotropin production |journal=Pathol Int |volume=47 |issue=9 |pages=592–9 |date=September 1997 |pmid=9311009 |doi=10.1111/j.1440-1827.1997.tb04547.x |url=}}</ref>


Note:
Note:
Line 45: Line 47:


===Epidemiology & etiology===
===Epidemiology & etiology===
*Arises from ''[[intratubular germ cell neoplasia]]'' (ITGCN).
*Arises from ''[[germ cell neoplasia in situ]]'', abbreviated ''GCNIS'' (previously known as ''intratubular germ cell neoplasia'').


==Gross==
==Gross==
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*+/-Lymphoctyes - interspersed (very common).
*+/-Lymphoctyes - interspersed (very common).
*+/-[[Syncytiotrophoblast]]s, [[AKA]] ''syncytiotrophoblastic giant cells'' (STGCs),<ref name=Ref_GUP542>{{Ref GUP|542}}</ref> present in ~10-20% of seminoma.<ref>URL: [http://www.webpathology.com/image.asp?case=31&n=10 http://www.webpathology.com/image.asp?case=31&n=10]. Accessed on: 22 May 2012.</ref>
*+/-[[Syncytiotrophoblast]]s, [[AKA]] ''syncytiotrophoblastic giant cells'' (STGCs),<ref name=Ref_GUP542>{{Ref GUP|542}}</ref> present in ~10-20% of seminoma.<ref>URL: [http://www.webpathology.com/image.asp?case=31&n=10 http://www.webpathology.com/image.asp?case=31&n=10]. Accessed on: 22 May 2012.</ref>
**Large + irregular, vesicular nuclei.  
**Large + irregular, [[vesicular nuclei]].  
**Eosinophilic vacuolated cytoplasm (contains hCG).
**Eosinophilic vacuolated cytoplasm (contains hCG).
***Syncytiotrophoblasts = closest to mom in normal [[chorionic villi]] - covers cytotrophoblast.<ref>URL: [http://upload.wikimedia.org/wikipedia/commons/4/45/Gray37.png http://upload.wikimedia.org/wikipedia/commons/4/45/Gray37.png]. Accessed on: 31 May 2010.</ref>
***Syncytiotrophoblasts = closest to mom in normal [[chorionic villi]] - covers cytotrophoblast.<ref>URL: [http://upload.wikimedia.org/wikipedia/commons/4/45/Gray37.png http://upload.wikimedia.org/wikipedia/commons/4/45/Gray37.png]. Accessed on: 31 May 2010.</ref>
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*Approximately 24% of Stage I seminomas have [[lymphovascular invasion]].<ref name=pmid23275274>{{Cite journal  | last1 = Soper | first1 = MS. | last2 = Hastings | first2 = JR. | last3 = Cosmatos | first3 = HA. | last4 = Slezak | first4 = JM. | last5 = Wang | first5 = R. | last6 = Lodin | first6 = K. | title = Observation versus adjuvant radiation or chemotherapy in the management of stage I seminoma: clinical outcomes and prognostic factors for relapse in a large US cohort. | journal = Am J Clin Oncol | volume = 37 | issue = 4 | pages = 356-9 | month = Aug | year = 2014 | doi = 10.1097/COC.0b013e318277d839 | PMID = 23275274 }}</ref>
*Approximately 24% of Stage I seminomas have [[lymphovascular invasion]].<ref name=pmid23275274>{{Cite journal  | last1 = Soper | first1 = MS. | last2 = Hastings | first2 = JR. | last3 = Cosmatos | first3 = HA. | last4 = Slezak | first4 = JM. | last5 = Wang | first5 = R. | last6 = Lodin | first6 = K. | title = Observation versus adjuvant radiation or chemotherapy in the management of stage I seminoma: clinical outcomes and prognostic factors for relapse in a large US cohort. | journal = Am J Clin Oncol | volume = 37 | issue = 4 | pages = 356-9 | month = Aug | year = 2014 | doi = 10.1097/COC.0b013e318277d839 | PMID = 23275274 }}</ref>
**Stage I = Tx N0 M0.<ref>URL: [http://emedicine.medscape.com/article/2006777-overview http://emedicine.medscape.com/article/2006777-overview]. Accessed on: October 8, 2014.</ref>
**Stage I = Tx N0 M0.<ref>URL: [http://emedicine.medscape.com/article/2006777-overview http://emedicine.medscape.com/article/2006777-overview]. Accessed on: October 8, 2014.</ref>
*Intertubular seminoma may ''not'' form a discrete mass and mimic a benign testis.<ref name=pmid15316315>{{Cite journal  | last1 = Henley | first1 = JD. | last2 = Young | first2 = RH. | last3 = Wade | first3 = CL. | last4 = Ulbright | first4 = TM. | title = Seminomas with exclusive intertubular growth: a report of 12 clinically and grossly inconspicuous tumors. | journal = Am J Surg Pathol | volume = 28 | issue = 9 | pages = 1163-8 | month = Sep | year = 2004 | doi =  | PMID = 15316315 }}</ref>


DDx:
DDx:
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*[[Granulomatous orchitis]] - if [[granuloma]]s are present.
*[[Granulomatous orchitis]] - if [[granuloma]]s are present.
*[[Testicular scar]] - seminomas may regress spontaneously.
*[[Testicular scar]] - seminomas may regress spontaneously.
*[[Testicular atrophy]] - esp. for intertubular predominant seminoma.<ref name=pmid15316315>{{Cite journal  | last1 = Henley | first1 = JD. | last2 = Young | first2 = RH. | last3 = Wade | first3 = CL. | last4 = Ulbright | first4 = TM. | title = Seminomas with exclusive intertubular growth: a report of 12 clinically and grossly inconspicuous tumors. | journal = Am J Surg Pathol | volume = 28 | issue = 9 | pages = 1163-8 | month = Sep | year = 2004 | doi =  | PMID = 15316315 }}</ref>


===Images===
===Images===
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Image:Seminoma_intermed_mag.jpg |Seminoma - intermed. mag. (WC/Nephron)
Image:Seminoma_intermed_mag.jpg |Seminoma - intermed. mag. (WC/Nephron)
Image:Rete_testis_with_seminoma.jpg |Seminoma in the rete testis. (WC/Nephron)
Image:Rete_testis_with_seminoma.jpg |Seminoma in the rete testis. (WC/Nephron)
</gallery>
====Syncytiotrophoblasts====
<gallery>
Image:Seminoma_with_syncytiotrophoblasts_-_intermed_mag.jpg |Seminoma with syncytiotrophoblasts - intermed. mag. (WC/Nephron)
Image:Seminoma_with_syncytiotrophoblasts_-_intermed_mag.jpg |Seminoma with syncytiotrophoblasts - intermed. mag. (WC/Nephron)
Image:Seminoma_with_syncytiotrophoblasts_-_very_high_mag.jpg |Seminoma with syncytiotrophoblasts - very high mag. (WC/Nephron)  
Image:Seminoma_with_syncytiotrophoblasts_-_very_high_mag.jpg |Seminoma with syncytiotrophoblasts - very high mag. (WC/Nephron)  
</gallery>
</gallery>
====Intertubular seminoma====
<gallery>
Image: Intertubular seminoma -- very low mag.jpg | ITS - very low mag. (WC)
Image: Intertubular seminoma -- low mag.jpg | ITS - low mag. (WC)
Image: Intertubular seminoma - alt -- low mag.jpg | ITS - low mag. (WC)
Image: Intertubular seminoma -- intermed mag.jpg | ITS - intermed. mag. (WC)
Image: Intertubular seminoma -- high mag.jpg | ITS - high mag. (WC)
Image: Intertubular seminoma -- very high mag.jpg | ITS - very high mag. (WC)
</gallery>
====Lymph node metastasis====
<gallery>
<gallery>
Image: Testicular seminoma (1) nodal metastasis.jpg | Seminoma in LN. (WC/KGH)
Image: Testicular seminoma (1) nodal metastasis.jpg | Seminoma in LN. (WC/KGH)
Image: Testicular seminoma (2) nodal metastasis.jpg | Seminoma in LN. (WC/KGH)
Image: Testicular seminoma (2) nodal metastasis.jpg | Seminoma in LN. (WC/KGH)
</gallery>
====Seminoma with granulomas====
<gallery>
Image: Seminoma with granulomas -- intermed mag.jpg | Seminoma with granulomas - intermed. mag.
Image: Seminoma with granulomas -- high mag.jpg | Seminoma with granulomas - high mag.
Image: Seminoma with granulomas -- very high mag.jpg | Seminoma with granulomas - very high mag.
Image: Seminoma with granulomas --- low mag.jpg | Seminoma with granulomas - low mag.
Image: Seminoma with granulomas --- intermed mag.jpg | Seminoma with granulomas - intermed. mag.
Image: Seminoma with granulomas --- high mag.jpg | Seminoma with granulomas - high mag.
Image: Seminoma with granulomas --- very high mag.jpg | Seminoma with granulomas - very high mag.
</gallery>
</gallery>


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A general panel:<ref name=pmid24832161>{{cite journal |author=Ulbright TM, Tickoo SK, Berney DM, Srigley JR |title=Best practices recommendations in the application of immunohistochemistry in testicular tumors: report from the international society of urological pathology consensus conference |journal=Am. J. Surg. Pathol. |volume=38 |issue=8 |pages=e50–9 |year=2014 |month=August |pmid=24832161 |doi=10.1097/PAS.0000000000000233 |url=}}</ref>
A general panel:<ref name=pmid24832161>{{cite journal |author=Ulbright TM, Tickoo SK, Berney DM, Srigley JR |title=Best practices recommendations in the application of immunohistochemistry in testicular tumors: report from the international society of urological pathology consensus conference |journal=Am. J. Surg. Pathol. |volume=38 |issue=8 |pages=e50–9 |year=2014 |month=August |pmid=24832161 |doi=10.1097/PAS.0000000000000233 |url=}}</ref>
*OCT4 +ve.
*OCT4 +ve.
**Choriocarcinoma, yolk sac tumour and spermatocytic seminoma all -ve.
**Choriocarcinoma, yolk sac tumour and [[spermatocytic tumour]] all -ve.
*CD117 +ve.
*CD117 +ve.
**-ve in embryonal carcinoma.
**-ve in embryonal carcinoma.
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*OCT3/4 +ve.<ref name=pmid20438407>{{Cite journal  | last1 = Emerson | first1 = RE. | last2 = Ulbright | first2 = TM. | title = Intratubular germ cell neoplasia of the testis and its associated cancers: the use of novel biomarkers. | journal = Pathology | volume = 42 | issue = 4 | pages = 344-55 | month = Jun | year = 2010 | doi = 10.3109/00313021003767355 | PMID = 20438407 }}</ref>
*OCT3/4 +ve.<ref name=pmid20438407>{{Cite journal  | last1 = Emerson | first1 = RE. | last2 = Ulbright | first2 = TM. | title = Intratubular germ cell neoplasia of the testis and its associated cancers: the use of novel biomarkers. | journal = Pathology | volume = 42 | issue = 4 | pages = 344-55 | month = Jun | year = 2010 | doi = 10.3109/00313021003767355 | PMID = 20438407 }}</ref>
**Also +ve in embryonal carcinoma.<ref name=pmid18045648>{{Cite journal  | last1 = Iczkowski | first1 = KA. | last2 = Butler | first2 = SL. | last3 = Shanks | first3 = JH. | last4 = Hossain | first4 = D. | last5 = Schall | first5 = A. | last6 = Meiers | first6 = I. | last7 = Zhou | first7 = M. | last8 = Torkko | first8 = KC. | last9 = Kim | first9 = SJ. | title = Trials of new germ cell immunohistochemical stains in 93 extragonadal and metastatic germ cell tumors. | journal = Hum Pathol | volume = 39 | issue = 2 | pages = 275-81 | month = Feb | year = 2008 | doi = 10.1016/j.humpath.2007.07.002 | PMID = 18045648 }}</ref>
**Also +ve in embryonal carcinoma.<ref name=pmid18045648>{{Cite journal  | last1 = Iczkowski | first1 = KA. | last2 = Butler | first2 = SL. | last3 = Shanks | first3 = JH. | last4 = Hossain | first4 = D. | last5 = Schall | first5 = A. | last6 = Meiers | first6 = I. | last7 = Zhou | first7 = M. | last8 = Torkko | first8 = KC. | last9 = Kim | first9 = SJ. | title = Trials of new germ cell immunohistochemical stains in 93 extragonadal and metastatic germ cell tumors. | journal = Hum Pathol | volume = 39 | issue = 2 | pages = 275-81 | month = Feb | year = 2008 | doi = 10.1016/j.humpath.2007.07.002 | PMID = 18045648 }}</ref>
*[[PLAP]] +ve.
**Largely replaced by ''OCT4'' or ''OCT3/4'' - which is more sensitive.<ref name=pmid15725806 >{{Cite journal  | last1 = Hattab | first1 = EM. | last2 = Tu | first2 = PH. | last3 = Wilson | first3 = JD. | last4 = Cheng | first4 = L. | title = OCT4 immunohistochemistry is superior to placental alkaline phosphatase (PLAP) in the diagnosis of central nervous system germinoma. | journal = Am J Surg Pathol | volume = 29 | issue = 3 | pages = 368-71 | month = Mar | year = 2005 | doi =  | PMID = 15725806 }}</ref>


==Sign out==
==Sign out==
<pre>
Right Testicle, Radical Orchitectomy:
    - SEMINOMA (pure).
    -- Margins clear.
    -- Germ cell neoplasia in situ (intratubular germ cell neoplasia) present.
    -- Please see synoptic report.
    - Background testis consists of Sertoli cells only, NEGATIVE for spermatogenesis.
</pre>
<pre>
Testis, Left, Radical Orchiectomy:
    - SEMINOMA (pure).
    -- Margins clear.
    -- Please see synoptic report.
</pre>
===Biopsy===
<pre>
<pre>
RETROPERITONEAL SOFT TISSUE, RIGHT, CORE BIOPSY:
RETROPERITONEAL SOFT TISSUE, RIGHT, CORE BIOPSY:
- SEMINOMA.
    - SEMINOMA.
</pre>
</pre>
===Micro===
 
====Micro====
The sections show large atypical, discohesive cells with prominent nucleoli, central
The sections show large atypical, discohesive cells with prominent nucleoli, central
nuclei and moderate clear cytoplasm, intermixed with mature lymphocytes. Mitotic
nuclei and moderate clear cytoplasm, intermixed with mature lymphocytes. Mitotic
activity is present.
activity is present.


===Small biopsy===
====Small biopsy====
A mixed germ cell tumour cannot be excluded; given the small quantity of tumour, this
A mixed germ cell tumour cannot be excluded; given the small quantity of tumour, this
biopsy is at a high risk for having undersampled other tumour components should they be
biopsy is at a high risk for having undersampled other tumour components should they be

Latest revision as of 19:24, 12 April 2022

Seminoma
Diagnosis in short

Seminoma. H&E stain.
LM fried egg-like cells (clear or eosinophilic cytoplasm, central nucleus), lymphocytic infiltrate (common), +/-syncytiotrophoblasts (rare), +/-granulomas (uncommon)
LM DDx embryonal carcinoma, GCNIS, mixed germ cell tumour, granulomatous orchitis, testicular scar, atrophic testis
IHC OCT4 +ve, CD117 +ve, CD30 -ve
Gross solid, white/tan
Grossing notes orchiectomy grossing
Staging testicular cancer staging
Site testis
Associated Dx GCNIS
Signs testicular mass, +/-retroperitoneal lymphadenopathy
Blood work LDH elevated, beta-hCG normal or slightly elevated
Prognosis good
Clin. DDx other testicular tumours (germ cell tumours, lymphoma)

Seminoma is a common testicular germ cell tumour.

It should not be confused with spermatocytic tumour (previously known as spermatocytic seminoma).

General

Clinical:

  • Elevated serum LDH.
  • Normal serum alpha fetoprotein.
  • Usually normal beta-hCG or slightly elevated.[1]

Note:

  • Rarely, it may present a retroperitoneal mass.[2]

Epidemiology & etiology

Gross

  • Solid, white/tan.

  • Seminoma (WC/Ed Uthman).

Microsopic

Features:

  • Cells with fried egg appearance - key feature:
    • Clear cytoplasm.
    • Central nucleus, with prominent nucleolus.
      • Nucleus may have "corners", i.e. it is not round.
  • +/-Lymphoctyes - interspersed (very common).
  • +/-Syncytiotrophoblasts, AKA syncytiotrophoblastic giant cells (STGCs),[3] present in ~10-20% of seminoma.[4]
    • Large + irregular, vesicular nuclei.
    • Eosinophilic vacuolated cytoplasm (contains hCG).
      • Syncytiotrophoblasts = closest to mom in normal chorionic villi - covers cytotrophoblast.[5]
  • +/-Florid granulomatous reaction.

Notes:

  • Memory device: 3 Cs - clear cytoplasm, central nucleus, corners on the nuclear membrane.
  • Approximately 24% of Stage I seminomas have lymphovascular invasion.[6]
    • Stage I = Tx N0 M0.[7]
  • Intertubular seminoma may not form a discrete mass and mimic a benign testis.[8]

DDx:

Images

  • Seminoma - high mag. (WC/Nephron)

  • Seminoma - intermed. mag. (WC/Nephron)

  • Seminoma in the rete testis. (WC/Nephron)

Syncytiotrophoblasts

  • Seminoma with syncytiotrophoblasts - intermed. mag. (WC/Nephron)

  • Seminoma with syncytiotrophoblasts - very high mag. (WC/Nephron)

Intertubular seminoma

  • ITS - very low mag. (WC)

  • ITS - low mag. (WC)

  • ITS - low mag. (WC)

  • ITS - intermed. mag. (WC)

  • ITS - high mag. (WC)

  • ITS - very high mag. (WC)

Lymph node metastasis

  • Seminoma in LN. (WC/KGH)

  • Seminoma in LN. (WC/KGH)

Seminoma with granulomas

  • Seminoma with granulomas - intermed. mag.

  • Seminoma with granulomas - high mag.

  • Seminoma with granulomas - very high mag.

  • Seminoma with granulomas - low mag.

  • Seminoma with granulomas - intermed. mag.

  • Seminoma with granulomas - high mag.

  • Seminoma with granulomas - very high mag.

IHC

ISUP consensus

A general panel:[11]

  • OCT4 +ve.
  • CD117 +ve.
    • -ve in embryonal carcinoma.
  • CD30 -ve.
    • +ve in embryonal carcinoma.

Seminoma versus choriocarcinoma:[12]

  • OCT4 (uniformily) +ve.
    • Choriocarcinoma = patchy staining.

Additional notes

  • D2-40 +ve ~100% of cases in one series.[13]
  • CD117 +ve (ckit) ~92% of cases.[13]
  • CD30 -ve.[15]
  • Cytokeratins usu. -ve, may have weak focal positivity.[15]
  • OCT3/4 +ve.[16]
    • Also +ve in embryonal carcinoma.[14]
  • PLAP +ve.
    • Largely replaced by OCT4 or OCT3/4 - which is more sensitive.[17]

Sign out

Right Testicle, Radical Orchitectomy:
     - SEMINOMA (pure).
     -- Margins clear.
     -- Germ cell neoplasia in situ (intratubular germ cell neoplasia) present.
     -- Please see synoptic report.
     - Background testis consists of Sertoli cells only, NEGATIVE for spermatogenesis.

Testis, Left, Radical Orchiectomy:
     - SEMINOMA (pure).
     -- Margins clear.
     -- Please see synoptic report.

Biopsy

RETROPERITONEAL SOFT TISSUE, RIGHT, CORE BIOPSY:
     - SEMINOMA.

Micro

The sections show large atypical, discohesive cells with prominent nucleoli, central nuclei and moderate clear cytoplasm, intermixed with mature lymphocytes. Mitotic activity is present.

Small biopsy

A mixed germ cell tumour cannot be excluded; given the small quantity of tumour, this biopsy is at a high risk for having undersampled other tumour components should they be present. Correlation with serology and consideration of re-biopsy is suggested.

See also

References

  1. ↑ Hori K, Uematsu K, Yasoshima H, Yamada A, Sakurai K, Ohya M (September 1997). "Testicular seminoma with human chorionic gonadotropin production". Pathol Int 47 (9): 592–9. doi:10.1111/j.1440-1827.1997.tb04547.x. PMID 9311009.
  2. ↑ Preda, O.; Nicolae, A.; Loghin, A.; Borda, A.; Nogales, FF. (2011). "Retroperitoneal seminoma as a first manifestation of a partially regressed (burnt-out) testicular germ cell tumor.". Rom J Morphol Embryol 52 (1): 193-6. PMID 21424055.
  3. ↑ Zhou, Ming; Magi-Galluzzi, Cristina (2006). Genitourinary Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 542. ISBN 978-0443066771.
  4. ↑ URL: http://www.webpathology.com/image.asp?case=31&n=10. Accessed on: 22 May 2012.
  5. ↑ URL: http://upload.wikimedia.org/wikipedia/commons/4/45/Gray37.png. Accessed on: 31 May 2010.
  6. ↑ Soper, MS.; Hastings, JR.; Cosmatos, HA.; Slezak, JM.; Wang, R.; Lodin, K. (Aug 2014). "Observation versus adjuvant radiation or chemotherapy in the management of stage I seminoma: clinical outcomes and prognostic factors for relapse in a large US cohort.". Am J Clin Oncol 37 (4): 356-9. doi:10.1097/COC.0b013e318277d839. PMID 23275274.
  7. ↑ URL: http://emedicine.medscape.com/article/2006777-overview. Accessed on: October 8, 2014.
  8. ↑ 8.0 8.1 Henley, JD.; Young, RH.; Wade, CL.; Ulbright, TM. (Sep 2004). "Seminomas with exclusive intertubular growth: a report of 12 clinically and grossly inconspicuous tumors.". Am J Surg Pathol 28 (9): 1163-8. PMID 15316315.
  9. ↑ URL: http://webpathology.com/image.asp?case=34&n=8. Accessed on: March 8, 2010.
  10. ↑ Hedinger, C.; von Hochstetter, AR.; Egloff, B. (Jul 1979). "Seminoma with syncytiotrophoblastic giant cells. A special form of seminoma.". Virchows Arch A Pathol Anat Histol 383 (1): 59-67. PMID 157614.
  11. ↑ Ulbright TM, Tickoo SK, Berney DM, Srigley JR (August 2014). "Best practices recommendations in the application of immunohistochemistry in testicular tumors: report from the international society of urological pathology consensus conference". Am. J. Surg. Pathol. 38 (8): e50–9. doi:10.1097/PAS.0000000000000233. PMID 24832161.
  12. ↑ Amin, MB.; Epstein, JI.; Ulbright, TM.; Humphrey, PA.; Egevad, L.; Montironi, R.; Grignon, D.; Trpkov, K. et al. (Aug 2014). "Best practices recommendations in the application of immunohistochemistry in urologic pathology: report from the international society of urological pathology consensus conference.". Am J Surg Pathol 38 (8): 1017-22. doi:10.1097/PAS.0000000000000254. PMID 25025364.
  13. ↑ 13.0 13.1 Lau, SK.; Weiss, LM.; Chu, PG. (Mar 2007). "D2-40 immunohistochemistry in the differential diagnosis of seminoma and embryonal carcinoma: a comparative immunohistochemical study with KIT (CD117) and CD30.". Mod Pathol 20 (3): 320-5. doi:10.1038/modpathol.3800749. PMID 17277761.
  14. ↑ 14.0 14.1 Iczkowski, KA.; Butler, SL.; Shanks, JH.; Hossain, D.; Schall, A.; Meiers, I.; Zhou, M.; Torkko, KC. et al. (Feb 2008). "Trials of new germ cell immunohistochemical stains in 93 extragonadal and metastatic germ cell tumors.". Hum Pathol 39 (2): 275-81. doi:10.1016/j.humpath.2007.07.002. PMID 18045648.
  15. ↑ 15.0 15.1 Cossu-Rocca, P.; Jones, TD.; Roth, LM.; Eble, JN.; Zheng, W.; Karim, FW.; Cheng, L. (Aug 2006). "Cytokeratin and CD30 expression in dysgerminoma.". Hum Pathol 37 (8): 1015-21. doi:10.1016/j.humpath.2006.02.018. PMID 16867864.
  16. ↑ Emerson, RE.; Ulbright, TM. (Jun 2010). "Intratubular germ cell neoplasia of the testis and its associated cancers: the use of novel biomarkers.". Pathology 42 (4): 344-55. doi:10.3109/00313021003767355. PMID 20438407.
  17. ↑ Hattab, EM.; Tu, PH.; Wilson, JD.; Cheng, L. (Mar 2005). "OCT4 immunohistochemistry is superior to placental alkaline phosphatase (PLAP) in the diagnosis of central nervous system germinoma.". Am J Surg Pathol 29 (3): 368-71. PMID 15725806.
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