embryonal carcinoma

What is Embryonal Carcinoma?

Embryonal carcinoma is a rare and aggressive form of testicular cancer that originates from germ cells, which are responsible for producing sperm [1]. It is also known as non-seminomatous germ cell tumor. This type of cancer can spread rapidly to other parts of the body, making early detection and treatment crucial [5].

Characteristics

Embryonal carcinoma is characterized by its rapid growth and ability to spread quickly. The gross appearance of this tumor is typically tan-white or gray, bulging with areas of hemorrhage or necrosis, and is poorly demarcated [6]. Microscopically, it shows a variable architecture, including tubulopapillary, glandular, solid, and embryoid bodies (ball of cells surrounded by empty space on three sides) [2].

Types and Locations

Embryonal carcinoma can occur in the testicles, ovaries, or other areas of the body. In extremely rare cases, it can start in other organs, like the ovaries. When it occurs in the ovaries, it is a rare ovarian germ cell tumor [11]. The term embryonal carcinoma is used to describe only the ovarian germ cell neoplasms showing the same histological appearance as their more common testicular counterparts [12].

Diagnostic Criteria

Strict diagnostic criteria should be followed when making this diagnosis. Embryonal carcinoma is characterized by the presence of large germ cells with abundant cytoplasm resembling epithelial cells, geographic necrosis, high mitotic activity, and pseudoglandular and pseudopapillary structures formation [14]. It can arise from the testis, ovary, and extragonadal sites (central nervous system and mediastinum).

Incidence

Embryonal carcinoma is a relatively common testicular germ cell tumor after puberty; 10% are pure embryonal tumors, and a substantial number of tumors will have a mixed embryonal component [3]. It can also be found in the ovaries and other areas of the body. Although it can occur in both men and women, it is most frequently associated with testicular cancer.

References

[1] Embryonal carcinoma is a type of non-seminomatous germ cell tumour characterized by its highly malignant nature and propensity to spread rapidly to other parts of the body [15]. [2] Microscopically, embryonal carcinoma shows a variable architecture, including tubulopapillary, glandular, solid, and embryoid bodies (ball of cells surrounded by empty space on three sides) [2]. [3] Embryonal carcinoma is a relatively common testicular germ cell tumor after puberty; 10% are pure embryonal tumors, and a substantial number of tumors will have a mixed embryonal component [3]. [5] This type of cancer can spread rapidly to other parts of the body, making early detection and treatment crucial [5]. [6] The gross appearance of this tumor is typically tan-white or gray, bulging with areas of hemorrhage or necrosis, and is poorly demarcated [6]. [11] In extremely rare cases, embryonal carcinoma can start in other organs, like the ovaries. When it occurs in the ovaries, it is a rare ovarian germ cell tumor [11]. [12] The term embryonal carcinoma is used to describe only the ovarian germ cell neoplasms showing the same histological appearance as their more common testicular counterparts [12]. [14] Embryonal carcinoma is characterized by the presence of large germ cells with abundant cytoplasm resembling epithelial cells, geographic necrosis, high mitotic activity, and pseudoglandular and pseudopapillary structures formation [14]. [15] Embryonal carcinoma is a type of non-seminomatous germ cell tumour characterized by its highly malignant nature and propensity to spread rapidly to other parts of the body [15].

Common Signs and Symptoms of Embryonal Carcinoma

Embryonal carcinoma, a type of testicular cancer, can manifest in various ways, depending on the stage and location of the tumor. Here are some common signs and symptoms:

• Painless lump or swelling: A painless lump or swelling in one of the testes is often the first noticeable symptom.
• Dull scrotal or testicular pain: Some individuals may experience dull pain or discomfort in the scrotum or testicles.
• Sensation of fullness in the scrotum: The scrotum may feel heavy or full, which can be a sign of embryonal carcinoma.
• Low back pain and flank pain: As the cancer spreads beyond the testicle, individuals may experience low back pain and flank pain.
• Shortness of breath (dyspnea): In advanced stages, symptoms like shortness of breath can occur due to metastasis in the lungs or other parts of the body.

Additional Symptoms

In some cases, embryonal carcinoma can cause more severe symptoms, including:

• Headaches: Due to increased intracranial pressure or metastasis.
• Nausea and vomiting: As a result of hormonal imbalances or tumor growth.
• Fatigue or lethargy: Caused by the body's response to cancer cells.
• Vision problems: In rare cases, embryonal carcinoma can cause vision disturbances.

Early Detection is Key

It's essential to note that early detection and treatment significantly improve the chances of recovery. If you experience any unusual symptoms or notice a change in your testicles, consult a healthcare professional promptly.

References:

[1] - A palpable testicular mass or asymmetric testicular enlargement in some cases (Source: #2) [4] - Symptoms · Swelling of the scrotum or the testicle · Pain or discomfort in the scrotum or the testicle · A lump (pain-free) in either testicle · Any change in how ... (Source: #4) [9] - Symptoms of embryonal carcinoma include: A swollen testicle. A (painless) lump or swelling in one of the testes; a sensation of fullness in the scrotum; dull scrotal or testicular pain (Source: #9) [10] - Symptoms of embryonal carcinoma are often vague and non-specific Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source. Contact a doctor if you notice any of these signs. a painless lump or swelling in one of the testes; a sensation of fullness in the scrotum; dull scrotal or testicular pain (Source: #10) [14] - What are the Signs and Symptoms of Embryonal Carcinoma of the Testis? Indications for Embryonal Carcinoma of the Testis include: Blood in vomit and cough; Blood in stool, urine; Trouble breathing; Headache; Low blood pressure; Anemia; Testicular pain, lump in the testes, feeling of heaviness in the scrotum; (Source: #14)

Diagnostic Tests for Embryonal Carcinoma

Embryonal carcinoma, a type of testicular cancer, requires a combination of physical examination, imaging studies, and laboratory tests to diagnose. Here are the diagnostic tests used to identify this condition:

• Physical Examination: A doctor will perform a physical exam to check the testicles and groin area for abnormal lumps or masses.
• Imaging Studies:
  • Ultrasound: An ultrasound of both testicles is usually the first imaging test performed, which can reveal signs of a tumor.
  • CT scan: Additional imaging tests may be needed to check for cancer spread.
  • MRI: May also be used to evaluate the extent of the tumor and its impact on surrounding tissues.
• Laboratory Tests:
  • Blood tests: Serum tumor markers such as alpha-fetoprotein (AFP) and human chorionic gonadotropin (hCG) may be ordered to detect cancer cells in the blood.
  • Biopsy: A biopsy of the affected testicle is necessary for definitive diagnosis, which involves removing a sample of tissue from the tumor.

Additional Tests

• Tumor Stage: Embryonal carcinoma is given a tumor stage between 1 and 4 based on the location of the tumor, its extent in surrounding tissues, and whether there is lymphovascular invasion.
• Other Tests: Depending on the findings, additional tests such as an MRI or CT scan may be performed to evaluate the extent of cancer spread.

References

• [2] Embryonal carcinoma is the most frequent tumor component of testicular mixed GCT, present in ~80 - 90% of ...
• [5] Diagnosis of embryonal carcinoma involves a combination of physical examination, imaging studies, and laboratory tests.
• [9] One specimen (undescended testis) was negative for SALL-4 and was diffusely positive for CD30 only, and hence, a diagnosis of embryonal carcinoma was given in correlation with the morphology.
• [15] Other tests include: Abdominal and pelvic CT scan; Blood tests for tumor markers: alpha fetoprotein (AFP).

Treatment Options for Embryonal Carcinoma

Embryonal carcinoma, a rare and aggressive form of testicular cancer, can be effectively treated with a combination of surgery and chemotherapy.

• Chemotherapy: Chemotherapy is often used to kill any remaining cancer cells after surgery. The most effective chemotherapeutic agents for embryonal carcinoma include:
  • Etoposide (VP-16) [7]
  • Cisplatin [4, 8]
  • Bleomycin [3, 8]
  • Ifosfamide (Ifex) [6]
  • Paclitaxel (Taxol) [6]
  • Vinblastine [6]

These chemotherapeutic agents can be used alone or in combination to target the cancer cells.

• Surgery: Surgery is often performed to remove the affected testicle and surrounding tissue. In some cases, additional surgery may be necessary to remove any remaining cancer cells.

References:

[3] Standard chemotherapy regimens include bleomycin, etoposide, and cisplatin (BEP) for three cycles or etoposide and cisplatin (EP) for four cycles. Mixed ...

[4] Cisplatin is one of the first metal-based chemotherapeutic drugs used for the treatment of various types of malignancies, including GCTs, lung, head and neck, ...

[6] Chemo drugs used · Cisplatin · Etoposide (VP-16) · Bleomycin · Ifosfamide (Ifex) · Paclitaxel (Taxol) · Vinblastine.

[7] May 29, 2023 — Etoposide is a topoisomerase inhibitor that leads to cell death in cancer cells by inducing DNA damage and cell cycle arrest. It is indicated ...

[8] by DR Feldman · 2008 · Cited by 456 — Two chemotherapy regimens are effective for patients with a good GCT prognosis: 4 cycles of etoposide and cisplatin (EP) or 3 cycles of bleomycin, etoposide, ...

Differential Diagnosis of Embryonal Carcinoma

Embryonal carcinoma, a type of germ cell tumor, can be challenging to diagnose due to its varied histological appearances and similarities with other tumors. The differential diagnosis for embryonal carcinoma includes:

• Seminoma: A common testicular cancer that can be difficult to distinguish from embryonal carcinoma, especially in limited biopsy specimens or poor tissue fixation [8].
• Yolk Sac Tumor (YST): Also known as endodermal sinus tumor, YST is a type of germ cell tumor that can mimic the appearance of embryonal carcinoma. Distinguishing features include strong nuclear reactivity with OCT4 and AFP positivity [10].
• Choriocarcinoma: A rare and aggressive form of testicular cancer characterized by biphasic histology with large syncytiotrophoblasts and mononucleated cytotrophoblasts.
• Teratoma: A type of germ cell tumor that can contain several different types of tissues, including epithelial, mesenchymal, and neural elements.
• Mixed Germ Cell Tumors (GCT): A combination of different types of germ cell tumors, including embryonal carcinoma, seminoma, YST, choriocarcinoma, and teratoma.

Key Features for Differential Diagnosis

To distinguish embryonal carcinoma from other germ cell tumors, the following features are important:

• Immunohistochemistry: Embryonal carcinomas are positive for OCT3/4, CD30, and cytokeratins such as CK7, CAM5.2, and AE1/AE3 [1].
• Histological Appearance: Embryonal carcinoma can have a variety of histological appearances, including spindled, epithelioid, or small round blue cells [6].
• Association with Intratubular Germ Cell Neoplasia (IGCN): In difficult cases, the presence of IGCN can be an important clue for diagnosing embryonal carcinoma.

References

[1] Ulbright TM. Difficult differential diagnosis in testicular pathology. Arch Pathol Lab Med. 2002;136(4):435-66. [8] 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. [10] AFP and OCT4 may be useful in distinguishing either embryonal carcinoma or tubular pattern seminoma from yolk sac tumor.

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