Germ cell tumor differential diagnosis

Germ cell tumor Differential diagnosis:

• Cytoplasmic membrane immunoreactivity for placental alkaline phosphatase and CD117, with usual negativity for AE1/AE3 cytokeratins, is helpful in the diagnosis of germinoma.
• The recently described marker, OCT3/4, a nuclear transcription factor, is especially helpful in the differential of germinoma and embryonal carcinoma with other neoplasms.
• Yolk sac tumor continues to be confused occasionally with clear cell carcinoma of the ovary.
• Glandular ('endometrioid-like') yolk sac tumors mimic endometrioid carcinomas
• Predominant or pure hepatoid yolk sac tumors cause concern for metastatic hepatocellular carcinoma or, in the ovary, primary hepatoid carcinoma, and solid patterns, especially in limited samplings, may be misinterpreted as germinoma
• The usually younger age of patients with yolk sac tumors helps with the differential considerations with the nongerm cell tumors, as do other clinical and microscopic features and selected immunohistochemical stains.
• Choriocarcinoma is rare in both gonads, and those in the ovary must be distinguished from metastatic tumors of placental origin
• Syncytiotrophoblast cells alone, admixed with other forms of germ cell tumor, still are confused with choriocarcinoma, but this phenomenon, which is much more frequent than choriocarcinoma, lacks the plexiform arrangement of different trophoblast cell types that typifies the latter

• Germinoma of the brain must be differentiated from other lesions in the pineal and suprasellar region, such as glial tumors which include astrocytomas and gangliomas, granular cell tumor, hamartomas, xanthogranuloma, meningiomas, colloid cysts, craniopharyngioma, cysticercosis, metastatic cancer with unknown primary site, pineal tumors, and pituitary macroadenomas

• Ovarian germ cell tumor must be differentiated from other diseases that cause ovarian mass, such as:
  • Stein-Leventhal syndrome
  • Tubal pregnancy
  • Ovarian epithelial tumors
  • Ovarian sex-cord stromal tumors
  • Tubo-ovarian abscess

• The main differential for testicular mass in young adults is non-seminomatous germ cell tumor (NGCT) which usually appear more heterogenous, often with cysts and calcification.
• Lymphadenopathy of non-seminomatous germ cell tumor may enhance more heterogenously.
• Testicular lymphoma is the main differential diagnosis to consider when para-aortic lymphadenopathy is the presenting finding or in the setting of bilateral testicular lesions.