32 year old man - cytology.ch · • local lumbal spine. radiotherapy. for residual tumor ... –...
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• 32 year old man• 2 months history of growing left supraclavicular lymph nodes• Antibiotic treatment was not successful• Thoraco-abdominal staging (at first CT, than PET-CT)
Prof. Dr. med. Beata BODE-LESNIEWSKAInstitute of Pathology and Molecular PathologyUniversity Hospital; Zurich
• 32 year old man• 2 months history of growing left supraclavicular
lymph nodes• Antibiotic treatment was not successful• Thoraco-abdominal staging (at first CT, than PET-
CT) showed large retroperitoneal, mediastinal and left supraclavicular tumor masses – based on imaging the strong clinical suspicion of a lymphoma has been rendered.
• Sonographically guided FNAC of the leftsupraclavicular lymph node
Differential diagnosis
• Carcinoma• Melanoma• Lymphoma
– Hodgkin– Non-Hodgkin (anaplastic)
• Sarcoma (e.g. epithelioid sarcoma, angiosarcoma, etc…)
• Germ cell tumor
• (Mesothelioma)
Differential diagnosis
• Carcinoma• Melanoma• Lymphoma
– Hodgkin– Non-Hodgkin
• Sarcoma• Germ cell tumor
• Mesothelioma
Final diagnosis• Metastatic (at presentation) seminoma
– Extensive metastases retroperitoneal and leftcervical
– Initial manifestation as supraclavicularlymphadenopathy
• «Burnt out» (regressed) germ cell tumor of the right testis– Semicastration with focal scaring– Advanced atrophy of the tubuli– Germ cell neoplasia in situ (GCNIS) present
Follow up• Recurrent tumor 6 month after initial
presentation• High dose chemotherapy with autologous
bone marrow transplantation – successful• Local lumbal spine radiotherapy for residual
tumor
• 6 years after initial presentation no furthertumor manifestations – declared as cured
Germ cell Tumors (GCT)• Rare (1% of male malignancy)• Incidence 1.5 -12 / 100 000 (higher in industrialiezed
countries)– Ethnicity / genetic susceptibility– Enviromental factors
• … however - most common cancer among young male patients (puberty to 40-ies) in industrialized countries
• High metastatic potential• Accompanied by tumor markers in blood (AFP, bHCG)
• Curable with modern combined therapy regimens(most important chemotherapy)
• Usual presentation as a testicular mass• Some 3-10% of seminomas and embryonal
carcinomas present as a metastatic disease• Practically all choriocarcinomas are metastatic
at presentation
• «Burnt out» (regressed) testicular tumors– May cause bulky metastatic diesease– Should not be confused with (rare) extragonadal
primaries (retroperitoneum, mediastinum)
GCT - Subtypes
• Seminoma• Non-seminomatous GCT
– Embryonal carcinoma– Yolk sac tumor– Choriocarcinoma– Teratomas
• Mixed GCT
Cytologic diagnosis of GCT• Not on primary tumors• Possible in metastatic setting
– First diagnosis, if testicular primary not obvious– Recurrent tumor– Advantage: rapid turn over time
• final pathologic tissue diagnosis within 2 days• No excisional biopsy neccessary• Semicastration on the 4th day• Disease specific diagnosis chemotherapy prompty started
Facit
• Metastatic germ cell tumor (GCT) may causecervial lymphydenopathy (not onlyretroperitoneal / mediastinal)
• Cytologic diagnosis of GCT is well feasible
• GCT should be considered as a differential diagnosis especially in young male patientswith rapidly progressive lymphadenopathy
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