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Embryonal Carcinoma

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  • 2nd most common pure GCT.
  • More commonly seen as component of mixed GCTs.
  • Serum α-AFP and HCG may be elevated.
  • Gross: often poorly circumscribed, variegated and with necrosis and hemorrhages (image A). (Contrasts classic seminoma).
  • Histology:
    • Characterized by large highly pleomorphic tumor cells (image B), (image C), & (image D).
    • Indistinct cell membrane and nuclei appear to pile upon one another other. (In contrast to non-overlapping cells and distinct cell border in seminoma).
    • Frequent mitosis and apoptosis.
    • Solid, glandular or papillary growth.
    • May have solid nest of EC cell surrounded by necrosis (applique pattern).

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  • Immunohistochemisty: CD30+, Keratin+, Oct3/4+ and SOX2+, and EMA-.
  • Has poorest prognosis among all GCTs.
  • Cure rate >95% for stage I and 70-85% for bulky stage II and stage III disease.
  • DDX:
    • Classic seminoma: non-overlapping clear cells with prominent border, fibrous septa and lymphocytic infiltrates and is CD117+.
    • Metastatic carcinoma: older patients, more often bilateral and is CD30-and EMA+.