J Pathol Transl Med.  2021 Sep;55(5):355-359. 10.4132/jptm.2021.06.16.

Primary hepatic mixed germ cell tumor in an adult

• Sung HJ
• Kim J
• Kim Kr
• Yoon S
• Lee JH
• Kang HJ

• KMID: 2520175
• DOI: http://doi.org/10.4132/jptm.2021.06.16

Abstract

Primary hepatic mixed germ cell tumor (GCT) is very rare, and less than 10 cases have been reported. We report a case of mixed GCT composed of a choriocarcinoma and yolk sac tumor, which occurred in the liver of a 40-year-old woman. A large mass was detected by computed tomography solely in the liver. Serum β-human chorionic gonadotropin (hCG) was highly elevated, otherwise, other serum tumor markers were slightly elevated or within normal limits. For hepatic choriocarcinoma, neoadjuvant chemotherapy was administered, followed by right lobectomy. Histologic features of the resected tumor revealed characteristic choriocarcinoma features with diffuse positivity for hCG in the syncytiotrophoblasts and diffuse positivity for α-fetoprotein and Sal-like protein 4 in the yolk sac tumor components. Primary malignant GCT in the liver is associated with a poor prognosis and requires specific treatment. Therefore, GCT should be considered during a differential diagnosis of a rapidly growing mass in the liver.

Keyword

Germ cell tumor; Choriocarcinoma; Yolk sac tumor; Liver; Adult

Figure

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  Fig. 1 Radiologic and gross findings. (A) Magnetic resonance image shows hepatomegaly with a large hypervascular mass in the right lobe. (B) The cut surface of a slice from a surgically resected specimen shows a heterogenous pinkish-yellow color, extensive necrosis, and hemorrhage.

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  Fig. 2 Microscopic and immunohistochemical (IHC) findings of the choriocarcinoma area. (A) Tumor cells are accompanied by extensive hemorrhage. (B) Tumor cells consist of a mixture of syncytiotrophoblastic and cytotrophoblastic cells. (C) The syncytiotrophoblastic cells are multinucleated with pleomorphic nuclei. (D) β-Human chorionic gonadotropin IHC staining is strongly and diffusely positive.

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  Fig. 3 Microscopic and immunohistochemical (IHC) findings of a yolk sac tumor with a hepatoid variant area. (A) A typical Schiller-Duval body is identified. (B) A hepatoid variant component of the yolk sac tumor is observed. (C) α-Fetoprotein IHC staining is strongly and diffusely positive. (D) Sal-like protein 4 IHC staining is partially positive.

Reference

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