Histomorphological Spectrum of Gonadal and Extragonadal Germ Cell Tumours at a Tertiary Cancer Centre in Southern Rajasthan, India

Abstract

Introduction: Germ Cell Tumours (GCT) are heterogenous tumours believed to arise from primordial germ cells. The GCT predominantly affects gonads (testis and ovary) and also involves extragonadal sites, characteristically locations along midline of the body. The GCT of testis, ovary and extragonadal sites show peculiar histomorphological features and types subject to the age and site of patient. Definite histopathological typing of GCT is of vital importance to decide the further treatment. Till now, very few studies have been conducted in India on GCT of gonads and extragonadal sites. Aim: To study the pathologic findings of GCT including macroscopic and microscopic features and to classify the tumours according to latest World Health Organisation (WHO) classification of GCT for designated site of origin. Materials and Methods: Retrospective analysis was conducted including 141 cases of GCT of all sites, diagnosed at a tertiary cancer centre in Udaipur, Rajasthan, India between January 2016 to April 2021. Data were collected regarding demographic, clinical, gross and histopathological details. Results were analysed using Statistical Package of Social Sciences (SPSS) software Version 21.0. method. Results: Germinal cell tumours shows various age ranges for different site of origin. Ovarian GCT age varies from seven years to 65 years. Age group of testicular GCT varies from 1-55 years. Extragonadal GCT (EG GCT) was seen as early as in four-day-old newborn. Out of 141 cases, 103 were ovarian, 21 were testicular and 17 were EG GCT cases. Most common ovarian GCT is Mature Teratoma (MT) (85 cases, 82.53%) and most common malignant ovarian GCT is dysgerminoma (9 cases, 8.74%). Most common testicular GCT type is Malignant Mixed GCT (MM GCT) (9 cases, 42.86%) followed by seminoma (5 cases, 23.81%) and Yolk Sac Tumours (YST) (3 cases, 14.29%). EG GCT involves retroperitoneum (5 cases, 29.41%), anterior mediastinum (4 cases, 23.53%), Sacrococcyx (3 cases, 17.65%) and Central Nervous System (CNS) (2 cases, 11.76%) with most common EG GCT is teratoma (9 cases, 52.94%) Conclusion: Gonadal and extragonadal GCT share many common tumours, albeit, distinctive site-specific histopathological findings also present. These features often complicate the definitive diagnosis of GCT for pathologists, specifically in cases of MM GCT.