Embryonal carcinoma overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Embryonal carcinoma is a type of testicular cancer of germ cell origin. It comprises about twenty-five percent of nonseminoma tumors of germ cell testicular tumors. Pure embryonal carcinomas are rare, but are very common in mixed germ cell tumors.
Historical Perspective
There's no specific information available yet on the discovery of embryonal carcinomas. However, the discovery of human chorionic gonadotropin (hcg) and α-fetoprotein (AFP) in 1927 and 1956, respectively, led to a major leap forward in the ability to diagnose, stage, and manage testicular cancer.
Classification
Embryonal carcinomas may be classified based on whether it is in a pure form or a mixed form ( i.e. component of a mixed germ cell tumor); or based on their histological patterns, which includes solid, tubular or glandlike, and papillary.
Pathophysiology
An initiating event that causes fetal gonocytes to undergo abnormal cell division is the most widely accepted theory on the development of germ cell tumors. It is also universally acknowledged that Intratubular germ cell neoplasia of unclassified type (IGCNU) is the precursor lesion of classical seminoma and non-seminomatous germ cell tumours.
Causes
The role of specific factors in the causality of embryonal carcinomais unclear.
Risk factors
Cryptorchidism, existing contralateral testicular cancer, family history of testicular cancer, genetic and environmental factors all increase the risk of developing germ cell tumors.
Epidemiology and Demographics
The incidence of embryonal carcinoma varies among different age groups. The highest incidence occurs in persons aged 20-30 years. It is extremely rare in infants. Overall, it is one of the most common germ cell tumors.
Differentiating Embryonal carcinoma from other Diseases
Embryonal carcinomas must be differentiated from other painless testicular nodules or swellings that cause scrotal discomfort, and also pathologically from other subtypes and variants of testicular cancer, including seminomas, non-seminoma germ cell tumours, non-germ cell tumors of the testis like Leydig cell tumor and Sertoli cell tumor, and secondary testicular tumors like lymphomas.
Natural History, Complications and Prognosis
Embryonal carcinoma has a poor prognosis as it is aggressive, easily metastasizes and has a high malignant potential. However, it still has a very good survival rate.
Diagnosis
Clinical findings are usually the initial clues or evidence that establishes the suspicion of any testicular tumor. Ultrasound, tumor markers and CT scan may be done to further support the diagnosis, but diagnostic confirmation is provided by histology.
History and Symptoms
Patients with embryonal carcinoma present either