{"id":4078,"date":"2022-04-18T16:08:05","date_gmt":"2022-04-18T16:08:05","guid":{"rendered":"https:\/\/iboblr.in\/gupathsociety\/?page_id=4078"},"modified":"2022-10-28T08:39:41","modified_gmt":"2022-10-28T08:39:41","slug":"cow-2022-2","status":"publish","type":"page","link":"https:\/\/iboblr.in\/gupathsociety\/cow-2022-2\/","title":{"rendered":"COW-2022-02"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"4078\" class=\"elementor elementor-4078\" data-elementor-settings=\"[]\">\n\t\t\t\t\t\t\t<div class=\"elementor-section-wrap\">\n\t\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-8ccfba1 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"8ccfba1\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-7d34946\" data-id=\"7d34946\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-33283ad elementor-widget elementor-widget-html\" data-id=\"33283ad\" data-element_type=\"widget\" data-widget_type=\"html.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<script>\r\njQuery(document).ready(function($) {\r\nvar delay = 100; setTimeout(function() {\r\n$('.elementor-tab-title').removeClass('elementor-active');\r\n $('.elementor-tab-content').css('display', 'none'); }, delay);\r\n});\r\n<\/script>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-74faef0 elementor-widget elementor-widget-heading\" data-id=\"74faef0\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.5.6 - 28-02-2022 *\/\n.elementor-heading-title{padding:0;margin:0;line-height:1}.elementor-widget-heading .elementor-heading-title[class*=elementor-size-]>a{color:inherit;font-size:inherit;line-height:inherit}.elementor-widget-heading .elementor-heading-title.elementor-size-small{font-size:15px}.elementor-widget-heading .elementor-heading-title.elementor-size-medium{font-size:19px}.elementor-widget-heading .elementor-heading-title.elementor-size-large{font-size:29px}.elementor-widget-heading .elementor-heading-title.elementor-size-xl{font-size:39px}.elementor-widget-heading .elementor-heading-title.elementor-size-xxl{font-size:59px}<\/style><h2 class=\"elementor-heading-title elementor-size-default\">CASE OF THE WEEK<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-7186cb4 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"7186cb4\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-ede62c7\" data-id=\"ede62c7\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-19a2630 elementor-widget elementor-widget-text-editor\" data-id=\"19a2630\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.5.6 - 28-02-2022 *\/\n.elementor-widget-text-editor.elementor-drop-cap-view-stacked .elementor-drop-cap{background-color:#818a91;color:#fff}.elementor-widget-text-editor.elementor-drop-cap-view-framed .elementor-drop-cap{color:#818a91;border:3px solid;background-color:transparent}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap{margin-top:8px}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap-letter{width:1em;height:1em}.elementor-widget-text-editor .elementor-drop-cap{float:left;text-align:center;line-height:1;font-size:50px}.elementor-widget-text-editor .elementor-drop-cap-letter{display:inline-block}<\/style>\t\t\t\t<p>Editors: Francesca Khani (Frk9007@med.cornell.edu) and Mahmut Akgul (akgulm@amc.edu)<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-684fa17 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"684fa17\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-3ec21f3\" data-id=\"3ec21f3\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-a25a93e elementor-widget elementor-widget-text-editor\" data-id=\"a25a93e\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p><strong>2022-02\/January 10<\/strong><br \/><strong>Contributors: Maria F Arisi and Li Li<\/strong><\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-bb0cdb3 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"bb0cdb3\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-d40593d\" data-id=\"d40593d\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-15e156f elementor-widget elementor-widget-text-editor\" data-id=\"15e156f\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p>A man in his 30\u2019s presented with 3 days of abdominal pain, nausea, and vomiting. CT imaging revealed a 14 cm ill-defined right retroperitoneal mass, a 2 cm left pulmonary nodule, and a 10 cm right testicular mass. Serum alpha-fetoprotein (AFP) was elevated, and beta-HCG and LDH were normal. He underwent biopsy of the retroperitoneal mass.<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-ae8a501 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"ae8a501\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-f7ab8bd\" data-id=\"f7ab8bd\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-2db91ce elementor-arrows-position-inside elementor-pagination-position-outside elementor-widget elementor-widget-image-carousel\" data-id=\"2db91ce\" data-element_type=\"widget\" data-settings=\"{&quot;navigation&quot;:&quot;both&quot;,&quot;autoplay&quot;:&quot;yes&quot;,&quot;pause_on_hover&quot;:&quot;yes&quot;,&quot;pause_on_interaction&quot;:&quot;yes&quot;,&quot;autoplay_speed&quot;:5000,&quot;infinite&quot;:&quot;yes&quot;,&quot;speed&quot;:500}\" data-widget_type=\"image-carousel.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.5.6 - 28-02-2022 *\/\n.elementor-widget-image-carousel .swiper-container{position:static}.elementor-widget-image-carousel .swiper-container .swiper-slide figure{line-height:inherit}.elementor-widget-image-carousel .swiper-slide{text-align:center}.elementor-image-carousel-wrapper:not(.swiper-container-initialized) .swiper-slide{max-width:calc(100% \/ var(--e-image-carousel-slides-to-show, 3))}<\/style>\t\t<div class=\"elementor-image-carousel-wrapper swiper-container\" dir=\"ltr\">\n\t\t\t<div class=\"elementor-image-carousel swiper-wrapper\">\n\t\t\t\t\t\t\t\t<div class=\"swiper-slide\"><a data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-slideshow=\"2db91ce\" data-elementor-lightbox-title=\"Fig 1\" e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6NDEzOSwidXJsIjoiaHR0cHM6XC9cL2lib2Jsci5pblwvZ3VwYXRoc29jaWV0eVwvd3AtY29udGVudFwvdXBsb2Fkc1wvMjAyMlwvMDRcL0ZpZy0xLTEuanBnIiwic2xpZGVzaG93IjoiMmRiOTFjZSJ9\" href=\"https:\/\/iboblr.in\/gupathsociety\/wp-content\/uploads\/2022\/04\/Fig-1-1.jpg\"><figure class=\"swiper-slide-inner\"><img decoding=\"async\" class=\"swiper-slide-image\" src=\"https:\/\/iboblr.in\/gupathsociety\/wp-content\/uploads\/2022\/04\/Fig-1-1.jpg\" alt=\"Fig 1\" \/><\/figure><\/a><\/div><div class=\"swiper-slide\"><a data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-slideshow=\"2db91ce\" data-elementor-lightbox-title=\"Fig 2\" e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6NDE0MCwidXJsIjoiaHR0cHM6XC9cL2lib2Jsci5pblwvZ3VwYXRoc29jaWV0eVwvd3AtY29udGVudFwvdXBsb2Fkc1wvMjAyMlwvMDRcL0ZpZy0yLTEuanBnIiwic2xpZGVzaG93IjoiMmRiOTFjZSJ9\" href=\"https:\/\/iboblr.in\/gupathsociety\/wp-content\/uploads\/2022\/04\/Fig-2-1.jpg\"><figure class=\"swiper-slide-inner\"><img decoding=\"async\" class=\"swiper-slide-image\" src=\"https:\/\/iboblr.in\/gupathsociety\/wp-content\/uploads\/2022\/04\/Fig-2-1.jpg\" alt=\"Fig 2\" \/><\/figure><\/a><\/div>\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"swiper-pagination\"><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"elementor-swiper-button elementor-swiper-button-prev\">\n\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-chevron-left\"><\/i>\t\t\t\t\t\t<span class=\"elementor-screen-only\">Previous<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"elementor-swiper-button elementor-swiper-button-next\">\n\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-chevron-right\"><\/i>\t\t\t\t\t\t<span class=\"elementor-screen-only\">Next<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-12364bf elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"12364bf\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-01df17a\" data-id=\"01df17a\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-63f9c8e elementor-widget elementor-widget-heading\" data-id=\"63f9c8e\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Quiz<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-f2b450d elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"f2b450d\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-b8314d2\" data-id=\"b8314d2\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-17f296b elementor-widget elementor-widget-text-editor\" data-id=\"17f296b\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p><strong>What is the correct diagnosis?<\/strong><\/p><p>a. Seminoma<\/p><p>b. Hepatoid Teratoma<\/p><p>c. Metastatic mixed germ cell tumor<\/p><p>d. Metastatic hepatocellular carcinoma<\/p><p>e. Urothelial carcinoma<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-e202dbb elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"e202dbb\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-75b3f79\" data-id=\"75b3f79\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-e752dce elementor-widget elementor-widget-accordion\" data-id=\"e752dce\" data-element_type=\"widget\" data-widget_type=\"accordion.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.5.6 - 28-02-2022 *\/\n.elementor-accordion{text-align:left}.elementor-accordion .elementor-accordion-item{border:1px solid #d4d4d4}.elementor-accordion .elementor-accordion-item+.elementor-accordion-item{border-top:none}.elementor-accordion .elementor-tab-title{margin:0;padding:15px 20px;font-weight:700;line-height:1;cursor:pointer;outline:none}.elementor-accordion .elementor-tab-title .elementor-accordion-icon{display:inline-block;width:1.5em}.elementor-accordion .elementor-tab-title .elementor-accordion-icon svg{width:1em;height:1em}.elementor-accordion .elementor-tab-title .elementor-accordion-icon.elementor-accordion-icon-right{float:right;text-align:right}.elementor-accordion .elementor-tab-title .elementor-accordion-icon.elementor-accordion-icon-left{float:left;text-align:left}.elementor-accordion .elementor-tab-title .elementor-accordion-icon .elementor-accordion-icon-closed{display:block}.elementor-accordion .elementor-tab-title .elementor-accordion-icon .elementor-accordion-icon-opened,.elementor-accordion .elementor-tab-title.elementor-active .elementor-accordion-icon-closed{display:none}.elementor-accordion .elementor-tab-title.elementor-active .elementor-accordion-icon-opened{display:block}.elementor-accordion .elementor-tab-content{display:none;padding:15px 20px;border-top:1px solid #d4d4d4}@media (max-width:767px){.elementor-accordion .elementor-tab-title{padding:12px 15px}.elementor-accordion .elementor-tab-title .elementor-accordion-icon{width:1.2em}.elementor-accordion .elementor-tab-content{padding:7px 15px}}<\/style>\t\t<div class=\"elementor-accordion\" role=\"tablist\">\n\t\t\t\t\t\t\t<div class=\"elementor-accordion-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2421\" class=\"elementor-tab-title\" data-tab=\"1\" role=\"tab\" aria-controls=\"elementor-tab-content-2421\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon elementor-accordion-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon-closed\"><i class=\"fas fa-plus\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon-opened\"><i class=\"fas fa-minus\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-accordion-title\" href=\"\">Quiz Answers<\/a>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div id=\"elementor-tab-content-2421\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"1\" role=\"tabpanel\" aria-labelledby=\"elementor-tab-title-2421\"><p>1. c<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-accordion-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2422\" class=\"elementor-tab-title\" data-tab=\"2\" role=\"tab\" aria-controls=\"elementor-tab-content-2422\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon elementor-accordion-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon-closed\"><i class=\"fas fa-plus\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon-opened\"><i class=\"fas fa-minus\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-accordion-title\" href=\"\">Diagnosis<\/a>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div id=\"elementor-tab-content-2422\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"2\" role=\"tabpanel\" aria-labelledby=\"elementor-tab-title-2422\"><p>Metastatic mixed germ cell tumor<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-accordion-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2423\" class=\"elementor-tab-title\" data-tab=\"3\" role=\"tab\" aria-controls=\"elementor-tab-content-2423\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon elementor-accordion-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon-closed\"><i class=\"fas fa-plus\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon-opened\"><i class=\"fas fa-minus\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-accordion-title\" href=\"\">Discussion<\/a>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div id=\"elementor-tab-content-2423\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"3\" role=\"tabpanel\" aria-labelledby=\"elementor-tab-title-2423\"><p>This young man presented with a quickly growing mass in the retroperitoneum and testicle, and elevated alpha-fetoprotein. A small biopsy of the mass showed multiple histologic patterns, including microcystic, solid and focal hepatoid-like cytology patterns with intracytoplasmic eosinophilic (hyaline) globules (Figure 1A and B). Perivascular growth pattern, but without Schiller-Duval bodies, was identified (Figure 1C). The biopsy also showed an area of glandular elements with primitive cell features (Figure 1D).<br \/><br \/>Most of the tumor components were positive for AFP (not shown), glypican-3, GATA3, and CDX2 (Figure 2A-C), but negative for OCT3\/4. The morphologic and immunophenotypic features support the diagnosis of yolk sac tumor (YST). The small portion of the tumor with glandular features stained with OCT3\/4, CD30, (Figure 2E-F), and CK7 (not shown) consistent with embryonal carcinoma (EC). The diagnosis in this case is therefore a metastatic mixed germ cell tumor consisting of cytokeratin AE1\/AE3 positive YST and EC components. Endometrioid-like YST can mimic embryonal carcinoma, but the immunostaining pattern does not support this diagnosis.<br \/><br \/>Seminoma occurs in young patients and is the most common testicular germ cell tumor. Seminoma typically shows pale and glycogen-filled cells. While this patient\u2019s tumor had some positive OCT3\/4 staining, it is inconsistent with seminoma component due to negative c-Kit staining (not shown). The hemorrhagic area was also negative for hCG immunostaining (not shown) and no elevated serum beta-HCG was detected; therefore, no choriocarcinoma is present in this mixed germ cell tumor.<br \/><br \/>There is no teratoma and\/or somatic malignancy component identified due to the limitation of submitted tissue. Accurate evaluation is needed in the primary site (testicle) and metastatic tumor especially if the patient underwent chemotherapy before the surgical resection. Somatic malignancy from teratoma or other mixed germ cell tumor component is commonly seen in the metastatic mixed germ cell tumor with post-chemotherapy.<br \/><br \/>The solid tumor component had hepatocyte like cytology with intercellular eosinophilic globules, and on immunostain was positive for CK7, glypican 3, and AFP, but negative for hepatocyte differentiation marker (HepPart-1 and Arginase-1), and without CK19+ ductule and bile canalicular-like structures. This supports the diagnosis of YST but not hepatoid YST. Hepatocellular carcinoma (HCC) could be on the differential. However, unlike HCC, this mass had no Mallory-Denk bodies and was negative for HepPar-1 and Arginase-1. Additionally, the overall clinical picture and young patient age was inconsistent with metastatic HCC. Rare hepatoid teratoma is a potential mimicker of a hepatoid YST, but morphology and immunostains do not support this entity.<br \/><br \/>Lastly, the transcriptional factor GATA3 nuclear staining is not specific for urothelial carcinoma, and it can be seen in YST and other germ cell tumor components. Negative p63 staining (not shown), and lack of the morphology of urothelial carcinoma was again inconsistent with this diagnosis.<br \/><br \/>In summary, this patient had a metastatic mixed testicular germ cell tumor with YST and embryonal carcinoma components. The hepatoid cytology features of YST introduced interesting differentials. Additional workup of this patient\u2019s lung nodule, testicular mass and metastatic mixed germ cell tumor would be warranted to classify the testicular tumor and for accurate clinical staging.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-accordion-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2424\" class=\"elementor-tab-title\" data-tab=\"4\" role=\"tab\" aria-controls=\"elementor-tab-content-2424\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon elementor-accordion-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon-closed\"><i class=\"fas fa-plus\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon-opened\"><i class=\"fas fa-minus\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-accordion-title\" href=\"\">References<\/a>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div id=\"elementor-tab-content-2424\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"4\" role=\"tabpanel\" aria-labelledby=\"elementor-tab-title-2424\"><p>Al-Obaidy KI, Williamson SR, Shelman N, Idrees MT, Ulbright TM. Hepatoid Teratoma, Hepatoid Yolk Sac Tumor, and Hepatocellular Carcinoma: A Morphologic and Immunohistochemical Study of 30 Cases. Am J Surg Pathol. 2021 Jan;45(1):127\u201336.<br \/><br \/>Miettinen M, McCue PA, Sarlomo-Rikala M, Rys J, Czapiewski P, Wazny K, et al. GATA3: a multispecific but potentially useful marker in surgical pathology: a systematic analysis of 2500 epithelial and nonepithelial tumors. Am J Surg Pathol. 2014 Jan;38(1):13\u201322.<br \/><br \/>Osman H, Cheng L, Ulbright TM, Idrees MT. The utility of CDX2, GATA3, and DOG1 in the diagnosis of testicular neoplasms: an immunohistochemical study of 109 cases. Hum Pathol. 2016 Feb;48:18\u201324.<br \/><br \/>Ulbright TM. Germ cell tumors of the gonads: a selective review emphasizing problems in differential diagnosis, newly appreciated, and controversial issues. Mod Pathol. 2005 Feb;18 Suppl 2:S61-79.<br \/><br \/>Ulbright TM. Gonadoblastoma and hepatoid and endometrioid-like yolk sac tumor: an update. Int J Gynecol Pathol. 2014 Jul;33(4):365\u201373.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-accordion-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2425\" class=\"elementor-tab-title\" data-tab=\"5\" role=\"tab\" aria-controls=\"elementor-tab-content-2425\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon elementor-accordion-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon-closed\"><i class=\"fas fa-plus\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon-opened\"><i class=\"fas fa-minus\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-accordion-title\" href=\"\">Contributors<\/a>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div id=\"elementor-tab-content-2425\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"5\" role=\"tabpanel\" aria-labelledby=\"elementor-tab-title-2425\"><p>Maria F Arisi<br \/>Thomas Jefferson University<br \/>maria.arisi@jefferson.edu<br \/><br \/>Li Li<br \/>Thomas Jefferson University<br \/>li.li@jefferson.edu<br \/>@lili_PathMSH<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-accordion-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2426\" class=\"elementor-tab-title\" data-tab=\"6\" role=\"tab\" aria-controls=\"elementor-tab-content-2426\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon elementor-accordion-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon-closed\"><i class=\"fas fa-plus\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon-opened\"><i class=\"fas fa-minus\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-accordion-title\" href=\"\">Organ Site<\/a>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div id=\"elementor-tab-content-2426\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"6\" role=\"tabpanel\" aria-labelledby=\"elementor-tab-title-2426\"><p>Testis<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-accordion-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2427\" class=\"elementor-tab-title\" data-tab=\"7\" role=\"tab\" aria-controls=\"elementor-tab-content-2427\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon elementor-accordion-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon-closed\"><i class=\"fas fa-plus\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon-opened\"><i class=\"fas fa-minus\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-accordion-title\" href=\"\">Keywords<\/a>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div id=\"elementor-tab-content-2427\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"7\" role=\"tabpanel\" aria-labelledby=\"elementor-tab-title-2427\"><p>mixed germ cell tumor, yolk sac tumor, embryonal carcinoma<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>CASE OF THE WEEK Editors: Francesca Khani (Frk9007@med.cornell.edu) and Mahmut Akgul (akgulm@amc.edu) 2022-02\/January 10Contributors: Maria F Arisi and Li Li A man in his 30\u2019s presented with 3 days of abdominal pain, nausea, and vomiting. CT imaging revealed a 14 cm ill-defined right retroperitoneal mass, a 2 cm left pulmonary nodule, and a 10 cm<br \/><a class=\"moretag\" href=\"https:\/\/iboblr.in\/gupathsociety\/cow-2022-2\/\">+ Read More<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"templates\/page-fullwidth_template.php","meta":{"pmpro_default_level":0,"footnotes":""},"class_list":["post-4078","page","type-page","status-publish","hentry","pmpro-has-access"],"_links":{"self":[{"href":"https:\/\/iboblr.in\/gupathsociety\/wp-json\/wp\/v2\/pages\/4078","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/iboblr.in\/gupathsociety\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/iboblr.in\/gupathsociety\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/iboblr.in\/gupathsociety\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/iboblr.in\/gupathsociety\/wp-json\/wp\/v2\/comments?post=4078"}],"version-history":[{"count":18,"href":"https:\/\/iboblr.in\/gupathsociety\/wp-json\/wp\/v2\/pages\/4078\/revisions"}],"predecessor-version":[{"id":8294,"href":"https:\/\/iboblr.in\/gupathsociety\/wp-json\/wp\/v2\/pages\/4078\/revisions\/8294"}],"wp:attachment":[{"href":"https:\/\/iboblr.in\/gupathsociety\/wp-json\/wp\/v2\/media?parent=4078"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}