Seminoma with Syncytial Trophoblastic Cells

[c-w]

Hi Everyone,
I just received the pathology report from my I/O, and the pathologist has determined the tumor to be a Seminoma with Syncytial Trophoblastic Cells.

The tumor was small, 0.7cm x 0.6cm x 0.6cm, and no metastatic spread was identified on the CT scans. The lymph nodes are not enlarged.

The microscopic description reads: "Sections through a testicle reveal a mass composed of polygonal cells separated by a delicate fibrovascular stroma including a sprinkling of lymphocytes. The tumor cells appear to be of high nuclear grade with vesicular nuclei and medium to large sized nucleoli. The nuclei are enlarged and irregular. Multi-nucleated giant cells are present, and this may represent Syncytial Trophoblastic Cells. The tumor is entirely contained within the testicular parenchyma. The spermatic cord and blood vessels are free of tumors. There is no evidence of a teratomatous component."

My urologist has asked the pathologist to send the tumor slides to University of VA in Charlottesville, for a second opinion. He is doing this because my beta HCG level before the surgery was elevated (33). Before the surgery, he informed us to expect a nonseminoma with likely choriocarcinoma make-up. So, long-story-short, we are a bit surprised at the pathology, given the results of the HCG.

Can any of you veterans shed a little light on this diagnosis?

[Scott]

...my beta HCG level before the surgery was elevated (33). Before the surgery, he informed us to expect a nonseminoma with likely choriocarcinoma make-up. So, long-story-short, we are a bit surprised at the pathology, given the results of the HCG.

Not such a surprise -- hCG is elevated in about 10-25% of pure seminoma cases.

[Fish]

It's most likely the syncitial trophoblastic cells which are producing the hcg, and they are not always present in seminoma. I don't remember for sure, but I don't think this finding affects your staging or prognosis. Based on the small size of the tumor, I 'd say you were very fortunate and found it quite early. Let us know what the UVa pathology report says.

Best wishes.

[c-w]

Thanks, thats the first I've heard that syncitial trophoblastic cells produce hcg.

Fish: By the way, did you get radiation for your first round of TC? Or just the RPLND? I am guessing the embryonal portion of your tumor caused your treatment to go the route of nonseminoma? I'm still learning so please bear witrh me.

My urologist acts like the terms "seminoma with syncytial trophoblastic cells" might actually mean we treat this as a nonseminoma. Do you (or anyone else) understand this?

[indiana9]

I too had elevated HCG (24 rising to 48 during 1st round of chemo) AND an elevated AFP of 24 with a diagnosis of "Pure Seminoma" from IU. Sounds like you are lucky and have caught this in its very earliest stage! You will be cured shortly!
Brian

[Fish]

Hi C-W:

Sorry for the delay in replying, I've been out of town. You're correct, my first TC was managed as nonseminoma. I had just the RPLND, they didn't find anything in the lymph nodes, so I did surveillence for 3 years.

I don't think the trophoblastic cells will put you in the nonseminoma category, but I just don't remember for certain. You might want to also contact the pathologist at Indiana University and send them your slides for a consult. Did you get the report back from UVa yet?

[c-w]

No, I haven't received the results from UVa yet, its supposed to be back late this week.

You make it sound easy to get IU to review my slides. Do you have a contact there, or is it just that easy?

[Fish]

C-W:

Here it the info from the TCRC site. I tried to check IU's website, but it doesn't seem to be working this morning.

Indiana University, Department of Pathology


Dr Thomas Ulbright
Dept of Pathology, Director of Anatomic Pathology
Phone: (317) 274-2498
For pathology consults, send slides to Dr Ulbright at this address:


Indiana University Hospital - Room 3465
550 North University Blvd
Indianapolis, IN 46202-5280

The slides should be accompanied by the original pathology report. IU will charge a consultation fee for this service, so include a copy of your insurance information if you want them to bill insurance directly.

If anyone has updated or different information hopefully they will post it for you.

You can try the links to IU, maybe they will be working later, they're on this webpage. Or you could try to call and find out more info.

http://tcrc.acor.org/experts.html

Best wishes,
Fish