Embryonal carcinoma

Embryonal carcinoma is a relatively uncommon type of germ cell tumour that occurs in the ovaries and testes.

Ovarian embryonal carcinoma
In the ovary, embryonal carcinoma is quite rare, amounting to approximately three percent of ovarian germ cell tumours. The median age at diagnosis is 15 years. Symptoms and signs are varied, and may include sexual precocity and abnormal (increased, reduced or absent) uterine bleeding . There may be elevations in serum human chorionic gonadotropin (hCG) and alpha fetoprotein (AFP) levels but it would be in association with other tumors, (e.g. yolk sac tumor,) because they themselves do not produce the serum markers. At surgery, there is extension of the tumour beyond the ovary in forty percent of cases. They are generally large, unilateral tumours, with a median diameter of 17 centimetres. Long term survival has improved following the advent of chemotherapy. The gross and histologic features of this tumour are similar to that seen in the testis.

Testicular embryonal carcinoma
In the testis pure embryonal carcinoma is also uncommon, and accounts for approximately ten percent of testicular germ cell tumours. However, it is present as a component of almost ninety percent of mixed nonseminomatous germ cell tumours. The average age at diagnosis is 31 years, and typically presents as a testicular lump which may be painful. One fifth to two thirds of patients with tumours composed predominantly of embryonal carcinoma have metastases at diagnosis.

Clinical symptoms and signs
The presenting features may be a palpable testicular mass or asymmetric testicular enlargement in some cases. The tumour may present as signs and symptoms relating to the presence of widespread metastases, without any palpable lump in the testis. The clinical features associated with metastasising embryonal carcinoma may include low back pain, dyspnoea, cough, haemoptysis, haematemesis and neurologic abnormalities.

Males with embryonal carcinoma tend to have a normal range serum AFP. The finding of elevated AFP is more suggestive of a mixed germ cell tumour, with the AFP being released by a yolk sac tumour component.

Pathologic features
The gross examination usually shows a two to three centimetre pale grey, poorly defined tumour with associated haemorrhage and necrosis.

The microscopic features include: indistinct cell borders, mitoses, a variable architecture (tubulopapillary, glandular, solid, embryoid bodies - ball of cells in surrounded by empty space on three sides), nuclear overlap, and necrosis. An important key to distinguish it from other tumors, such as seminoma (vacuolated),teratocarcinoma (3 differentiated germ layers), yolk sac tumor (Schiller-Duval bodies), and the seroli-leydig cell tumor (strings of glands), is that the embryonal carcinoma is "trying" to evolve into their next stage. So in the testicle, they are often observed as blue cells attempting to form primitive tubules.