Sinonasal teratocarcinosarcoma with yolk sac elements: a neoplasm of somatic or germ cell origin?
Sinonasal teratocarcinosarcoma is an uncommon, aggressive, morphologically heterogenous tumor composed of cells derived from the 3 somatic layers. A histogenetic origin from a multipotential adult somatic stem cell with divergent differentiation has been favored over a germ cell origin. This assumption has been based on the lack of germ cell elements and, until recently, the absence of demonstrable amplification of 12p. We report a case that exhibited foci of yolk sac elements with papillary structures and intracytoplasmic periodic acid-Schiff-positive, diastase-resistant, α-fetoprotein-positive, hyaline globules. An expanded area of undifferentiated cells, likely precursor cells, in the basal layer of the overlying mucosal epithelium transitions into and merges with the immature epithelial, neuroepithelial, and mesenchymal components. These previously unreported histomorphological features support the hypothesis that this tumor is a teratomatous tumor arising from pluripotent embryonic stem cells in the basal layer of the sinonasal epithelium. That notion is further supported by fluorescence in situ hybridization cytogenetic analysis, which showed a distinct subpopulation of the tumor cells with an extra copy of chromosome 12p13.
Department of Pathology, Louisiana State University Health Sciences Center, Shreveport, 71130, USA. jtho19@lsuhsc.edu
Jaiyeola
J
Thomas
Patrick
P
Adegboyega
Kenny
K
Iloabachie
John Wesley
JW
Mooring
Timothy
T
Lian
D000071443:12E7 Antigen; D015703:Antigens, CD / Q000378:metabolism; D001706:Biopsy; D002296:Carcinosarcoma / Q000235:genetics / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D015815:Cell Adhesion Molecules / Q000378:metabolism; D058674:Chromosome Duplication / Q000235:genetics; D002881:Chromosomes, Human, Pair 12 / Q000235:genetics*; D003937:Diagnosis, Differential; D005260:Female; D005854:Germ Cells / Q000473:pathology; D006801:Humans; D006818:Hyalin / Q000378:metabolism; D007150:Immunohistochemistry; D017404:In Situ Hybridization, Fluorescence; D018404:Isochromosomes / Q000235:genetics; D007633:Keratins / Q000378:metabolism; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010255:Paranasal Sinus Neoplasms / Q000235:genetics / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D010256:Paranasal Sinuses / Q000473:pathology; D010503:Periodic Acid-Schiff Reaction; D013724:Teratoma / Q000235:genetics / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D015017:Yolk Sac / Q000473:pathology*; D000509:alpha-Fetoproteins / Q000378:metabolism
D000071443:12E7 Antigen; C097353:AFP protein, human; D015703:Antigens, CD; C061828:CD99 protein, human; D015815:Cell Adhesion Molecules; D000509:alpha-Fetoproteins; D007633:Keratins