Mixed germ cell tumors: Experience of a single institution over past 15 Years

Malignant mixed germ cell tumors [MMGCT] are rare ,biologically diversified and diagnostically challenging tumors. They arise in the gonads more frequently than at extragonadal sites and their individual constituents are the same in both gonads .In the testis they account for 40-45% of all primary testicular tumors .In the ovary an incidence between 12% to 28% is reported in literature. Extragonadal GCT [germ cell tumors] constitute nearly 3% of pediatric brain tumors and Germinomas alone account for approximately two thirds, of all GCT . Aim: The purpose of this retrospective study was to present the clinicopathological profile of these rare, less well studied and intriguing malignant mixed germ cell tumors [MMGCTs] in both genders and inclusive of gonadal and extra gonadal locations. All primitive germ cell tumors inclusive of both genders and all sites were retrieved from the archives of the Anatomical Pathology Department at King AbdulAziz University Hospital,Jeddah between 1995-2010 through a computerized search. A total of 28 primitive GCTs were retrieved in both genders and in all locations. Nineteen [67.85%] of the tumors were pure germ cell type. MMGCTs were 9 [32.14%] of all primitive GCTs with a mean age of 21.22 years. Of the 9 MMGCTs in both genders that were studied further 7[25%] were gonadal and 2[7.14%] were extra-gonadal [intracranial] in location . Five [17.85%] were testicular MMGCTs with a mean age of 23.6 years. Two [7.14%] were ovarian MMGCTs with a mean age of 27 years. Two [7.14%] cases were extragonadal [intracranial] in location and both the patients were pediatric males with a mean age of 9.5 years. Clinical, radiological, demographic origin, pathological characteristics and immunohistochemical profile of all MMGCTs are presented along with review of literature. Malignant germ cell tumors are rare and our findings suggest that MMGCTs in general have a favourable prognosis regardless of histological constituents or location and despite a higher clinical stage

value of fine needle aspiration cytology in the diagnosis of male breast lesions

The aim of this retrospective case series is to explore and highlight the subject of male breast diseases in Jeddah, Saudi Arabia and to assess the value of fine needle aspiration in diagnosing these lesions. Material and Data on male breast biopsies and fine needle aspiration cytology [FNAC] done between 1984 and 1999 were retrieved from the laboratory records. The same pathologist blindly examined all the cytology and histology slides. Histopathology diagnoses were classified into benign and malignant. FNAC diagnoses w e re categorized as positive, negative, inconclusive or unsatisfactory. Cytohistologic correlation was done with data from histopathology records. Sensitivity, specificity, and predictive values of FNAC were calculated using standard statistical methods. Our results were also compared with a similar large study. Sixty-three [6.0%] of 1044 patients undergoing breast surgical biopsies were males. Benign lesions comprised 55 cases [87.3%], but eight cases [12.7%] were malignant lesions [six ductal carcinomas and two metastatic adenocarcinoma]. Gynecomastia is the most common male breast lesion, constituting 54% [mean age 31.23 years]. Amajority [54%] of these patients presented near puberty. Twelve patients had cytohistological records for correlation, giving a sensitivity of 100%, specificity of 83.33%, positive predictive value of 85.71%, negative predictive value of 100%, false positive fraction of 8.3% and a false negative fraction of 0%. Male breast lesions constituted 6% of all breast lesions and male breast carcinomas constituted 2.59% of all breast carcinomas. This study also shows that FNAC is an accurate tool for diagnosing male breast lesions. It is highly sensitive and specific. FNAC should, therefore, be used confidently and be included as an integral part of primary assessment of breast lumps in males