Large germ cells with notably enlarged, round to irregularly shaped, hyperchromatic nuclei and prominent nucleoli line the seminiferous tubules. Normal spermatogenesis is not present.
C-kit strongly highlights the cells of ITGCN.
Intratubular germ cell neoplasia is seen adjacent to all testicular germ cell tumors with the exception of spermatocytic seminoma, epidermoid/dermoid cysts and some pediatric tumors such as teratomas and yolk sac tumors.1 ITCGN occurs in approximately 80% of testes with malignant GCTs, 2-8% of patients with crytorchidism and approximately 1% of testes biopsied for infertility.2
Microscopically, pleomorphic germ cells with round, irregularly shaped nuclei containing prominent nucleoli line the seminiferous tubules. The malignant cells may also be seen in the interstitum. The plasma membranes of the neoplastic cells should be immunoreactive for CD117 and PLAP.2
Usually affects in men between age 30-50. More frequently found intersex patients, androgen insensitivity syndrome and gonadal dysgenesis syndromes -- these patients generally have cryptorchidism.1,2
If untreated, ITCGN will progress into invasive germ cell tumor in over 50% of cases within 5 years. Thus, orchiectomy, radiation, chemotherapy and/or watchful waiting will be employed depending on whether the patient wishes to perserve fertility. Sperm-banking should be considered prior to these treatments.
1 Kumar V, Abbas AK, Fausto N. Robbins and Cotran Pathologic Basis of Disease. 7th Ed. Philadelphia, PA: Elsevier; 2005: 1041.
2 Zhou M, Magi-Galluzzi, C. Genitourinary Pathology: Foundations in Diagnostic Pathology. Philadelphia, PA: Elvesier; 2006: 536-8.