Analysis of cytology of germ cell tumors with histopathological and serum tumor marker correlation: a tertiary care centre experience


  • Sindhu Nair P. Department of Pathology, Regional Cancer Centre, Trivandrum, Kerala, India
  • Jayasree Kattoor Department of Pathology, Regional Cancer Centre, Trivandrum, Kerala, India
  • Nileena Nayak Department of Pathology, Regional Cancer Centre, Trivandrum, Kerala, India
  • Preethi T. R. Department of Pathology, Regional Cancer Centre, Trivandrum, Kerala, India



Fine needle aspiration cytology, Germ cell tumor, Serum tumor markers


Background: Germ cell tumors are found primarily in children and young adults usually arising from gonads and rarely from extragonadal sites like mediastinum, retroperitoneum, pineal gland and sacrococcygeal region. Involvement of lymphnodes or bodycavities (pleural/peritoneal cavity) is usually associated with metastatic disease.

Methods: This is a retrospective analysis of 96 cases of germ cell tumor for which a primary diagnosis of germ cell tumor was given by cytology from primary and metastatic sites. The study period is from January 1993- December 2013. Pap stained and Romanowsky stained smears and cell block sections (10cases) were studied. Serum tumor markers (LDH, BetaHCG and AFP) were correlated in all cases along with histopathology in available cases.

Results: Among 96 cases 34 were diagnosed as seminoma/dysgerminoma,10 as embryonal carcinoma,9 as yolk sac tumor,6 as teratoma and 2 as mixed germ ell tumor. In 25 cases the cytology report was suggestive of germ cell tumor and in 10 cases malignant cells favouring germ cell tumor. Among the 10 cases the serum markers were high in six of the cases and the clinician after discussing with the pathologist treated them as germ cell tumors. 47 cases had histopathology and it correlated with cytology except in 14 cases which showed no residual neoplasm after chemotherapy. 15 cases expired immediately after the diagnosis or during the course of treatment 12cases were lost to follow up. Rest of the cases have completed the treatment. In our study the serum tumor markers showed a sensitivity of 92.75% and positive predictive value was 71.11%.

Conclusions: The study highlights the importance of picking up the diagnosis of germ cell tumors by fine needle aspiration cytology so that patient can get an early diagnosis, effective treatment and a multidisciplinary approach is essential in diagnosing a difficult case of germ cell tumor. Previous history, radiology, clinical features and serum tumor markers all aid in the cytological diagnosis of germ cell tumor.


Stanley MW,Powers CN,Pitman MB,Korourian S,Bardales RH,Khurana K:Cytology of Germ cell tumors:Extragonadal,extracranial masses and intra operative problems.Cancer.1997 ;81(4):220-27

Pandey A, Nandini N, Jha A, Manjunath G. Fine needle aspiration cytology and cell block in the diagnosis of seminoma testis. J Cytol. 2011;28(1):39-41.

Ulbright T. M. Germ cell tumors of the gonads: a selective review emphasizing problems in differential diagnosis, newly appreciated, and controversial issues. Modern Pathology. 2005;18(2):S61–S79.

Dagil AF,Pehllvan,Cihangiroglu G,Ozercan MR.Cytology of mixed germ cell tumor with mediastinal metastasis.J Cytol2009;26:120-2.

Shabb NS, Fahl M, Shabb B, Haswani P, Zaatari G. Fine-needle aspiration of the mediastinum: A clinical, radiologic cytologic, and histologic study of 42 cases. Diagn Cytopathol. 1998;19:428–36

Chhieng DC, Lin O, Moran CA, Eltoum IA, Jhala NC, Jhala DN, et al. Fine-needle aspiration biopsy of nonteratomatous germ cell tumors of the mediastinum. Am J Clin Pathol. 2002;118:418–24.

Malagon HD,Montel DP.Mediastinal Germ Cell Tumors.Diagnostic Histopathology.2010 ;16(5):: 228-236.

Chao TY,Nieh S,Huang SH,Lee WH,Cytology of Fine Needle Aspirates of Primary Extragonadal Germ Cell Tumors:Acta Cytologica; 1997;41:497-503

Yang GC,Hwang SJ,Yee HT.Fine needle aspiration cytology of unusual germ cell tumours of the mediastinum:Atypical seminoma and parietal yolk sac tumor. Diagn Cytopathol. 2002;27(2):69-74.

DeyP.Diagnostic dilemma:Diagnostic algorithm in fine needle aspiration cytology of mediastinal tumors.Indian J Pathol Microbiol 2010;53:395-402.

Dehner LP.Germ cell tumors of the mediastinum,Semin Diagn Pathol1990,;7(4):266-84.

Willis R. Borderland of embryology and pathology. 2nd ed. Washington, DC: Butterworth and Company; 1992.

J garcía‐solano j., sánchez‐sánchez c., montalbán‐romero s., sola‐pérez j. and pérez‐guillermo m. Fine needle aspiration (FNA) of testicular germ cell tumours; a 10‐year experience in a community hospital(1998) Cytopathology ,volume9(4), 248–262

Gupta R,Mathur SR,Arora KV,Sharma GS,Cytologic Features ofExtra gonadal Germ Cell Tumors ,A Study of 88 cases with aspiration Cytology:CANCER,2008;114(6):504-11.

N. P. Caraway, C. V. Fanning, R. J. Amato, N. Sneige, Fine-needle aspiration cytology of seminoma: a review of 16 cases,Diagnostic CytopathologyJune1995,12(4).327–333

Bandyopadhyay A, Chakraborty J, Chowdhury AR, Bhattacharya A, Bhattachrya P, Chowdhury M J Fine needle aspiration cytology of ovarian tumors with histological correlation.Cytol. 2012 Jan;29(1):35-40.

Kataria SP, Misra K, Singh G, Kumar S, Cytological findings of an extragonadal yolk sac tumor presenting at an unusual site J Cytol. 2015 Jan-Mar;32(1):62-4..

Kafil Akhtar, Mohammad Jaseem Hassan, Tamkeen Khan, Ghazala Mehdi, Yolk Sac Tumor: A Rare Cytological Presentation. Int J clinical & case.2017:1(6): 131-33

RyuYJ,Yoo SH,Jung MJ,Jang S,CHO K-J,, An Embryonal Rhabdomyosarcoma Arising from a Mediastinal Teratoma : An Unusual Case Report ,J Korean Med Sci. 2013 Mar; 28(3): 476–479.

Kefeli M,Kandemir B,AkpolatI,Yildrim A,Kokcu A,Rhabdomyosarcoma Arising in a Mature Cystic Teratoma With Contralateral Serous Carcinoma: Case Report and Review of the Literature: International Journal of Gynecological Pathology : Official Journal of the International Society of Gynecological Pathologists Jul 2009, 28(4):372-375

Omezzine C. Khouatra S. Larivé G. Freyer S. Isaac-Pinet L. GérinièreJ.-P. Droz P.-J. Souquet :Rhabdomyosarcoma arising in mediastinal teratoma in anadult man: a case report ,Annals of Oncology,2002; 13(2):323–26

Tickoo SK, Amin MB, Cramer HM, Harik LR, Ulbright TM. The testis, paratesticular structures, and male external genitalia. Chapter 34, vol 2; In Silverberg SG, DeLellis RA, Frable WJ, Li Volsi VA, Wick MR (Eds.): Silverberg's principles and practice of surgical pathology and cytopathology, 4 ed. China: Churchill Livingstone, Elsevier; 2006: 1731-89.

JA,Sharmila PS,Mahantachar V,Rajaram T. Metastatic Testicular Mixed Germ Cell Tumors. A Diagnostic Dilemma in Cytology, J Clin Biomed Sci 2013 ; 3 (2),90-95

Tanaka Y,Okamura T,Ngai T,Kobayashi D,KobayashiT,Akitha H et al A Study of Patients with Primary Mediastinal Germ Cell Tumors Treated Using Multimodal Therapy,Adv Urol. 2017; 2017: 1404610

Mani R, Jamil K . Specificity of Serum Tumor Markers (CA125, CEA, AFP, Beta HCG) in Ovarian Malignancies. Trends in Medical Research ;2007:2 (3): 128-134.

Milose JC, Filson CP, Weizer AZ, Hafez KS, Montgomery JS. Role of biochemical markers in testicular cancer:diagnosis,staging and surveillance, Open Access J Urol. 2011 Dec 30;4:1-8.

Gilligan TD, Seidenfeld J, Basch EM, et al. American Society of Clinical




How to Cite

P., S. N., Kattoor, J., Nayak, N., & R., P. T. (2019). Analysis of cytology of germ cell tumors with histopathological and serum tumor marker correlation: a tertiary care centre experience. International Journal of Research in Medical Sciences, 7(11), 4084–4089.



Original Research Articles