PMC3917416_01
Histological features of mixed germ cell tumor and sarcomatous component. (A) Compact nests of tumor cells separated by fibrous septa, seminoma. Hematoxylin and eosin, 10x. (B) Keratinizing squamous epithelium, teratoma, hematoxylin and eosin, 4x. (C) Striated muscle cells with bizzare hyperchromatic nuclei, rhabdomyosarcoma. Hematoxylin and eosin, 20x. (D) Admixture of polygonal cells (cytotrophoblasts) and multinucleated cells (syncytiotrophoblasts) in a hemorrhagic background, choriocarcinoma. Hematoxylin and eosin, 10x.
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F1
Histopathology showed a mixed GCT, confined to the testis containing seminoma, classic type (40%; Figure  1A), teratoma (40%; Figure  1B) with a secondary somatic malignancy (rhabdomyosarcoma; Figure  1C) and choriocarcinoma (20%; Figure  1D).
Striated muscle cells, rhabdomyosarcoma. Hematoxylin and eosin, 40x.
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F2
The SC consisted of striated muscle cells with hyperchromatic bizarre nuclei and mitotic figures (Figure  2).
Immunohistochemical stains. (A) Seminoma, positive staining for placental alkaline phosphatase, 20x. (B) Seminoma, positive staining for c-Kit, 20x. (C) Teratoma, positive staining for epithelial membrane antigen, 10x. (D) Choriocarcinoma, positive staining for inhibin, 10x.
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F3
Immunohistochemistry stains displayed strong staining with placental alkaline phosphatase (Figure  3A) and c-kit (Figure  3B) in the seminomatous component. Epithelial membrane antigen (Figure  3C) and cytokeratin positivity were observed in the glandular component of the teratoma. The rhabdomyosarcoma showed positivity with vimentin and the choriocarcinoma was positive for inhibin (Figure  3D), cytokeratin and beta-hCG.