Jak odczytać mój wynik biopsji?

Lekarze w Anglii wysyłają mnie na chemioterapię teraz 26 lutego i trochę się martwię i dlatego pytam opini drugich osób. Rak jądra , lewe wycięte , i jest podobno guz na wiezłach chłonnych. Proszę o pomoc Ponizej wyniki biopsji i na samym dole ct scan z kontrastem Paweł Left testis and cord. CLINICAL DETAILS Left testis mass clinically and on ultrasound. Raised alpha fetoprotein- 18, beta HCG- 2240. GROSS APPEARANCE Pot labelled with patient details and left testicle and cord. Specimen consists of a testis 56x41x34mm with attached segment of spermatic cord 55x24mm. The testis contains a multinodular tumour measuring 41x29x23mm. At the inferior pole a 13x12mm seemingly discrete nodule with a grey cartilaginous appearance is seen, but may well represent a continuation of the same tumour. The tumour has a variegated appearance with haemorrhagic and microcystic areas as well as areas appearing more solid and grey tan to yellow. A rim of normal appearing parenchyma is present. No spermatic cord or tunica vaginalis involvement is apparent grossly. A1) Spermatic cord margin. A2) Mid cord. A3) Base of cord. A4-A6) Composite sagittal slice testis. A7 and A8) Composite sagittal slice testis and tumour. A9) Base of cord to A7 and A8. A10) Testis with tumour and base of cord. A11-A15) Cruciate sections. Tissue remains. (90% of tumour submitted). Cut up by Dr Solange De Noon (Specialist Trainee 1) MICROSCOPY The orchidectomy demonstrates a mixed germ cell tumour, including choriocarcinoma, embryonal carcinoma, teratoma and classic seminoma subtypes. Choriocarcinoma is the dominant subtype, forming approximately 60% of the tumour with extensive associated tumour necrosis. There is immunoreactivity for Beta-HCG, AE1/3 and EMA. Embryonal carcinoma accounts for approximately 24% of the tumour and expresses Oct 3/4 and CD30. AE1/3 and EMA highlight the teratoma component, which accounts for approximately 15% of the tumour. Classic seminoma is focally present in 2 blocks (A5 and A8); this component is positive for Oct 3/4. Oct3/4 also highlights associated germ cell neoplasia in situ (GCNIS). There is focal tumour displacement, but no definite lymphovascular invasion is identified. No involvement of the rete testis, epididymis, spermatic cord or tunica vaginalis is identified. The background testis shows minimal spermatogenesis and Leydig cell hyperplasia. TESTICULAR GERM CELL TUMOUR DATASET CORE MACROSCOPIC ITEMS Specimen type Radical orchidectomy Laterality LEFT Macroscopic tunica vaginalis invasion No Macroscopic cord invasion No Maximum tumour diameter 41mm CORE MICROSCOPIC ITEMS Tumour types Choriocarcinoma, embryonal carcinoma, teratoma, classic seminoma Percentage of each subtype present Choriocarcinoma - 60% Embryonal carcinoma - 24% Teratoma - 15% Classic seminoma - 1% Lymphovascular invasion No Rete testis stromal invasion No Hilar/direct spermatic cord invasion No Tumour at margins (state site) No Microscopic tunica vaginalis invasion No Germ cell neoplasia in situ (GCNIS) Yes pT1 stage (TNM8, 2017) CONCLUSION Left testis and cord, radical orchidectomy: - 41mm mixed germ cell tumour. - Choriocarcinoma (60%), embryonal carcinoma, teratoma, classic seminoma. - No definite lymphovascular invasion identified. - No involvement of tunica vaginalis, rete testis or spermatic cord. - Margins clear. - GCNIS present. - pT1 (TNM 8th edition). REPORTED BY Dr Solange De Noon (Specialist Trainee 1) Dr Colan Ho-Yen ( IMG_0327.HEIC Paweł