Yolk sac tumor of postpubertal-type does not exhibit immunohistochemical loss of SMARCB1/INI1 and SMARCA4/BRG1…but choriocarcinoma?

In the 5th edition of the World Health Organization (WHO) Classification of Head and Neck Tumours, a new entity called SWI/SNF complex-deficient sinonasal carcinoma (SMARCB1 & SMARCA4) has been introduced [1]. These are poorly-differentiated carcinomas that demonstrate functional loss of one of the SWI/SNF complex subunits (either SMARCB1 or SMARCA4) and lack histologic features of other defined entities [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16]. Histologically, they may contain a variable amount of yolk sac tumor-like components [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16]. Additionally, they may express germ cell (SALL4) and yolk sac (Glypican-3, GATA3, AFP) immunomarkers and/or present with a concurrent elevation of serum AFP levels [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16]. Tumors with similar characteristics (yolk sac-like histology, immunohistochemical loss of SMARCB1/INI1 and SMARCA4/BRG1, and elevated serum AFP levels) have also been reported in other sites, especially in the female genital tract [17], [18], [19], [20], [21]. Based on these findings, we hypothesized that testicular YSTpt may demonstrate similar alterations. To test our hypothesis, we interrogated a retrospective case series of testicular YSTpt from a single institution using SMARCA4/BRG1 and SMARCB1/INI1 immunohistochemistry.

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