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Epithelial Tumors and Precursors, Type 2, Pathology of the Uterine Corpus 107
https://t.me/med1917
E
Epithelial Tumors and Precursors, Type 2, Pathology
of the Uterine Corpus, Fig. 7 (a). FIGO grade 1 endo-
metrioid carcinoma with a juxtaposed (b).
undifferentiated endometrial carcinoma
– The differentiated endometrioid component
usually lines the endometrial cavity, while
the undifferentiated component grows
beneath it.
– The interface between the differentiated and
undifferentiated components is abrupt.
Immunophenotype
– Differentiated components will express ER,
PR, and strong epithelial markers.
– Undifferentiated components are typically
negative for ER and PR (see undifferentiated
endometrial carcinoma).
Molecular Features
– Approximately one-half of the tumors display
high microsatellite instability with MLH1 promoter methylation and loss of MLH1 and
PMS2 expression.
Epithelial Tumors and Precursors, Type 2, Pathology
of the Uterine Corpus, Fig. 8 (a). FIGO grade 1 endo-
metrioid carcinoma with a juxtaposed undifferentiated
endometrial carcinoma. (b). Undifferentiated component
showing sheets of discohesive medium to large cells with
vesicular chromatin and prominent nucleoli
Differential Diagnosis
• Endometrioid carcinoma, FIGO grade 3
– High-grade component is cohesive.
– Strong expression of epithelial markers.
References and Further Reading
Brinton, L. A., et al. (2013). Etiologic heterogeneity in endo-
metrial cancer: Evidence from a Gynecologic oncology
group trial. Gynecologic Oncology, 129, 277–284.
Clemet, P. B., & Young, R. H. (2004). Non-endometrioid
carcinomas of the uterine corpus: A review of their
pathology with emphasis on recent advances and problematic aspects. Advances in Anatomic Pathology, 11,
117–142.
Mahdi, H., et al. (2015). Alteration in PI3K/mTOR,MAPK
pathways and Her2 expression/amplification is more
frequent in uterine serous carcinoma than ovarian
serous carcinoma. Journal of Surgical Oncology, 112,
188–194.
108 Epithelial Tumors, Pathology of the Peritoneum
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Epithelial Tumors, Pathology
of the Peritoneum
Ben Davidson
Department of Pathology, Norwegian Radium
Hospital, Oslo University Hospital, Oslo, Norway
University of Oslo, Faculty of Medicine, Institute
of Clinical Medicine, Oslo, Norway
High-Grade Serous Carcinoma
Synonyms
High grade; Peritoneal serous carcinoma.
Definition
High-grade serous carcinoma (HGSC) for which
origin in the uterus, fallopian tube, or ovary has
been excluded.
Clinical Features
• Incidence
These tumors are currently considered to be
distinctly uncommon, following the implementation of the SEE-FIM protocol for sectioning of the fallopian tube.
• Age
Adults, the majority >60 years.
• Sex
Female.
• Site
Peritoneum, largest disease volume often in
the omentum.
• Treatment
Surgery, chemotherapy, and targeted therapy.
• Outcome
Poor.
Macroscopy
Often diffuse peritoneal carcinomatosis, with
multiple white-gray friable or firm nodules
covering the peritoneal surfaces.
Microscopy
Same as HGSC of the fallopian tube or ovary
(Pathology of the fallopian tube and broad ligament, Pathology of the ovary; Fig. 1).
Epithelial Tumors, Pathology of the Peritoneum,
Fig. 1 Omental resection of a primary peritoneal high-
grade serous carcinoma. Morphology is identical to
corresponding tumors arising in the fallopian tube or ovary
Immunophenotype
Tumors are positive for epithelial/carcinoma
markers (Ber-EP4, MOC-31, claudin-4, and
B72.3) and express PAX8 and WT1, with aberrant
p53 pattern and block positivity for p16, in the
majority of cases.
Molecular Features
Near universal mutations in TP53. Mutations in
BRCA1/2 in about 15% of cases. Less common
mutations in other DNA repair genes.
Differential Diagnosis
1. LGSC; Distinction based on morphology
(degree of atypia, mitotic activity) and p53
staining pattern.
2. Ovarian adenocarcinoma of another histological type or origin. WT1 often resolves the
former differential, wher eas WT1 and PAX8
resolve the latter. Other markers should be used
as mandated by tumor morphology.
3. Malignant mesothelioma (MM); Distinction
based on immunohistochemistry. HGSC
expresses claudin-4, B72.3, and PAX8; is negative or focally positive for calretinin; and has
retained BAP1 expression. Peritoneal MM
stains negative for claudin-4 and B72.3,
is usually PAX8-negative, is diffusely
calretinin-positive and has loss of BAP1 in
>50% of cases.
Epithelial Tumors, Pathology of the Peritoneum 109
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4. Reactive mesothelial hyperplasia (RMH); Distinction based on immunohistochemistry.
HGSC expresses claudin-4, B72.3, and
PAX8; is negative or focally positive for
calretinin; and lacks desmin expression. RMH
stains negative for claudin-4 and B72.3, is
usually PAX8-ne gative, and diffusely
expresses calretinin and desmin.
Low-Grade Serous Carcinoma
Definition
Low-grade serous carcinoma (LGSC), arising
de novo or from a serous borderline tumor,
for which origin in the ovary has been
excluded.
Clinical Features
• Incidence
These are uncommon tumors, as the majority
of LGSC have their origin in the ovary.
• Age
Adults, wide age range, generally younger than
patients with HGSC (high-grade serous carcinoma) (median: 43–47 years).
• Sex
Female.
• Site
Peritoneum, largest disease volume often in
the omentum.
• Treatment
Surgery, chemotherapy (often limited
response), and targeted therapy (hormone
receptor inhibition, MEK inhibition, and antiangiogenic therapy).
• Outcome
Longer survival than patients with HGSC; the
majority recur and are often fatal. Patients
with a peritoneal primary have longer survival
than those with tumors originating in the
ovary.
Macroscopy
Often diffuse peritoneal carcinomatosis, with
multiple white-gray friable or firm nodules covering the peritoneal surfaces. Cut surface may be
gritty due to calcification.
E
Epithelial Tumors, Pathology of the Peritoneum,
Fig. 2 Omental resection of a primary peritoneal low-
grade serous carcinoma. Morphology is identical to
corresponding tumors arising in the fallopian tube or ovary
Microscopy
Invasive adenocarcinoma with low-medium
degree of atypia and few mitoses. Psammoma
bodies are commonly seen. Tumor groups may
have papillary, micropapillary, cribriform, glandular, or solid architecture. Desmoplastic reaction
in the surrounding stroma (Fig. 2).
Immunophenotype
Tumors are positive for epithelial/carcinoma
markers (Ber-EP4, MOC-31, claudin-4, and
B72.3), and express PAX8 and WT1, with wildtype p53 pattern and patchy positivity for p16, in
the majority of cases.
Molecular Features
Frequent activating mutations in KRAS, BRAF,
ERBB2, NRAS, and NF1, resulting in deregulation
of the mitogen-activated protein kinase (MAPK)
pathway.
Differential Diagnosis
1. HGSC; Distinction based on morphology
(degree of atypia, mitotic activity) and p53
staining pattern.
2. Serous borderline tumor/implants. Evidence of
destructive invasion of a tumor morphologically consistent with LGSC is required.
3. Ovarian adenocarcinoma of other histological
type or origin. WT1 often resolves the former
110 Epithelial Tumors, Pathology of the Peritoneum
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differential, whereas WT1 and PAX8 resolve
the latter. Other markers should be used as
mandated by tumor morphology.
4. Malignant mesothelioma (MM); Distinction
based on immunohistochemistry. LGSC
expresses claudin-4, B72.3, and PAX8; is negative or focally positive for calretinin; and has
retained BAP1 expression. Peritoneal MM
stains negative for claudin-4 and B72.3, is
usually PAX8-negative, is diffusely
calretinin-positive, and has loss of BAP1 in
>50% of cases.
5. Reactive mesothelial hyperplasia (RMH); Distinction based on immunohistochemistry.
LGSC expresses claudin-4, B72.3, and
PAX8; is negative or focally positive for
calretinin; and lacks desmin expression. RMH
stains negative for claudin-4 and B72.3, is
usually PAX8-ne gative, and diffusely
expresses calretinin and desmin.
Serous Borderline Tumor
Definition
Noninvasive low-grade serous tumor arising in
the peritoneum, for which origin in the ovary has
been excluded.
Macroscopy
Larger tumors are exophytic, smaller ones may be
difficult to detect or present as fibrosis. Cut surface may be gritty due to calcification.
Microscopy
Similar to their ovarian counterparts (see
Chapter 6).
Immunophenotype
Tumors are positive for epithelial/carcinoma
markers (Ber-EP4, MOC-31, claudin-4, and
B72.3) and express PAX8 and WT1, with wildtype p53 pattern and patchy positivity for p16, in
the majority of cases.
Molecular Features
Activating mutations in KRAS and BRAF as
in LGSC.
Differential Diagnosis
SBT is a morphological diagnosis that generally
does not require immunohistochemistry. The
main differential diagnoses are low-grade serous
carcinoma and implants from a primary serous
borderline in the ovary, which are excluded
based on the absence of destructive invasion and
an ovarian primary, respectively.
Clinical Features
• Incidence
These are uncommon tumors, as the majority
of peritoneal lesions with serous borderline
tumor (SBT) morphology are implants associated with an ovarian primary.
• Age
Mean age 31 and 33 years in two series (range:
16–67 years).
• Sex
Female.
• Site
Peritoneum.
• Treatment
Surgery.
• Outcome
Longer survival than patients with low-grade
serous carcinoma but may recur or progress to
low-grade serous carcinoma over time.
References and Further Reading
Bell, D. A., & Scully, R. E. (1990). Serous borderline
tumors of the peritoneum. The American Journal of
Surgical Pathology, 14, 230–239.
Biscotti, C. V., & Hart, W. R. (1992). Peritoneal serous
micropapillomatosis of low malignant potential (serous
borderline tumors of the peritoneum).
A clinicopathologic study of 17 cases. The American
Journal of Surgical Pathology, 16, 467–475.
Davidson, B., Firat, P., & Michael, C. (Eds.). (2018).
Serous effusions – etiology, diagnosis, prognosis and
therapy. London: Springer.
Gershenson, D. M., Bodurka, D. C., Lu, K. H., Nathan,
L. C., Milojevic, L., Wong, K. K., Malpica, A., et al.
(2015). Impact of age and primary disease site on
outcome in women with low-grade serous carcinoma
of the ovary or peritoneum: Results of a large singleinstitution registry of a rare tumor. Journal of Clinical
Oncology, 33, 2675–2682.
Longacre, T. A., McKenney, J. K., Tazelaar, H. D.,
Kempson, R. L., & Hendrickson, M. R. (2005).
Epithelial Tumors, Pathology of the Peritoneum 111
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Ovarian serous tumors of low malignant potential
(borderline tumors): Outcome-based study of
276 patients with long-term (> or ¼5-year) followup. The American Journal of Surgical Pathology, 29,
707–723.
McKenney, J. K., Gilks, C. B., Kalloger, S., & Longacre,
T. A. (2016). Classification of extraovarian implants in
patients with ovarian serous borderline tumors (tumors
of low malignant potential) based on clinical outcome.
The American Journal of Surgical Pathology, 40,
1155–1164.
Przybycin, C. G., Kurman, R. J., Ronnett, B. M., Shih Ie,
M., & Vang, R. (2010). Are all pelvic (nonuterine)
serous carcinomas of tubal origin? The American Jour-
nal of Surgical Pathology, 34, 1407–1416.
Schmeler, K. M., Sun, C. C., Malpica, A., Deavers, M. T.,
Bodurka, D. C., & Gershenson, D. M. (2011). Lowgrade serous primary peritoneal carcinoma. Gyneco-
logic Oncology, 121, 482–486.
Singh, N., McCluggage, W. G., & Gilks, C. B. (2017).
High-grade serous carcinoma of tubo-ovarian origin: Recent developments. Histopathology, 71,
339–356.
Slomovitz, B., Gourley, C., Carey, M. S., Malpica, A.,
Shih, I. M., Huntsman, D., Fader, A. N., et al. (2020).
Low-grade serous ovarian cancer: State of the science.
Gynecologic Oncology, 156, 715–725.
Vang, R., Hannibal, C. G., Junge, J., Frederiksen, K.,
Kjaer, S. K., & Kurman, R. J. (2017). Long-term
behavior of serous borderline tumors subdivided into
atypical proliferative tumors and noninvasive lowgrade carcinomas: A population-based clinicopathologic study of 942 cases. The American Journal of
Surgical Pathology, 41, 725–737.
WHO Classification of Tumours Editorial Board.
(2020). volume 4: Female genital tumours
(5th ed.). Lyon: International Agency for Research
on Cancer.
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Germ Cell Tumors, Pathology
of the Fallopian Tube
Isabel Alvarado-Cabrero
Department of Pathology, Mexican Oncology
Hospital, Mexico City, Mexico
Teratoma (Mature and Immature)
Synonyms
None.
Definition
A rare tumor composed of mature or immature
tissues from more than one germ cell layer.
Clinical Features
• Incidence
The occurrence of teratoma in the fallopian
tube is very uncommon. Since the firstreportin
1865, there have been over 70 cases of teratoma
of fallopian tube including 5 mixed teratomas
and 3 immature teratomas (Sari et al., 2015).
• Age
Fallopian tube teratomas can occur at any age.
Most occur in the first two decades of life; rare
examples occur in postmenopausal women
(Khatib et al., 2013).
• Site
Fallopian tube.
Clinical Presentation
Some patients are asymptomatic; tumors are
accidentally discovered and confirmed by pelvic surgery, as a result of diagnosis of uterine
leiomyomas, ovarian cysts, and cesarean sections (Li et al., 1999). If the tumor grows to a
large enough size, it can cause symptoms such
as pelvic pressure or pain (Kutteh & Albert,
1991).
Treatment
Except for patients with malignant implants, conservative treatment (cystectomy or unilateral salpingooopherectomy) is sufficient treatment (Sari et al.
2015).
Outcome
They are usually benign tumors, except for immature teratomas and in cases of mixed malignant
germ cell tumors (Li et al., 1999).
Macroscopy
They are usually attached by a pedicle to the tubal
mucosa and have ranged from 0.7 to 20 cm in
diameter (Khatib et al., 2013). Most tumors have
been dermoid cysts (Fig. 1a, b), but rare examples
have been solid and mature or immature (Mazarella
et al., 1972).
© Springer Nature Switzerland AG 2023
S. Stolnicu, R. Ali-Fehmi (eds.), Gynecologic Pathology, Encyclopedia of Pathology,
https://doi.org/10.1007/978-3-030-97378-0
114 Germ Cell Tumors, Pathology of the Ovary
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Microscopy
As with their ovarian counterparts, ectodermal,
mesodermal, and endodermal tissues are
represented by mature elements. Most are in the
form of a dermoid cyst (Fig. 1a, b) (Khatib et al.,
2013). Rare teratomas consisting entirely of
mature thyroid tissue have been described in the
tube; one solid mature teratoma had a component
of insular carcinoid tumor (Scully et al., 1998).
Immature teratoma includes immature
neuroectodermal issue.
Immunophenotype
Not clinically relevant.
Molecular Features
Not clinically relevant.
References
Khatib, G., Guzel, A. B., Kucukgoz-Gulec, U., Vardar,
M. A., Musaev, A., & Melekoglu, R. (2013). Mature
cystic teratoma of the fallopian tube. Journal of Obstet-
rics and Gynaecology, 33, 120–124.
Kutteh, W. H., & Albert, T. (1991). Mature cystic teratoma
of the fallopian tube associated with an ectopic pregnancy. Obstetrics and Gynecology, 78, 984–986.
Li, S., Zimmerman, R. L., & LiVolsi, V. A. (1999). Mixed
malignant germ cell tumor of the fallopian tube. Inter-
national Journal of Gynecological Pathology, 18,
183–185.
Mazzarella, P., Okagaki, T., & Richard, R. M. (1972).
Teratoma of the uterine tube. A case report and review
of the literature. Obstetrics and Gynecology, 39,
381–388.
Sari, M. E., Ozdemir, O., Kadirogullari, P., Ertugrul, F. A.,
& Atalay, C. R. (2015). Mature cystic teratoma of the
fallopian tube in a postmenopausal woman: A case
report and review of the literature. Case Reports in
Obstetrics and Gynecology, 2015, 583021.
Scully, R. E., Young, R. H., & Clement, P. B. (1998). Atlas
of tumor pathology. Tumors of the ovary, maldeveloped
gonads, fallopian tube, and broad ligaments (3rd ed.).
Washington, D.C: AFIP.
Germ Cell Tumors, Pathology of the Fallopian Tube,
Fig. 1 Fallopian tube. Mature teratoma 1a. Cyst is
bilocular; keratinized squamous epithelia line the cysts
1b. Cyst is lined chiefly by squamous epithelium with
underlying adnexal structures
Germ Cell Tumors, Pathology
of the Ovary
Oudai Hassan
Henry Ford Health System, Detroit, MI, USA
Germ cell tumors of the ovary are a rare group of
tumors; however, they represent the majority of
ovarian tumors in the young, about 70% of all
ovarian tumors in the first two decades of life
(Mulligan 1975; Young 2014). This group of neoplasms is derived from the germ cells. They
include dysgerminoma, embryonal carcinoma,
yolk sac tumor, nongestational choriocarcinoma,
mature and immature teratomas, and
gonadoblastoma. Some of these tumors are composed of undifferentiated cells such as
dysgerminoma and embryonal carcinoma while
others show differentiation such as teratoma and
choriocarcinoma. Malignant germ cell tumors of
the ovary are rare and the most common ovarian
germ cell tumor is benign cystic teratoma.
Germ Cell Tumors, Pathology of the Ovary 115
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Dysgerminoma
Definition
Primitive germ cell tumor that represent the most
common malignant germ cell tumor of the ovaries
accounting for around 1% of ovarian malignancies (Björkholm et al. 1990; Santesson 1947).
Clinical Features
Dysgerminoma are usually seen in children and
women at younger age (Young 2014). They can
also arise in phenotypically female individuals
with gonadal dysgenesis. In these patients
dysgerminoma may arise in association with
gonadoblastoma (Young 2014).
The most common presentation of
dysgerminoma is abdominal pain and/or abdominal mass. Tumor is bilateral in 10% of cases
(Young 2014). The tumor usually show s elevated
serum LDH levels. In the rare cases with scattered
syncytiotrophoblasts, serum HCG maybe elevated. Rarely, paraneoplastic hypercalcemia may
be present in patients with dysgerminoma (Young
2014). The majority of patients present with stage
1 disease (Figs. 1, 2 and 3).
Dysgerminoma is staged based on the Union
for International Cancer Control (UICC) TNM
classification of ovarian, fallopian tube, and primary peritoneal carcinoma and the FIGO
staging.
The main prognostic factor of dysgerminoma
is stage. Overall, tumor has good prognosis with a
10-year progression-free survival rate > 90%.
However, 10% of patients may have recurrence
which usually happen within 2 years of initial
presentation (Vicus et al. 2010).
Germ Cell Tumors, Pathology of the Ovary,
Fig. 1 Dysgerminoma showing nested growth pattern
separated by fibrous septea with intermingled lymphocytes
Germ Cell Tumors, Pathology of the Ovary,
Fig. 2 Dysgerminoma at higher magnification showing
tumor cells with clear cytoplasm and squared off nuclei
with intermingled lymphocytes
G
Macroscopy
The average size of dysgerminoma is 15 cm
(Young 2014). Tumor is usually fleshy, tanyellow, and lobulated. In large tumors, cystic
degeneration and necrosis maybe seen. The presence of areas of calcification maybe a sign that
there is a focus of gonadoblastoma.
Microscopy
Microscopically, on low power the cells are
arranged in sheets and nests separated by fibrous
Germ Cell Tumors, Pathology of the Ovary,
Fig. 3 Yolk sac tumor, glandular pattern
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septa. The septa are often infiltrated by lymphocytic infiltrate which range from light to heavy
infiltrate. In some cases, the tumor may show
small nests, cord, or individual tumor cells in a
dense hyalinized stroma. Tubular pattern may
rarely be seen. On high power, tumor cells are
round to polygonal and usually show clear to
lightly eosinophilic cytoplasm with distinct cell
membranes. Foci of cells with eosinophilic cytoplasm may be seen. Tumor cells usually show
centrally located nuclei with at least one prominent nucleolus. In some cases, the nuclei might be
eccentric imparting a plasmacytoid appearance.
The nuclei of dysgerminoma cells usually show
flattened nuclear membrane imparting the
Germ Cell Tumors, Pathology of the Ovary,
Fig. 4 Yolk sac tumor, microcystic and endodermal
sinus patterns
so-called squared-off appearance. Scattered lymphocytes sparkling in between tumor cells are
common. Poor fixation may lead to syncytial
growth pattern and eosinophilic cytoplasm.
A granulomatous reaction is common and may
be used as a clue for the diagnosis. Foci of necrosis may be seen when tumor overgrow its blood
supply. In rarely cases, scattered syncytiotrophoblastic cells are present. These cases
are associated with increased levels of
serum HCG.
Immunophenotype
Dysgerminoma cells are usually immunoreactive
for SALL4, OCT 3/4, LIN28, NANOG, CD117,
and D2–40. Cytokeratin maybe focally positive.
Immunostains for EMA, CD30, AFP, and glypican
3 are usually negative. PAN cytokeratin may be
focally positive in some cases (Figs. 4 and 5).
Molecular Features
The most common molecular changes present in
dysgerminoma are abnormalities involving chromosome 12 (80% of cases), usually isochromosome 12P or 12P amplifi cation. We might also
see alterations involving the Kit gene whether Kit
mutations are present in 30–50% of patients with
dysgerminoma or Kit amplificat i on s are seen in
30% of patients with dysgerminoma (Cheng
et al. 2011; “Female Genital Tumours WHO
Classification of Tumours, 5th Edition,
volume 4”).
Germ Cell Tumors, Pathology of the Ovary,
Fig. 5 Yolk sac tumor, parietal pattern
Yolk Sac Tumor (YST)
Definition
YST is a primitive germ cell tumor which shows
multiple morphologic patterns reflecting the allantois and to a lesser degree the endodermal somatic
tissue.
Clinical Features
YST usual ly present as an abdominal pain or with
a pelvic mass in the second or third decade of life
(Young 2014). YST usually present as a component of a mixed germ cell tumor; however, rarely
it might be an isolated yolk sac tumor. Most
patients have elevated serum alpha-fetoprotein
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(AFP). YST represents 20% of malignant ovarian
germ cell tumors.
Yolk sac tumor is staged based on the Union
for International Cancer Control (UICC) TNM
classification of ovarian, fallopian tube, and primary peritoneal carcinoma and the FIGO staging
(“Female Genital Tumours WHO Classification
of Tumours, 5th Edition, volume 4”).
The main prognostic factor is stage . Overall,
five-year survival in more than 95% for stage I–II
while it goes down to 50% for stage IV. Tumors
associated with ovarian or endometrial cancer
tend to have worse prognosis (Figs. 6 and 7).
Germ Cell Tumors, Pathology of the Ovary,
Macroscopy
Grossly, yolk sac tumor presents as a unilateral
Fig. 6 Embryonal carcinoma, solid growth pattern with
minute focus of Yolk sac tumor, reticular pattern in the
background
large solid and cystic mass with a hemorrhagic
and necrotic appearance (Young 2014).
Microscopy
This tumor shows many patterns. The most common pattern is the reticular pattern which shows
anastomosing cords of tumor cells that surrounds
myxoid lightly eosinophilic secretion. Tumor cells
are usually cuboidal with nuclear pleomorphism
and moderate cytologic atypia. A variant of this
pattern is the microcystic pattern which results
from the development of large intracytoplasmic,
empty vacuoles that leads to sieve-like appearance.
The endodermal sinus pattern is characterized
by a papillary core with a central blood vessel
surrounded by a layer of malignant cells
surrounded by a space surrounded by a layer of
Germ Cell Tumors, Pathology of the Ovary,
Fig. 7 Choriocarcinoma with adjacent extensive areas of
hemorrhage and necrosis
malignant cells. This structure is called “SchillerDuval bodies.”
The polyvesicular vitelline pattern shows
cysts lined by flattened tumor cells in a variable
mesenchymal backgro und that ranges from
patterns. In older women when YST is present
in association with ovaria or endometrial carcinoma, it usually shows reticular morphology
(Fig. 8).
myxoid to fibrous. In the parietal pattern, there
is eosinophilic basement membrane material
between and around tumor cells. The hepatoid
variant shows small clusters of liver-like tumor
cells in solid nests, cords, or tubules. Bile canaliculi can be seen in hepatoid varia nt and hy aline globules are commonly seen. There are
multiple other morphologic patterns including
papillary, solid, glandular, and intestinal
Immunophenotype
Immunohistochemically, tumor cells are usually
positive for AE1/AE3 and SALL4. AFP and
glypican 3 are usually positive in tumor cells.
HepPar-1 can be positive in hepatoid pattern.
CDX2 can be positive in intestinal pattern.
Tumor cells are negative for OCT3/4, CD117,
CD30, and GATA3.
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