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Mediastinal germ cell tumors: many questions and perhaps an answer
J. Wolter Oosterhuis, Leendert H.J. Looijenga
J. Wolter Oosterhuis, Leendert H.J. Looijenga
Published November 16, 2020
Citation Information: J Clin Invest. 2020;130(12):6238-6241. https://doi.org/10.1172/JCI143884.
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Commentary

Mediastinal germ cell tumors: many questions and perhaps an answer

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Abstract

Some germ cell tumors (GCTs) in men develop into hematologic malignancies; however, the clonal origins of such malignancies remain unknown. In this issue of the JCI, Taylor, Donoghue, et al. unravel the clonal relationship between primary mediastinal nonseminomas (PMNs) and hematologic somatic-type malignancies (HSTMs). Whole-exome sequencing was used to construct phylogenetic trees of the PMNs and the ensuing HSTM clones. HSTMs were derived from multiple distinct clones not detected within the PMNs. Clones from PMNs and HSTMs shared a common precursor, arguably an embryonal carcinoma cell resulting from a reprogrammed primordial germ cell from the thymus. Mutational and copy number variation analysis of a large cohort of patients with PMNs also demonstrated a high prevalence of TP53 mutations not found in testicular nonseminomas. These data likely explain why patients with PMNs are frequently resistant to platinum-based chemotherapy and provide TP53 mutations as potential targets.

Authors

J. Wolter Oosterhuis, Leendert H.J. Looijenga

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Figure 1

Model for the pathogenesis of type I and II germ cell tumors.

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Model for the pathogenesis of type I and II germ cell tumors.
PGCs give ...
PGCs give origin to extragonadal GCTs. During embryogenesis (shown here at week seven), early PGCs (PGC1, light blue) migrate from the yolk sac to the genital ridge, and along the midline of the body. Early PGCs undergo apoptosis, unless, very rarely, they are reprogrammed (R) to a primed embryonic stem cell (ESC, orange), the stem cell of type I GCTs, usually benign teratomas. Type I GCTs can also develop in the genital ridge/developing gonads prior to completion of epigenetic reprogramming to late PGCs (PGC2, dark blue). Early PGCs escape apoptosis physiologically when they reach the niches in the genital ridge/developing gonad, and nonphysiologically when they lodge in the surrogate niches in the thymus or in the pineal gland/hypothalamus. In each of these niches, early PGCs can complete epigenetic reprogramming to become late PGCs/gonocytes. In the gonads their normal fate is spermatogenesis in the testis and oogenesis in the ovary. Rarely, late PGCs undergo malignant transformation (T) and form the precursor lesions for seminoma (PLS), a malignant GCT (black). A transformed late PGC/gonocyte may be reprogrammed into an ECC (purple), which is the malignant counterpart of a naive ESC, and becomes the stem cell that gives rise to the various components of a nonseminoma. In the thymus and the pineal gland/hypothalamus, late PGCs undergo apoptosis, unless they are transformed to the precursors of seminomas. Also, in these sites, transformed PGCs may be reprogrammed to ECCs, giving rise to nonseminomas, and in the thymus also hematologic malignancy.

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ISSN: 0021-9738 (print), 1558-8238 (online)

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