A genetic perspective of male germ cell tumors.

Adult human male germ cell tumors (GCTs) arise by transformation of germ cells (GCs). The transformed GCs exhibit pluripotentiality to differentiate into embryonic, extra-embryonic, and somatic tissue types, and are highly sensitive to cisplatin-based chemotherapy. Recent investigations into the genetics of GCTs have advanced methods of diagnosis and provided leads to the understanding of molecular basis of transformation, differentiation, and sensitivity/resistance. Cytogenetic and molecular cytogenetic studies have identified multiplication of 12p, manifested in i(12p) or tandem duplication of 12p, as a unique change in GCTs which serves as a diagnostic marker. Ectopic over-expression of cyclin D2, a gene mapped to 12p, as early as in carcinoma in situ identifies a candidate gene in GC transformation. Genetic alterations identified in the tumor suppressor genes deleted in colorectal cancer, retinoblastoma 1 and non-metastatic protein 23 (NME) in GCT suggest that their inactivation play a key role in transformation or differentiation. A number of regions of chromosomal deletion have been identified including those previously known to be deleted in various tumor types and novel candidate tumor suppressor gene sites such as 12q13, 12q22, and 5p15.1-15.2. Identification and characterization of the genes in these sites will provide important clues in understanding the biology of GCT. The molecular studies have also enumerated several possible differentiation controls such as switching of KIT and mast cell growth factor gene expression in a lineage-associated manner, and loss of certain types of genes such as NME in teratomas that may act in a dominant negative fashion in differentiation. The exquisite sensitivity of these tumors to chemotherapy is reflected in their over-expression of wild-type p53 protein and lack of TP53 mutations. These data indicate that multiple genetic events play a role in distinct pathways in the development of GCT, and further elucidation of the underlying genetic and biochemical mechanisms is central to unraveling biology and improving treatment of GCT.