Ovarian germ cell tumor diagnostic study of choice: Difference between revisions

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__NOTOC__
__NOTOC__
{{Ovarian germ cell tumor}}
{{Ovarian germ cell tumor}}
{{CMG}}; {{AE}}
{{CMG}}; {{AE}} {{Sahar}} {{MD}}
== Overview ==
== Overview ==
 
[[Histology]] of the excised [[tumor]] after [[surgery]] is the [[Gold standard (test)|gold standard]] test for the [[diagnosis]] of [[ovarian]] [[germ cell]] [[Tumor|tumors]]. [[Surgery]] must be performed when the patient presents with an [[adnexal]] [[mass]] in the [[abdominal]]/[[pelvic]] [[Physical examination|exam]] and elevated serum concentration of associated [[tumor markers]]. [[Mature cystic teratoma|Mature teratoma]] may be [[Diagnosis|diagnosed]] using [[Ultrasound|ultrasonographic imaging]]. However, the [[tumor]] should be removed [[Surgery|surgically]].
== Diagnostic Study of Choice ==
== Diagnostic Study of Choice ==
[[Histology]] of the excised [[tumor]] after [[surgery]] is the [[Gold standard (test)|gold standard]] test for the [[diagnosis]] of [[ovarian]] [[germ cell]] [[tumors]].<ref name="PectasidesPectasides2008">{{cite journal|last1=Pectasides|first1=D.|last2=Pectasides|first2=E.|last3=Kassanos|first3=D.|title=Germ cell tumors of the ovary|journal=Cancer Treatment Reviews|volume=34|issue=5|year=2008|pages=427–441|issn=03057372|doi=10.1016/j.ctrv.2008.02.002}}</ref><ref name="LowIlancheran2012">{{cite journal|last1=Low|first1=Jeffrey J.H.|last2=Ilancheran|first2=Arunachalam|last3=Ng|first3=Joseph S.|title=Malignant ovarian germ-cell tumours|journal=Best Practice & Research Clinical Obstetrics & Gynaecology|volume=26|issue=3|year=2012|pages=347–355|issn=15216934|doi=10.1016/j.bpobgyn.2012.01.002}}</ref>
* [[Surgery]] must be performed when:
** The patient presents with an [[adnexal]] [[mass]] in the [[abdominal]]/[[pelvic]] exam, and elevated serum concentration of [[Human chorionic gonadotropin|hCG]], [[Lactate dehydrogenase|LDH]], [[AFP]], and other associated [[tumor markers]].
** [[Mature cystic teratoma|Mature teratoma]] may be [[Diagnose|diagnosed]] using [[Ultrasound imaging|ultrasonographic imaging]]. However, the [[tumor]] should be removed [[Surgery|surgically]].


=== Study of choice ===
[Name of the investigation] is the gold standard test for the diagnosis of [disease name].
OR
The following result of [gold standard test] is confirmatory of [disease name]:
* [Result 1]
* [Result 2]
OR
[Name of the investigation] must be performed when:
* The patient presents with [symptom/sign 1], [symptom/sign 2], and [symptom/sign 3].
* A [name of test] is positive for [sign 1], [sign 2], and [sign 3] in the patient.
OR
[Name of the investigation] is the gold standard test for the diagnosis of [disease name].
OR
The diagnostic study of choice for [disease name] is [name of the investigation].
OR
There is no single diagnostic study of choice for the diagnosis of [disease name].
OR
There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
OR
[Disease name] is primarily diagnosed based on the clinical presentation.
OR
Investigations:
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.
==== The comparison of various diagnostic studies for [disease name] ====
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! style="background: #4479BA; color: #FFFFFF; text-align: center;" | Test
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|}
<small> [Name of test with higher sensitivity and specificity] is the preferred investigation based on the sensitivity and specificity</small>
===== Diagnostic results =====
The following finding(s) on performing [investigation name] is(are) confirmatory for [disease name]:
* [Finding 1]
* [Finding 2]
===== Sequence of Diagnostic Studies =====
The [name of investigation] must be performed when:
* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
* A positive [test] is detected in the patient, to confirm the diagnosis.
OR
The various investigations must be performed in the following order:
* [Initial investigation]
* [2nd investigation]
=== Name of Diagnostic Criteria ===
'''It is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.'''
[Disease name] is primarily diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
OR
There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
OR
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
OR
The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
OR
[Disease name] may be diagnosed at any time if one or more of the following criteria are met:
* Criteria 1
* Criteria 2
* Criteria 3
OR
'''IF there are clear, established diagnostic criteria'''
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
OR
The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
OR
The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
OR


'''IF there are no established diagnostic criteria'''


There are no established criteria for the diagnosis of [disease name].
{{familytree/start |summary=PE diagnosis Algorithm.}}
{{familytree | | | | | | | | | | A02 | | | | | |A02=[[Malignant]] [[germ cell]] [[tumor]]}}
{{familytree | | | |,|-|-|-|-|-|-|^|-|-|-|-|-|-|-|.| | | | | | }}
{{familytree | | | C01 | | | | | | | | | | | | | C02 | | |C01=Prior [[surgery]]|C02=Initial [[surgery]]}}
{{familytree | |,|-|^|-|.| | | | | | | | | | |,|-|^|-|.| | }}
{{familytree | D01 | | D02 | | | | | | | | | D03 | | D04 |D01=Complete staging|D02=Incomplete staging|D03=[[Fertility]] sparing prefered|D04=[[Fertility]] sparing not prefered}}
{{familytree | |!| | | |!| | | | | | | | | | |!| | | |!| | }}
{{familytree | E01 | | E02 | | | | | | | | | E03 | | E04 |E01=Treatment based<br>on<br>the staging|E02=[[Imaging]]:<br>[[Chest]]/<br>[[abdomen]]/<br>[[pelvis]] [[CT]] with [[contrast]]|E03=[[Fertility]] sparing [[surgery]]<br>and<br>complete staging|E04=[[Surgery]] to stage}}
{{familytree | | | | | |!| | | | | | | | | | |!| | | |!| | | | }}
{{familytree | | | | | |!| | | | | | | | | | |`| F02 |'| | | |F02=Treatment based on the staging and [[pathology]] of [[tumor]]}}
{{familytree | | | |,|-|^|-|-|-|-|-|-|-|.| | | | | | | }}
{{familytree | | | G01 | | | | | | | | G02 | | | | | | | | | | | | | | |G01=[[Yolk sac tumor]]<br>grade2-3 immature [[teratoma]],<br>non-gestational [[choriocarcinoma]]<br>or mixed [[histology]]|G02=[[Dysgerminoma]]<br>or<br>grade 1 immature [[teratoma]]|L03=[[Dysgerminoma]] or grade 1 immature [[teratoma]]}}
{{familytree | | | |!| | | | | | | | | |!| | | | | | | | | | | | }}
{{familytree | | | |!| | | | | |,|-|-|-|+|-|-|-|.|}}
{{familytree | | | |!| | | | | I02 | | I03 | | I04 | |I02=[[Imaging]] and [[tumor markers]]<br>are<br>positive|I03=Negative [[imaging]]<br>and<br>positive [[tumor markers]]|I04=Negative [[imaging]]<br>and<br>negative or positive [[tumor markers]]}}
{{familytree | | | |!| | | | | |!| | | |!| | | |!| | | |}}
{{familytree | |,|-|^|-|.| | | K03 | | K04 | | K05 | | |K03=Decide according to [[fertility]] sparing preference<br>and/or [[pathologic]] finding<br>for [[surgery]] and<br>further [[adjuant therapy]]|K04=Observe|K05=Observe|}}
{{familytree | J01 | | J02 | | | | | | | | | | | | | | | | | | |J01=[[Imaging]] and [[tumor markers]]<br>are<br>positive|J02=Negative [[imaging]]<br>and<br>negative and positive [[tumor markers]]}}
{{familytree | |!| | | | | | | | | | | | | | | | | | | | | |}}
{{familytree | K01 | | | | | | | | | | | | | | | | | | | |K01=Decide<br>according to<br>[[fertility]] sparing preference<br>for [[surgery]] and further [[chemotherapy]]|}}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | |}}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | |}}
{{familytree/end}}


==References==
==References==
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Latest revision as of 13:51, 22 April 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sahar Memar Montazerin, M.D.[2] Monalisa Dmello, M.B,B.S., M.D. [3]

Overview

Histology of the excised tumor after surgery is the gold standard test for the diagnosis of ovarian germ cell tumors. Surgery must be performed when the patient presents with an adnexal mass in the abdominal/pelvic exam and elevated serum concentration of associated tumor markers. Mature teratoma may be diagnosed using ultrasonographic imaging. However, the tumor should be removed surgically.

Diagnostic Study of Choice

Histology of the excised tumor after surgery is the gold standard test for the diagnosis of ovarian germ cell tumors.[1][2]


 
 
 
 
 
 
 
 
 
Malignant germ cell tumor
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Prior surgery
 
 
 
 
 
 
 
 
 
 
 
 
Initial surgery
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Complete staging
 
Incomplete staging
 
 
 
 
 
 
 
 
Fertility sparing prefered
 
Fertility sparing not prefered
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Treatment based
on
the staging
 
Imaging:
Chest/
abdomen/
pelvis CT with contrast
 
 
 
 
 
 
 
 
Fertility sparing surgery
and
complete staging
 
Surgery to stage
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Treatment based on the staging and pathology of tumor
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yolk sac tumor
grade2-3 immature teratoma,
non-gestational choriocarcinoma
or mixed histology
 
 
 
 
 
 
 
Dysgerminoma
or
grade 1 immature teratoma
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Imaging and tumor markers
are
positive
 
Negative imaging
and
positive tumor markers
 
Negative imaging
and
negative or positive tumor markers
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Decide according to fertility sparing preference
and/or pathologic finding
for surgery and
further adjuant therapy
 
Observe
 
Observe
 
 
 
 
 
 
 
 
Imaging and tumor markers
are
positive
 
Negative imaging
and
negative and positive tumor markers
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Decide
according to
fertility sparing preference
for surgery and further chemotherapy
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

References

  1. ↑ Pectasides, D.; Pectasides, E.; Kassanos, D. (2008). "Germ cell tumors of the ovary". Cancer Treatment Reviews. 34 (5): 427–441. doi:10.1016/j.ctrv.2008.02.002. ISSN 0305-7372.
  2. ↑ Low, Jeffrey J.H.; Ilancheran, Arunachalam; Ng, Joseph S. (2012). "Malignant ovarian germ-cell tumours". Best Practice & Research Clinical Obstetrics & Gynaecology. 26 (3): 347–355. doi:10.1016/j.bpobgyn.2012.01.002. ISSN 1521-6934.

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