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{{CMG}}{{AE}} {{MD}}
{{CMG}}{{AE}} {{MD}}
==Overveiw==
==Overveiw==
The pathophysiology of ovarian germ cell tumor depends on the histological subtype.<ref name=Robbins>{{cite book|last=Abbas, Fausto, Mitchell|title=Basic Pathology|year=2010|publisher=Elsevier|isbn=978-81-312-1036-9|pages=696–697}}</ref>
It is difficult to distinguish subtypes of ovarian germ cell tumor on gross pathology alone. The majority of ovarian germ cell tumors have a solid and cystic appearance with areas of hemorrhage and necrosis. On microscopic pathology, ovarian germ cell tumors may be characterized by a uniform “fried egg” appearance (dysgerminoma), presence of Schiller-Duval bodies (yolk sac tumor),  presence of embryonic-like neural, GI, and/or cartilaginous tissue (teratoma), or mixed histopathological features (embryonal cell carcinoma).


==Gross Patholgy==
==Gross Patholgy==
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|-
|-
|''' Dysgerminomas'''||
|''' Dysgerminomas'''||
* Uniform cells that resemble primordial germ cells <ref name= wqd> Dysgerminoma. https://en.wikipedia.org/wiki/Dysgerminoma. URL Accessed on November 12, 2015</ref>
* Uniform cells with "fried egg apperance" (large cytoplasm and small nucleus) that resemble primordial germ cells <ref name= wqd> Dysgerminoma. https://en.wikipedia.org/wiki/Dysgerminoma. URL Accessed on November 12, 2015</ref>
* The stroma contains lymphocytes and about 20% of patients have sarcoid-like granulomas
* The stroma contains lymphocytes and about 20% of patients have sarcoid-like granulomas
| [[File:Dysgerminoma.jpg|thumb|none|400px|Micrograph a seminoma, a tumor that is histologically indistinguishable from dysgerminoma.]]
| [[File:Dysgerminoma.jpg|thumb|none|400px|Micrograph a seminoma, a tumor that is histologically indistinguishable from dysgerminoma.]]
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|-
|-
|'''Endodermal sinus tumor or yolk sac tumors'''||
|'''Endodermal sinus tumor or yolk sac tumors'''||
* Schiller-Duval bodies - key feature<ref name= wrr> Endodermal sinus tumor. https://en.wikipedia.org/wiki/Endodermal_sinus_tumor. URL Accessed on November 12, 2015</ref>
* Schiller-Duval bodies (resemble renal glomeruli) - key feature<ref name= wrr> Endodermal sinus tumor. https://en.wikipedia.org/wiki/Endodermal_sinus_tumor. URL Accessed on November 12, 2015</ref>
| [[Image:800px-Mixed_germ_cell_tumour_-_high_mag.jpg|thumb|none|300px|Micrograph showing the yolk sac component of a mixed germ cell tumor.]]
| [[Image:800px-Mixed_germ_cell_tumour_-_high_mag.jpg|thumb|none|300px|Micrograph showing the yolk sac component of a mixed germ cell tumor.]]


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* Necrosis common
* Necrosis common
* Nuclei overlap
* Nuclei overlap
Other features:
Additional features that are often mixed:
* Variable architecture:
* Variable architecture:
* Tubulopapillary
* Tubulopapillary

Revision as of 19:05, 18 November 2015

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

Overveiw

It is difficult to distinguish subtypes of ovarian germ cell tumor on gross pathology alone. The majority of ovarian germ cell tumors have a solid and cystic appearance with areas of hemorrhage and necrosis. On microscopic pathology, ovarian germ cell tumors may be characterized by a uniform “fried egg” appearance (dysgerminoma), presence of Schiller-Duval bodies (yolk sac tumor), presence of embryonic-like neural, GI, and/or cartilaginous tissue (teratoma), or mixed histopathological features (embryonal cell carcinoma).

Gross Patholgy

Ovarian germ cell tumor subtype Features on Gross Pathology
Dysgerminoma
  • External surface is smooth and bosselated (knobby)[1]
  • Cut surface it is soft, fleshy and either cream-coloured, gray, pink or tan
Endodermal sinus tumor or yolk sac tumors
  • External surface is smooth and glistening[2]
  • Cut surface is cystic with hemorrhage and necrosis
Embryonal Carcinoma
Teratoma

Teratoma-mature

  • Solid or cystic[4]
  • Cystic content may contain greasy material composed of keratin, hair and teeth
  • Teeth may be found in Rokitansky’s protuberance - a well-defined, nipple-like structure covered with hair

Teratoma-immature

  • Bulky, solid or cystic with necrosis, hemorrhage[5]

Microscopic Pathology

Ovarian germ cell tumor subtype Features on Histopathological Microscopic Analysis Image
Dysgerminomas
  • Uniform cells with "fried egg apperance" (large cytoplasm and small nucleus) that resemble primordial germ cells [1]
  • The stroma contains lymphocytes and about 20% of patients have sarcoid-like granulomas
Micrograph a seminoma, a tumor that is histologically indistinguishable from dysgerminoma.
Endodermal sinus tumor or yolk sac tumors
  • Schiller-Duval bodies (resemble renal glomeruli) - key feature[6]
Micrograph showing the yolk sac component of a mixed germ cell tumor.


Embryonal carcinoma

Main features:[3]

  • Nuclear atypia
  • Nucleoli prominent
  • Necrosis common
  • Nuclei overlap

Additional features that are often mixed:

  • Variable architecture:
  • Tubulopapillary
  • Glandular
  • Solid
  • Embryoid bodies - ball of cells in surrounded by empty space on three sides
  • Mitoses common
Embryonal carcinoma
Teratoma

Mature teratoma

  • The sections show ovarian parenchyma with a lesion consisting of benign dermal, gastrointestinal and neural elements [7]
  • The neural elements show focal degenerative changes with macrophages, and giant cells
  • Siderophages are present

Immature teratoma

  • Primitive neuroepithelium [8]
  • Neuron-specific enolase (NSE) +ve.
  • Neuron-specific B tubulin +ve.
  • Synaptophysin +ve.
Teratoma

References

  1. ↑ 1.0 1.1 Dysgerminoma. https://en.wikipedia.org/wiki/Dysgerminoma. URL Accessed on November 12, 2015
  2. ↑ Ovary tumor Germ cell tumors Yolk sac tumor. http://www.pathologyoutlines.com/topic/ovarytumoryolksac.html. URL Accessed on November 12, 2015
  3. ↑ 3.0 3.1 Abbas, Fausto, Mitchell (2010). Basic Pathology. Elsevier. pp. 696–697. ISBN 978-81-312-1036-9.
  4. ↑ Ovary tumor Germ cell tumors Teratoma-mature. http://www.pathologyoutlines.com/topic/ovarytumorteratomamature.html. URL Accessed on November 12, 2015
  5. ↑ Ovary tumor Germ cell tumors Teratoma-immature. http://www.pathologyoutlines.com/topic/ovarytumorteratomaimmature.html. URL Accessed on November 12, 2015
  6. ↑ Endodermal sinus tumor. https://en.wikipedia.org/wiki/Endodermal_sinus_tumor. URL Accessed on November 12, 2015
  7. ↑ Mature teratoma. http://librepathology.org/wiki/index.php/Teratoma#Mature_teratoma. URL Accessed on November 12, 2015
  8. ↑ Immature teratoma. http://librepathology.org/wiki/index.php/Teratoma#Mature_teratoma. URL Accessed on November 12, 2015

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