Ovarian germ cell tumor overview: Difference between revisions
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==Classification== | ==Classification== | ||
Ovarian germ cell tumor may be classified into 7 subtypes based on histology.<ref name= | Ovarian germ cell tumor may be classified into 7 subtypes based on histology.<ref name=abc> Cellular Classification of Ovarian Germ Cell Tumors. http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_. URL Accessed on November 4, 2015</ref> | ||
==Pathophysiology== | ==Pathophysiology== | ||
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==Epidemiology and Demographics== | ==Epidemiology and Demographics== | ||
Ovarian germ cell tumor are rare tumors, accounting for 2% to 3% of all ovarian cancers. The median age for diagnosis is 16 to 20 (range 6 to 40 years)<ref name= | Ovarian germ cell tumor are rare tumors, accounting for 2% to 3% of all ovarian cancers. The median age for diagnosis is 16 to 20 (range 6 to 40 years)<ref name=dfg> Updates in the Management of Ovarian Germ Cell Tumors. http://meetinglibrary.asco.org/content/31-132. URL Accessed on November 11, 2015</ref> | ||
==Risk Factors== | ==Risk Factors== | ||
Abnormal [[gonad]]s (due to [[gonadal dysgenesis]] and [[androgen insensitivity syndrome]]) have a high risk of developing a dysgerminoma.<ref name= | Abnormal [[gonad]]s (due to [[gonadal dysgenesis]] and [[androgen insensitivity syndrome]]) have a high risk of developing a dysgerminoma.<ref name= hij>{{cite book | last = Kliegman | first = Robert | title = Nelson textbook of pediatrics | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2011 | isbn = 978-1-4377-0755-7 }}</ref> | ||
==Differentiating From Ovarian Germ Cell Tumor Other Diseases== | ==Differentiating From Ovarian Germ Cell Tumor Other Diseases== | ||
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==History and Symptoms== | ==History and Symptoms== | ||
Symptoms of ovarian germ cell tumor include [[abdominal distention]], acute/ sub acute [[abdominal pain]], [[menstrual irregularities]], and [[precocious puberty]].<ref>{{cite book | last = Hoffman | first = Barbara | title = Williams gynecology | publisher = McGraw-Hill Medical | location = New York | year = 2012 | isbn = 9780071716727 }}</ref> | Symptoms of ovarian germ cell tumor include [[abdominal distention]], acute/ sub acute [[abdominal pain]], [[menstrual irregularities]], and [[precocious puberty]].<ref name= lmn>{{cite book | last = Hoffman | first = Barbara | title = Williams gynecology | publisher = McGraw-Hill Medical | location = New York | year = 2012 | isbn = 9780071716727 }}</ref> | ||
==Ovarian Germ Cell Tumor Physical Examination== | ==Ovarian Germ Cell Tumor Physical Examination== | ||
Physical examination of patients with ovarian germ cell tumor is usually remarkable for [[vaginal bleeding]], [[abdominal distention]], and adnexal mass.<ref name= | Physical examination of patients with ovarian germ cell tumor is usually remarkable for [[vaginal bleeding]], [[abdominal distention]], and adnexal mass.<ref name= lmn>{{cite book | last = Hoffman | first = Barbara | title = Williams gynecology | publisher = McGraw-Hill Medical | location = New York | year = 2012 | isbn = 9780071716727 }}</ref> | ||
==Ovarian germ cell tumor Laboratory Findings== | ==Ovarian germ cell tumor Laboratory Findings== | ||
The laboratory findings associated with ovarian germ cell tumor are the following: serum [[lactate dehydrogenase]] (LDH), [[human chorionic gonadotropin]] (HCG), [[CA-125]], and [[alpha-fetoprotein]] (AFP).<ref> Ovary: Germ cell tumors. http://atlasgeneticsoncology.org/Tumors/OvarianGermCellID5067.html. URL Accessed on November 10, 2015</ref> | The laboratory findings associated with ovarian germ cell tumor are the following: serum [[lactate dehydrogenase]] (LDH), [[human chorionic gonadotropin]] (HCG), [[CA-125]], and [[alpha-fetoprotein]] (AFP).<ref name= ors> Ovary: Germ cell tumors. http://atlasgeneticsoncology.org/Tumors/OvarianGermCellID5067.html. URL Accessed on November 10, 2015</ref> | ||
==CT== | ==CT== | ||
It is difficult to distinguish ovarian germ cell tumors on CT alone. Dysgerminoma often appears as multilobulated solid masses with prominent fibrovascular septa while, mature ovarian teratoma may demonstrate fat (areas with very low Hounsfield values), fat-fluid level, calcification (sometimes dentiform), Rokitansky protuberance, and tufts of [[hair]].<ref name= | It is difficult to distinguish ovarian germ cell tumors on CT alone. Dysgerminoma often appears as multilobulated solid masses with prominent fibrovascular septa while, mature ovarian teratoma may demonstrate fat (areas with very low Hounsfield values), fat-fluid level, calcification (sometimes dentiform), Rokitansky protuberance, and tufts of [[hair]].<ref name= opq> Ovarian dysgerminoma. http://radiopaedia.org/articles/ovarian-dysgerminoma. URL Accessed on November 11, 2015</ref><ref name= qst> Mature (cystic) ovarian teratoma. http://radiopaedia.org/articles/mature-cystic-ovarian-teratoma. URL Accessed on November 11, 2015</ref><ref name=ppp > Immature ovarian teratoma. http://radiopaedia.org/articles/immature-ovarian-teratoma. URL Accessed on November 11, 2015</ref> | ||
==MRI== | ==MRI== | ||
It is difficult to distinguish subtypes of ovarian germ cell tumor on MRI alone. The majority of ovarian germ cell tumors have a solid and cystic appearance with areas of hemorrhage and necrosis. On MRI, ovarian germ cell tumors may be characterized by T2: the septae are often hypointense or isointense 3 T1 C+ (Gd): the septae often show marked enhancement (dysgerminoma), the presence of a prominent solid component containing calcifications and small foci of fat (mature teratoma), areas of haemorrhage can also be seen (yolk sac tumor).<ref name= | It is difficult to distinguish subtypes of ovarian germ cell tumor on MRI alone. The majority of ovarian germ cell tumors have a solid and cystic appearance with areas of hemorrhage and necrosis. On MRI, ovarian germ cell tumors may be characterized by T2: the septae are often hypointense or isointense 3 T1 C+ (Gd): the septae often show marked enhancement (dysgerminoma), the presence of a prominent solid component containing calcifications and small foci of fat (mature teratoma), areas of haemorrhage can also be seen (yolk sac tumor).<ref name= opq> Ovarian dysgerminoma. http://radiopaedia.org/articles/ovarian-dysgerminoma. URL Accessed on November 11, 2015</ref><ref name= qst> Mature (cystic) ovarian teratoma. http://radiopaedia.org/articles/mature-cystic-ovarian-teratoma. URL Accessed on November 11, 2015</ref><ref name=ppp> Ovarian yolk sac tumour. http://radiopaedia.org/articles/ovarian-yolk-sac-tumour. URL Accessed on November 11, 2015</ref> | ||
==Ultrasound== | ==Ultrasound== | ||
It is difficult to distinguish ovarian germ cell tumors on ultrasound alone. Both solid and cystic lesions with calcification may be present. Dysgerminoma often appears as a hypoechoic mass while other ovarian germ cell tumors often have variable echogenicity. Ovarian teratoma may be further characterized by the presence of sebaceous and hair components arising from the rokitansky protuberance.<ref name= | It is difficult to distinguish ovarian germ cell tumors on ultrasound alone. Both solid and cystic lesions with calcification may be present. Dysgerminoma often appears as a hypoechoic mass while other ovarian germ cell tumors often have variable echogenicity. Ovarian teratoma may be further characterized by the presence of sebaceous and hair components arising from the rokitansky protuberance.<ref name= opq> Ovarian dysgerminoma. http://radiopaedia.org/articles/ovarian-dysgerminoma. URL Accessed on November 11, 2015</ref><ref name= qst> Mature (cystic) ovarian teratoma. http://radiopaedia.org/articles/mature-cystic-ovarian-teratoma. URL Accessed on November 11, 2015</ref><ref name= ppp> Ovarian yolk sac tumour. http://radiopaedia.org/articles/ovarian-yolk-sac-tumour. URL Accessed on November 11, 2015</ref><ref name=xyz> Immature ovarian teratoma. http://radiopaedia.org/articles/immature-ovarian-teratoma. URL Accessed on November 11, 2015</ref> | ||
Revision as of 21:24, 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]
Classification
Ovarian germ cell tumor may be classified into 7 subtypes based on histology.[1]
Pathophysiology
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).
Epidemiology and Demographics
Ovarian germ cell tumor are rare tumors, accounting for 2% to 3% of all ovarian cancers. The median age for diagnosis is 16 to 20 (range 6 to 40 years)[2]
Risk Factors
Abnormal gonads (due to gonadal dysgenesis and androgen insensitivity syndrome) have a high risk of developing a dysgerminoma.[3]
Differentiating From Ovarian Germ Cell Tumor Other Diseases
Ovarian germ cell tumor must be differentiated from other neoplastic ovarian mass, non neoplastic ovarian mass, and adnexal mass.
Staging
According to the FIGO cancer staging system, there are 4 stages of ovarian germ cell tumor.
History and Symptoms
Symptoms of ovarian germ cell tumor include abdominal distention, acute/ sub acute abdominal pain, menstrual irregularities, and precocious puberty.[4]
Ovarian Germ Cell Tumor Physical Examination
Physical examination of patients with ovarian germ cell tumor is usually remarkable for vaginal bleeding, abdominal distention, and adnexal mass.[4]
Ovarian germ cell tumor Laboratory Findings
The laboratory findings associated with ovarian germ cell tumor are the following: serum lactate dehydrogenase (LDH), human chorionic gonadotropin (HCG), CA-125, and alpha-fetoprotein (AFP).[5]
CT
It is difficult to distinguish ovarian germ cell tumors on CT alone. Dysgerminoma often appears as multilobulated solid masses with prominent fibrovascular septa while, mature ovarian teratoma may demonstrate fat (areas with very low Hounsfield values), fat-fluid level, calcification (sometimes dentiform), Rokitansky protuberance, and tufts of hair.[6][7][8]
MRI
It is difficult to distinguish subtypes of ovarian germ cell tumor on MRI alone. The majority of ovarian germ cell tumors have a solid and cystic appearance with areas of hemorrhage and necrosis. On MRI, ovarian germ cell tumors may be characterized by T2: the septae are often hypointense or isointense 3 T1 C+ (Gd): the septae often show marked enhancement (dysgerminoma), the presence of a prominent solid component containing calcifications and small foci of fat (mature teratoma), areas of haemorrhage can also be seen (yolk sac tumor).[6][7][8]
Ultrasound
It is difficult to distinguish ovarian germ cell tumors on ultrasound alone. Both solid and cystic lesions with calcification may be present. Dysgerminoma often appears as a hypoechoic mass while other ovarian germ cell tumors often have variable echogenicity. Ovarian teratoma may be further characterized by the presence of sebaceous and hair components arising from the rokitansky protuberance.[6][7][8][9]
References
- ↑ Cellular Classification of Ovarian Germ Cell Tumors. http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_. URL Accessed on November 4, 2015
- ↑ Updates in the Management of Ovarian Germ Cell Tumors. http://meetinglibrary.asco.org/content/31-132. URL Accessed on November 11, 2015
- ↑ Kliegman, Robert (2011). Nelson textbook of pediatrics. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1-4377-0755-7.
- ↑ 4.0 4.1 Hoffman, Barbara (2012). Williams gynecology. New York: McGraw-Hill Medical. ISBN 9780071716727.
- ↑ Ovary: Germ cell tumors. http://atlasgeneticsoncology.org/Tumors/OvarianGermCellID5067.html. URL Accessed on November 10, 2015
- ↑ 6.0 6.1 6.2 Ovarian dysgerminoma. http://radiopaedia.org/articles/ovarian-dysgerminoma. URL Accessed on November 11, 2015
- ↑ 7.0 7.1 7.2 Mature (cystic) ovarian teratoma. http://radiopaedia.org/articles/mature-cystic-ovarian-teratoma. URL Accessed on November 11, 2015
- ↑ 8.0 8.1 8.2 Immature ovarian teratoma. http://radiopaedia.org/articles/immature-ovarian-teratoma. URL Accessed on November 11, 2015
- ↑ Immature ovarian teratoma. http://radiopaedia.org/articles/immature-ovarian-teratoma. URL Accessed on November 11, 2015