Ovarian germ cell tumor history and symptoms
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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]
The signs and symptoms
associated with these tumors are varied, but in general, most arise from tumor growth and the hormones they produce. Subacute abdominal pain is the presenting symptom in 85 percent of patients and reflects rapid growth of a large, unilateral tumor undergoing capsular distension, hemorrhage, or necrosis. Less commonly, cyst rupture, torsion, or intraperitoneal hemorrhage leads to an acute abdomen in 10 percent of cases (Gershenson, 2007a). In more advanced disease, ascites may develop and cause abdominal distension. Because of the hormonal changes that frequently accompany these tumors, menstrual irregularities may also develop. Although most individuals note one or more of these symptoms, one quarter of individuals are asymptomatic, and a pelvic mass is noted unexpectedly during physical or sonographic examination (Curtin, 1994).
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Individuals typically seek care within 1 month of the onset of abdominal complaints, although some note subtle waxing and waning of symptoms for more than a year. Most young women with these tumors are nulligravidas with normal periods, but as discussed later, individuals with dysgenetic gonads are at significant risk for development of these tumors (Curtin, 1994). Therefore, adolescents who present with pelvic masses and delayed menarche should be evaluated for gonadal dysgenesis (Chap. 16).