Ovarian germ cell tumor pathophysiology

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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, gastrointestinal, 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) Soft, fleshy and either cream-coloured, gray, pink or tan in color on cut surface
Endodermal sinus tumor or yolk sac tumors	External surface is smooth and glistening Cut surface is cystic with hemorrhage and necrosis
Embryonal Carcinoma	A poorly defined, pale grey tumor with associated haemorrhage and necrosis.
Teratoma	Teratoma-mature Solid or cystic 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

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 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	Micrograph showing the yolk sac component of a mixed germ cell tumor.
Embryonal carcinoma	Main features: 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 The neural elements show focal degenerative changes with macrophages, and giant cells Siderophages are present Immature teratoma Primitive neuroepithelium Neuron-specific enolase (NSE) +ve Neuron-specific B tubulin +ve Synaptophysin +ve	Teratoma