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: Sahar Memar Montazerin, M.D.[2]

Overveiw

The pathophysiology of ovarian germ cell tumors depends on the histological subtype. However, their origin is the primordial germ cells that transformed pathologically in different stages of development.

Pathophysiology

Physiology

The normal physiology of [name of process] can be understood as follows:

Pathogenesis

• The exact pathogenesis of or is not completely understood.

OR

• It is understood that ovarian germ cell tumors are the result of the pathologic transformation of primordial germ cells during different stages of the development.
• [Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].
• The progression to [disease name] usually involves the [molecular pathway].
• The pathophysiology of [disease/malignancy] depends on the histological subtype.

Genetics

[Disease name] is transmitted in [mode of genetic transmission] pattern.

OR

Genes involved in the pathogenesis of [disease name] include:

• [Gene1]
• [Gene2]
• [Gene3]

OR

The development of [disease name] is the result of multiple genetic mutations such as:

• [Mutation 1]
• [Mutation 2]
• [Mutation 3]

Associated Conditions

Conditions associated with [disease name] include:

• [Condition 1]
• [Condition 2]
• [Condition 3]

Gross Pathology

On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].

• Mature teratoma is usually found on the left side more.

Gross Pathology

Ovarian germ cell tumor subtype	Features on Gross Pathology
Dysgerminoma	External surface is smooth and bosselated (knobby) Soft, fleshy and either cream-colored, 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 hemorrhage 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 appearance" (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 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

Microscopic Pathology

On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].