Cureus unclassified mixed germ cellsex cordstromal tumor. Types of ovarian cancer there are 3 main types of ovarian tumors. The world health organization histological classification for ovarian tumors separates ovarian neoplasms according to the most probable tissue of origin. There is a controversy concerning the value of second look surgery and lymph node sampling for patients with germ cell tumors of the ovary. Cause is unknown but genetics may play a role, as a familial predilection may be present. Germ cell tumors are composed of a number of histologically different tumor types derived from the primitive germ cells of the embryonic gonad. Ovarian leydig cell tumors have been divided into two subtypes by some pathologists, the hilus cell tumor and the leydig cell tumor, nonhilar type. Although most benign and malignant ovarian tumors are derived from the surface epithelium of the ovary, a variety of often morphologically complex tumors originate from the most highly specialized elements of the organ, namely, the sex cords, the stroma or mesenchyme, and the germ cells. The patients with granulosa cell tumor of the ovary constituted 7. Malignant ovarian germ cell tumors are rare tumors that mainly affect patients of reproductive age.
Most of the important develop ments have occurred during the past two decades, al. Ovarian germ cell tumors usually occur in teenage girls or young women and most often affect just one ovary the ovaries are a pair of organs in the female reproductive system. Some germ cell cancers release certain protein markers such as human chorionic gonadotropin hcg and alphafetoprotein afp into the blood. In an additional 7 families, males had germ cell tumors. In this case report, we clinically, pathologically, and immunohistochemically analyzed a mixed germ cell tumor, wherein a benign mature teratoma and embryonal carcinoma coexisted in the left ovary. Malignant ovarian germ cell tumors occur in the first four decades and are rare thereafter. Oophorectomy, salpingooophorectomy, subtotal oophorectomy or removal of tumor in fragments, hysterectomy with salpingooophorectomy note. Interest in their clinical and histologic features has somewhat diminished in the last 2 decades, with relatively few clinicopathologic series reported. Screening tests for germ cell tumors stromal tumors there are no recommended screening tests for germ cell tumors or stromal tumors. However, in females younger than 20 years of age, about 70% of all ovarian tumors are of germ cell origin, onethird of which are malignant 1. Malignant ovarian germ cell tumors mogcts are rare but curable at all stages of disease. Apr 30, 2003 most tumors of the ovary can be placed into one of three major categoriessurface epithelial. Some studies have found that size and histology were the major factors determining prognosis for patients with malignant mixed germ cell tumors of the ovary. Three quarters of the patients are between 10 30 years old median age is about 20 yrs.
Characteristic features of omgcts dysgerminoma dysgerminoma is the ovarian counterpart to testicular. Ovarian germ cell tumors treatment pdqpatient version. We herein report a rare case of malignant mixed germ cell tumor comprising both an embryonal carcinoma 60% and a yolk sac tumor 40%. Female malignant ovarian germ cell tumours mogcts are rare, but early diagnosis and multiagent chemotherapy are 1associated with high cure rates of 85. In adults, 30 % of ovarian tumors are of germ cell origin 1. The age of presentation is more frequent in girls younger than 10 years of age. Pathology and classification of ovarian tumors chen.
In female dogs, germ cell tumors are much less common than the other major types. Malignant germ cell tumors represent 5% of ovarian tumors. Germ cell tumor of the ovary is an eminently treatable disease and selected patients can be managed with fertilitypreserving surgery. The most common histological types of malignant ovarian germ cell tumors are dysgerminoma about 50%, endodermal sinus tumor 22%, and malignant immature teratoma 15%. We performed a literature search in the pubmed of almost all relevant articles concerning mogcts on pathology, prognostic factors, surgery, postoperative therapy and late effects of therapy. The concept of germ cell tumors as a specific group of gonadal neoplasms has evolved over the last several decades. Results prognostic factors for mogct include the international federation of gynecology and obstetrics staging.
Pdf malignant ovarian germ cell tumors rejin kebudi and p. Dec 17, 2019 the classification of ovarian germ cell tumours has remained unchanged for many years, while there have been considerable changes in the testicular classification. Sex cordstromal, steroid cell, and germ cell tumors of. Ovarian germ cell cancer dysgerminoma yolk sac tumour immature teratoma mixed germ cell tumour bep. Aug 01, 2008 a modified version of the third who classification 2003 version of germ cell tumors of the ovary is presented in table 2. Signs of ovarian germ cell tumor are swelling of the abdomen or vaginal bleeding after menopause tests that examine the ovaries, pelvic area, blood, and ovarian tissue are used to detect find and diagnose ovarian germ cell tumor. Malignant ovarian germ cell tumors account for less than 5% of all ovarian malignancies. Protocol for the examination of specimens from patients. Mogcts, which include dysgerminomas, immature teratomas, embryonal tumours and endodermal sinus. We conducted a retrospective study of 16 cases of mogcts diagnosed from january 2008 to december 20. These neoplasms comprise approximately 20 to 25 percent of ovarian neoplasms overall, but account for only an approximate 5 percent of all malignant ovarian neoplasms.
May 01, 2014 ovarian malignant germ cell tumors omgcts are heterogeneous tumors that are derived from the primitive germ cells of the embryonic gonad. Based on ajccuicc tnm, 7th edition protocol web posting date. Ovarian germcell tumors represent 1520% of all ovarian tumors. A patient is presented with endodermal sinus tumor in a mixed germ cell tumor of the ovary. A multicentre retrospective cohort study of ovarian germ cell tumours. Primary ovarian tumors are generally classified as epithelial, germ cell, or sex cordstromal tumors. Pathology and classification of ovarian tumors chen 2003. Ovarian germ cell tumors usually occur in teenage girls or young women and most often affect just one ovary. Seven tumor markers were analyzed clinically in 5 patients with germ cell tumors of the ovary who were treated in tokai ovarian tumor study group, an association comrising nagoya university and. Signs of ovarian germ cell tumor are swelling of the abdomen or vaginal bleeding after menopause. Patients with carcinoma of the ovary protocol applies to all primary borderline and malignant surface epithelial tumors, and also to germ cell tumors and sex cordstromal tumors. Ovarian germ cell tumors ogcts show a heterogeneity that is not seen in their testicular counterparts and include benign mature cystic teratomas, intermediate immature teratomas, malignant germ cell tumors gcts dysgerminomas, endoderma. Ovarian neoplasms coelomic epithelium germ cell specialized gonadal stroma nonspecific mesenchyme metastatic tumors 5070% 1520% 510% 510% 510%.
Feb 10, 2016 in children and adolescents, more than 60% of ovarian neoplasms are of germ cell origin, and one third are malignant. What are the tumor markets for ovarian dysgerminomas. Mature teratoma by far the most common ovarian germ cell tumour, these tumours are benign unless a somatic transformation occurs, which is. Sex cordstromal, steroid cell, and germ cell tumors of the. Types of ovarian tumors ovarian cancer johns hopkins. Management of female malignant ovarian germ cell tumours. Their levels were elevated in 85 % of patient with these tumors19. Tests that examine the ovaries, pelvic area, blood, and ovarian tissue are used to diagnose ovarian germ cell tumor. Ovarian germ cell tumors treatment pdqhealth professional. Chromosome 12 abnormalities in malignant ovarian germ cell tumors. About 23% of all ovarian cancers are germ cell tumors.
In recent years there has been concern about the overtreatment of clinical stage 1 testicular germ cell tumours with increasing use of surveillance for low. Introductionmalignant germ cell tumors of the ovary are uncommon neoplasms. Germ cell tumors of the ovarylymph node metastases. Diseasefree survival rates in these patients are quite high and recurrences can be managed with secondline chemotherapy. Protocol for the examination of specimens from patients with. Ogcts arise primarily in young women between 10 and 30 years of age and represent 70. Unclassified mixed germ cellsex cordstromal tumor of the.
Histogenetic analysis of ovarian germ cell tumors by dna. Germ cell tumors of the ovary lymph node metastases. Among these, a common form is teratoma with endodermal sinus tumor. Ovarian germ cell tumor is a disease in which malignant cells form in the germ egg cells of the ovary. Etiology ovarian germ cell tumors are derived from the oocyte. Mar 01, 2014 on the other hand, malignant ovarian germ cell tumors mogcts account for only a small fraction of ovarian germ cell neoplasms. Stromal tumors start from structural tissue cells that hold the ovary together and produce the female hormones estrogen and progesterone. Jan 28, 2017 dysgerminoma most common of the primitive germ cell tumors most common malignant ovarian germ cell neoplasm 0. Although 2025% of all ovarian tumors are derived from germ cells, only about 3% of germ cell tumors are malignant. Ovarian germ cell tumor is a disease in which malignant cancer cells form in the germ egg cells of the ovary. Pdf malignant ovarian germ cell tumors rejin kebudi.
Hcg play crucial roles in the management of patients with germ cell tumors. Ovarian germ cell tumors ogcts are heterogeneous tumors that are derived from the primitive germ cells of the embryonic gonad, which accounts for about. Malignant germ cell ovarian tumors mogcts represent less than 20% of ovarian cancers. Histologically, there are nests of transitional epithelial cells with longitudinal nuclear grooves coffee bean nuclei lying in abundant fibrous stroma also recall that the coffee bean nuclei are the nuclear grooves exceptionally pathognomonic to the sex cord stromal tumor, the ovarian granulosa cell tumor, with the fluidfilled spaces callexner bodies between the granulosa cells. Recurrent ovarian mixed germ cell tumor with unusual. The retrospective study presented here reports the clinicopathologic profile of germ cell tumors of the ovary studied at b. Ovarian malignant germ cell tumors rsna publications online. There are four main types of ogcts, namely dysgerminomas, yolk sac tumor, teratoma, and choriocarcinoma dygerminomas are malignant germ cell tumor of ovary and particularly prominent in patients.
Publications dealing solely with the successful management of patients w. The term mixed germ cell tumor is used to describe tumors with more than two types of germ cell components 12, 15. They are rapidly growing neoplasms that arise from primordial germ cells derived from the embryonal gonad. Although many reports have been published about germ cell tumors of the ovary in developed countries, there has been no such documentation from nepal. The former, which is much more common, originates in the ovarian hilus from hilar leydig cells, which have been identified in 8085% of adult ovaries.
Teratocarcinoma refers to a germ cell tumor that is a mixture of teratoma with embryonal carcinoma, or with choriocarcinoma, or with both. Cases in 7 families have been reported in which female firstdegree relatives had germ cell tumors. Ovarian germ cell tumors ogcts are derived from primordial germ cells of the ovary. Malignant ovarian germ cell tumors mogcts are rare ovarian tumors that account for 2%5% of all ovarian malignancies. Ogcts comprise of 23% of all malignant ovarian tumors registered globally, with highest rates in young women of 15 to 30 years old 1. In adults 95% are benign and consist of mature cystic teratomas dermoid cysts. Ovarian germ cell tumors union for international cancer. Malignant gct make up 3% and 20% of all ovarian cancers in western countries and asianafrican countries respectively. Embryonal carcinoma of the ovary is a rare malignant germ cell tumor of the ovary, usually diagnosed in women younger than 25 years of age. These tumors affect both adults and children and therefore the recommendations apply to the eml lists for both adults and children regimen distinctions are included in the present briefing. During this time 26 cases of non epithelial ovarian malignancy were diagnosed which 16 are germinal tumors 61%.
While sharing many similarities with male germ cell tumours gcts, a group of. Cellular classification and clinical and imaging features1 ovarian malignant germ cell tumors omgcts are heterogeneous tumors that are derived from the primitive germ cells of the embryonic gonad. Mixed germ cell tumors may secrete bhcg, afetoprotein, or both, depending on the components. This kind of mixed germ cell tumor may be known simply as a teratoma with elements of embryonal carcinoma or choriocarcinoma, or simply by. Pathology ovarian mixed germcell tumor comprising mature. Ovarian cancer early detection, diagnosis, and staging.
Expression profile of genes from 12p in testicular germ cell tumors of adolescents and adults associated with i12p and amplification at 12p11. Eightyeight percent of ovarian germ cell tumors have increased serum lactic dehydrogenase isoenzyme1 11,12. Reproductive outcomes and fertility preservation strategies. Results prognostic factors for mogct include the international federation of gynecology and obstetrics.
Malignant germ cell cancers of the ovary include dysgerminomas and nondysgerminomas, which include immature teratomas, embryonal cell carcinoma, yolk sac tumors, primary ovarian nongestational choriocarcinomas, polyembryoma, and mixed germ cell tumors. Epithelial tumors start from the cells that cover the outer surface of the ovary. Germ cell tumor presenting with precocious puberty in a girl in. Germ cell tumors start from the cells that produce the eggs. Ovarian germ cell tumors ogcts are heterogeneous tumors that are derived from the primitive germ cells of the embryonic gonad, which accounts for about 2. Few cases have been reported in the literature so far.
As with epithelial ovarian cancers, it is a good idea to consult with a gynecologic oncologist for treating malignant germ cell tumors, especially because these are so uncommon. Introduction germ cell tumors embrace morphologically heterogeneic neoplasms considered to be originated from germ cells of the gonad and are the most common ovarian tumors in women during the second and third decades of life, accounting for approximately 20% of all ovarian tumors. Genetic analysis of ovarian germ cell tumors by comparative. Protocol applies to all primary borderline and malignant. Pdf germ cell tumors of the ovary an update researchgate. Diagnosis of this tumor during pregnancy could be expected. Germ cell tumors begin in the reproductive cells egg or sperm of the body. Ovarian germ cell tumors represent 1520% of all ovarian tumors. Management of ovarian germ cell tumors journal of clinical. Applies to primary borderline tumors, carcinomas, germ cell tumors, and sexcord stromal tumors only based on ajccuicc tnm, 6th edition and figo 2001 annual report ovary. Malignant germ cell tumor of ovary is a rare ovarian cancer see this term arising from germ cells in the ovary, frequently unilateral at diagnosis which. Germ cell tumors of the ovary, textbook of uncommon cancer. The field of ovarian germ cell tumors ogcts has remained relatively unchanged in the last 2 decades.
Jan 10, 2019 mixed germ cell tumors represent only less than 1% in all ovarian germ cell tumors, in contrast to the testis, in which its proportion is up to 33%. More than 95% of gct are benign dermoid cysts mature cystic teratomas. Smith ho analyzed 1262 cases of malignant germ cell tumors and reported a lowest overall survival rate 67. There are four main types of ogcts, namely dysgerminomas, yolk sac tumor, teratoma, and choriocarcinoma.
However, the introduction of new stem cell pluripotency markers has provided a new. Highdose chemotherapy for recurrent ovarian germ cell tumors. Ovarian germ cell tumor treatment ovarian teratoma treatment. Germ cell and stromal tumors of the ovary university of kentucky. Malignant ovarian tumors are a very rare cause of precocious puberty.
Serum lactate dehydrogenase levels in malignant germ cell. Ovarian germ cell tumors ogct account for 25% of ovarian malignancies, with an. Jan 08, 2021 germ cell tumors gct originate from primordial germ cells and make up 30% of all ovarian tumors. While sharing many similarities with male germ cell tumours gcts, a group of cancers 20 times more common than mogcts. Primary ovarian neoplasms in children may originate from sex cord or stromal tissue, epithelium, or the germ cell line, 176 with granulosa cell tumors being the most frequent ovarian tumor that induces precocious puberty. This group of ovarian neoplasms is composed of a number of histologically different tumor types and embraces all the neoplasms considered to be ultimately derived from the primitive germ cells of the embryonic gonad. Few occur under age6 or over age 60 only 4% of the patients are over 40 yrs.
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