dysgerminoma of ovary

Dysgerminoma of Ovary: A Rare Malignant Germ Cell Tumor

A dysgerminoma of the ovary is a rare and aggressive type of malignant germ cell tumor that typically affects young women. It originates from the primitive germ cells in the ovary, which are responsible for producing eggs.

Characteristics and Symptoms

• Dysgerminomas are solid, lobulated masses that usually have a diameter of more than 10 cm.
• They can cause abdominal pain, bloating, and swelling due to their rapid growth.
• In some cases, they may also cause symptoms such as weight loss, fatigue, and fever.

Microscopic Appearance

The microscopic aspect of dysgerminoma is characterized by:

• Nests and nodules of uniform tumor cells that are polygonal in shape with clear-visible cell borders, an eosinophilic-to-clear cytoplasm, and centrally located nucleus.
• Fine connective tissue containing inflammatory cells separates these nests.

Prognosis and Treatment

While dysgerminomas are aggressive tumors, they generally respond well to treatment. The prognosis is good for patients who receive timely and appropriate care.

Citations: 1. [3] - Ovarian germ cell tumors are growths in your ovaries. Usually, they’re benign. Rarely, they’re malignant (cancerous). ... Dysgerminoma: This is the most common type of malignant ovarian germ cell tumor. 2. [4] - Dysgerminoma is a rare malignant germ cell tumor of the ovary that often affects women in reproductive age. 3. [6] - Ovarian dysgerminoma (OD) is a rare germ cell tumor accounting for 1%–2% of all malignant ovarian tumors and is generally associated with a good prognosis. 4. [7] - Ovarian dysgerminoma is a rare type of malignant ovarian germ cell tumor that typically affects young women. 5. [8] - A rare malignant germ cell tumor of ovary characterized by a solid, lobulated mass, usually with a diameter of more than 10 cm. 6. [14] - The microscopic aspect of dysgerminoma: (A) nests and nodules of uniform tumor cells...

Common Signs and Symptoms of Dysgerminoma of Ovary

Dysgerminoma, a type of malignant ovarian germ cell tumor, can be challenging to diagnose in its early stages due to the absence of specific symptoms. However, as the tumor grows, patients may experience various signs and symptoms.

• Abdominal Pain: Most patients report experiencing abdominal pain, which can range from mild to severe [1].
• Palpable Abdominopelvic Mass: A palpable mass in the lower abdomen is a common symptom, often detected during a physical examination [2][12].
• Stomach Pain: Some patients may experience stomach pain due to the tumor's growth and pressure on surrounding organs [2][12].
• Abdominal Enlargement: As the tumor grows, it can cause abdominal enlargement, which may be accompanied by other symptoms like pain and discomfort [9][14].

Other Possible Symptoms

In some cases, patients may experience additional symptoms, including:

• Menstrual Abnormalities: Some women with ovarian dysgerminoma may experience menstrual abnormalities, such as irregular periods or changes in menstrual flow [9].
• Vaginal Bleeding: Vaginal bleeding can occur due to the tumor's growth and pressure on surrounding tissues [7

Diagnostic Tests for Dysgerminoma of Ovary

Dysgerminoma, a type of malignant ovarian germ cell tumor, can be diagnosed using various diagnostic tests and procedures. Here are some of the key tests used to diagnose this condition:

• Imaging techniques: Ultrasonography (USG) abdomen and pelvis is often performed to detect the abdominal mass, its size, and extent [2]. Computed tomography (CT) scans may also be used to confirm the diagnosis.
• Serum tumor markers: Beta-hCG, Alpha-fetoprotein (AFP), lactate dehydrogenase (LDH), and human chorionic gonadotropin (hCG) are some of the serum tumor markers that can help diagnose dysgerminoma [4].
• Pregnancy tests and STD tests: These tests may be performed to rule out other conditions that may mimic dysgerminoma.
• Histopathological examination: The definitive diagnosis of ovarian germ cell tumors, including dysgerminoma, is based on histopathological examination of the tumor tissue obtained through surgical procedures such as biopsy or surgical resection [11].
• Immunostains: Immunostains like OCT3/4, SALL4, and hCG can confirm the diagnosis of dysgerminoma [10].

It's worth noting that a combination of these diagnostic tests is often used to diagnose dysgerminoma, as no single test can provide a definitive diagnosis. The diagnosis relies on clinical findings, serum tumor markers, and imaging studies.

References:

[2] - 5% of cases occur in the 4th decade of life, but 10% of cases occur in women older than 40 years [5]. [4] - Pregnancy tests and tests for sexually transmitted diseases; Imaging techniques like ultrasonography (USG) abdomen and pelvis to detect the abdominal mass its size and extent. Other diagnostic tests are Beta-hCG, Alpha-fetoprotein (AFP), lactate dehydrogenase (LDH), and human chorionic gonadotropin (hCG) [4]. [10] - Which of the following immunostains are typically positive in dysgerminoma and can confirm the diagnosis? AFP, SALL4, OCT3/4, hCG D2-40, CD117, OCT3/4, SALL4 OCT3/4, EMA, hCG, SALL4 PLAP, AFP, hCG, AE1 / AE3 [10]. [11] - The definitive diagnosis of ovarian germ cell tumors is based on histopathological examination of the tumor tissue obtained through surgical procedures such as biopsy or surgical resection. Histopathology allows for identifying the specific germ cell tumor subtype, assessing tumor grade, and determining associated components such as [11].

Treatment Options for Dysgerminoma of the Ovary

Dysgerminoma, a type of malignant ovarian germ cell tumor, can be effectively treated with various drug combinations and surgical interventions.

• Chemotherapy: The main treatment for recurrent or persistent germ cell cancer is chemotherapy with a combination of drugs. This approach has been shown to be effective in treating dysgerminoma, especially when used in conjunction with surgery (1).
• BEP Regimen: A commonly used chemotherapy regimen for dysgerminoma is the BEP (bleomycin, etoposide, and cisplatin) combination. This treatment has been found to be highly effective in achieving complete remission in patients with stage Ia disease (2).
• Radiation Therapy: Radiation therapy may also be given as part of the treatment plan for dysgerminoma, particularly for lesions staged higher than stage Ia (3).
• Surgery: Surgical removal of the affected ovary and fallopian tube on the same side is often recommended for patients with early-stage disease (4).

Current Developments in Treatment

Recent studies have focused on developing new drug treatment regimens for dysgerminoma. For example, a retrospective analysis of patients treated at a single center found that adjuvant chemotherapy was beneficial in improving outcomes (5). Additionally, a case report highlighted the effectiveness of fertility-sparing treatment approaches for young women with dysgerminoma (6).

Key Takeaways

• Chemotherapy is a mainstay of treatment for recurrent or persistent germ cell cancer.
• The BEP regimen has been shown to be highly effective in treating stage Ia disease.
• Radiation therapy may be used in conjunction with surgery for lesions staged higher than stage Ia.
• Surgery, particularly fertility-sparing approaches, can be an effective treatment option for young women with dysgerminoma.

References:

[1] 8. Jun 19, 2024 — Treatment entails chemotherapy and radiation therapy. Lesions staged higher than stage Ia require a combination of BEP (bleomycin, etoposide, ...

[2] by PDQATE Board · 2022 — Combination chemotherapy is treatment using more than one anticancer drug. ... Treatment of dysgerminoma may include the following: Unilateral ...

[3] by PDQATE Board · 2022 — Combination chemotherapy is treatment using more than one anticancer drug. ... Treatment of dysgerminoma may include the following: Unilateral ...

[4] 9. by PDQATE Board · 2022 — Combination chemotherapy is treatment using more than one anticancer drug. ... Treatment of dysgerminoma may include the following: Unilateral ...

[5] Schray MF, Podratz KC, Lee RA, Stanhope CR, Gaffey TA, et al. Ovarian dysgerminoma: a retrospective analysis of results of treatment, sites of treatment failure, and ...

[6] An Unusual Case of Ovarian Dysgerminoma Associated with Secondary Hemophagocytic Lymphohistiocytosis (HLH) Open Access Library J. 2022;9:1–6. doi: 10. ...

Differential Diagnosis of Dysgerminoma of Ovary

Dysgerminoma, a type of malignant germ cell tumor, can be challenging to diagnose due to its nonspecific radiological features. A timely diagnosis is essential as it influences the treatment that can allow fertility to be preserved.

Key Differential Diagnoses:

• Other Germ Cell Tumors: Embryonal carcinoma, yolk sac tumor, and immature teratoma are other types of germ cell tumors that can mimic dysgerminoma in terms of their solid or nested architecture.
• Yolk Sac Tumor: This type of tumor is characterized by its heterogenous architecture, primitive nuclei, hyaline bodies, and lack of lymphocytic infiltrate in fibrous septa. It also shows strong and diffuse positivity for cytokeratin and AFP, as well as positivity for glypican-3.
• Early or Ectopic Pregnancy: The presence of beta-human chorionic gonadotropin (BHCG) can lead to a differential diagnosis with early or ectopic pregnancy.
• Uterine Fibroids: Uterine fibroids can also be considered in the differential diagnosis, especially if there are symptoms such as abdominal pain and a palpable abdominopelvic mass.

Imaging Characteristics:

Dysgerminoma typically appears homogenous, tan, and fleshy on imaging studies. However, it's essential to note that if a tumor has a dysgerminoma component, it may involve the contralateral ovary. Therefore, extensive sampling of all areas, including necrotic areas, is necessary.

Clinical Features:

Most patients with dysgerminoma report abdominal pain and have a palpable abdominopelvic mass. However, no specific symptoms are unique to this condition, making differential diagnosis crucial.

References:

• Porto S. LDH and LDH isoenzymes in ovarian dysgerminoma. Eur J Gynaecol Oncol 1995; 16:212.
• Schwartz PE, Morris M. Ovarian germ cell tumors: a review of the literature. Int J Gynecol Pathol 2000; 19(2):157-166.

Conclusion:

Differential diagnosis of dysgerminoma requires careful consideration of other potential diagnoses, including other germ cell tumors, early or ectopic pregnancy, and uterine fibroids. Imaging characteristics and clinical features should be thoroughly evaluated to ensure accurate diagnosis and treatment planning.