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Ovarian Dysgerminomas Pathology
Ovarian Dysgerminomas Pathology
Ovarian Dysgerminomas Pathology
Dysgerminomas
Author: Florette K Gray Hazard, MD; Chief Editor: Ramya Masand, MD more...
Updated: Oct 20, 2015
Extraovarian tumor spread of dysgerminomas often involves the retroperitoneal and pelvic lymph nodes; these
tumors are highly susceptible to radiotherapy.[1] In addition, hematogenous spread may occur; common sites of
involvement are the lungs, liver, and bone.[2]
Go to Ovarian Cancer and Borderline Ovarian Cancer for complete information on these topics.
Laboratory Markers
Dysgerminomas are associated with elevated serum levels of lactate dehydrogenase (LDH).
Although these tumors are thought to be hormonally inert, at least 1 case of precocious puberty occurring in
association with dysgerminoma has been reported.[5]The patient was a 6-year-old girl whose precocious
puberty was caused by elevations in the levels of betahuman chorionic gonadotropin (beta-hCG), alphafetoprotein (AFP), and estradiol.
Additionally, elevated serum levels of neuron-specific enolase, [6] calcium,[7] inhibin,[8]placental alkaline
phosphatase (PLAP), and prolactin [9] have been reported. These serologic elevations readily resolve following
surgical excision; after the elevations resolve, the serum levels may be used as tumor markers to monitor for
recurrence. Because these markers are more commonly associated with other germ cell tumors (ie, yolk sac,
embryonal carcinoma, choriocarcinoma), many scientists contend that secreting dysgerminomas are
misdiagnosed as pure lesions and that they actually represent mixed tumors containing other malignant germ
cell components.[2]
Go to Gynecologic Tumor Markers for complete information on this topic.
Although numerous architectural variants exist, the cytologic features remain constant. These varying
architectural patterns include but are not limited to sparse lymphocytes, trabeculae, microcysts, and tubules, as
well as extensive hyalinization. As yet, no prognostic significance has been attributed to these architectural
patterns.
Dysgerminomas demonstrate a characteristic tigroid background and loosely cohesive, polygonal cells with
round to oval nuclei, vesicular chromatin, and multiple (1-4) distinct nucleoli on cytology preparations.
Immunohistochemistry
Immunohistochemistry (IHC) plays an important role in characterizing germ cell tumors. Although the wide
range of architectural patterns may make establishing the pathologic diagnosis difficult, the
immunohistochemical profile is often informative.[1, 2]
The neoplastic cells of dysgerminomas express placental alkaline phosphatase (PLAP), CD117 (c-kit), OCT
3/4, SALL4, and, variably, cytokeratin (see the images below). They do not express epithelial membrane
antigen (EMA), S100 protein, CD45 (LCA), or alpha-fetoprotein (AFP).
Syncytiotrophoblastlike giant cells are the source of beta-hCG production; this protein expression is confirmed
by immunohistochemistry. D2-40 membrane expression has been established in testicular seminoma[10] but has
not been extensively explored in dysgerminoma.
Gonadoblastomas are neoplastic proliferations found almost exclusively in patients with gonadal dysgenesis
(pure or mixed), male pseudohermaphroditism, and Turner syndrome (45,XO and mosaics). More than 90% of
patients with gonadoblastomas have a Y chromosome.
Gonadoblastomas are histologically characterized by expanded nests containing Sertoli cells, germ cells, and
granulosa cells admixed with variable amounts of hyaline. These nests morphologically resemble the CallExner bodies associated with granulosa cell tumors. Leydig cells may also be found within the interstitium.
Characteristically, these neoplastic nests and/or fibrotic stroma between nests often contain large, irregular
calcifications. Mitotic activity, cytologic atypia, and necrosis are minimal or absent.
The following images depict examples of gonadoblastoma histology.
It is not uncommon to see regions of neoplastic overgrowth by dysgerminoma; however, other malignant germ
cell elements may be seen, such as yolk sac and choriocarcinoma. [1, 2]