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Ovarian Dysgerminomas Pathology Overview of Ovarian Dysgerminomas
Ovarian Dysgerminomas Pathology Overview of Ovarian Dysgerminomas
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Ovarian Dysgerminomas
Pathology Overview of Ovarian
Dysgerminomas
Author: Florette K Gray Hazard, MD; Chief Editor: Ramya Masand, MD more...
Laboratory Markers
Immunohistochemistry
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http://emedicine.medscape.com/article/1951026-overview
Common signs and symptoms of ovarian dysgerminomas include abdominal/pelvic pain (5585%), abdominal mass (35%), fever (10-25%), vaginal bleeding (10%), and, occasionally,
ascites. Unlike other germ cell tumors, dysgerminomas often occur bilaterally (approximately
10-20% of cases).
and percentages of malignant germ cell tumors.
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.
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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 6year-old girl whose precocious puberty was caused by elevations in the levels of betahuman
chorionic gonadotropin (beta-hCG), alpha-fetoprotein (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.
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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 alphafetoprotein (AFP).
http://emedicine.medscape.com/article/1951026-overview
Dysgerminoma
immunohistochemistry (x200). CD117 = a proto-oncogen (c-kit) ; CKAE1/CAM5.2 =
cytokeratins; D2-40 = a monoclonal antibody; H&E = hematoxylin-eosin; OCT 3/4 = a
transcription factor; PLAP = placental alkaline phosphatase.
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.
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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.
Dysgerminoma and
gonadoblastoma histology. A: Dysgerminoma with an adjacent zone of necrosis and large
calcifications (40). B: Gonadoblastoma with an adjacent dysgerminoma (40). C:
Gonadoblastoma with an adjacent dysgerminoma (40). D: Gonadoblastoma (200).
Gonadoblastoma
immunohistochemistry (200). CD117 = a proto-oncogen (c-kit), ; CKAE1/CAM5.2 =
cytokeratins; D2-40 = a monoclonal antibody; H&E = hematoxylin-eosin; OCT 3/4 = a
transcription factor; PLAP = placental alkaline phosphatase.
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]
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