Ovarian germ cell tumor pathophysiology: Difference between revisions

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==Overveiw==
==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.
The [[pathophysiology]] of [[ovarian]] [[germ cell]] [[tumors]] depends on the [[histological]] subtype. However, their origin is the [[primordial germ cells]] that [[Transformation|transformed]] [[Pathology|pathologically]] in different stages of development.


==Pathophysiology==
==Pathophysiology==
===Physiology===
===Pathogenesis===
The normal physiology of [name of process] can be understood as follows:
*It is understood that [[ovarian]] [[germ cell]] [[tumors]] are the result of the [[Pathology|pathologic]] [[transformation]] of [[primordial germ cells]] during different stages of the development.<ref name="El-MaarriRijlaarsdam2015">{{cite journal|last1=El-Maarri|first1=Osman|last2=Rijlaarsdam|first2=Martin A.|last3=Tax|first3=David M. J.|last4=Gillis|first4=Ad J. M.|last5=Dorssers|first5=Lambert C. J.|last6=Koestler|first6=Devin C.|last7=de Ridder|first7=Jeroen|last8=Looijenga|first8=Leendert H. J.|title=Genome Wide DNA Methylation Profiles Provide Clues to the Origin and Pathogenesis of Germ Cell Tumors|journal=PLOS ONE|volume=10|issue=4|year=2015|pages=e0122146|issn=1932-6203|doi=10.1371/journal.pone.0122146}}</ref><ref>{{cite book | last = Carcangiu | first = M. L. | title = WHO Classification of Tumours of Female Reproductive Organs | publisher = International Agency for Research on Cancer | location = Lyon | year = 2014 | isbn = 978-92-832-4487-5 }}</ref>
 
 
 
{{familytree/start |summary=Sample 1}}
{{familytree | | | | | | | | A01 |A01=[[Germ cell]]}}
{{familytree | | | | |,|-|-|-|^|-|-|-|-|.| | | }}
{{familytree | | | B01 | | | | | | | | B02 | | |B01=[[Pathogenesis]]|B02=[[Malignant transformation]]}}
{{familytree | | | |!| | | | | | | | | |!| }}
{{familytree | | | C01 | | | | | | | | |!| |C01=[[Mature teratoma]]}}
{{familytree | | | | | | | | | | | | | |!}}
{{familytree | | | | | | | | | |,|-|-|-|+|-|-|-|.| }}
{{familytree | | | | | | | | | E01 | | E02 | | E03 |E01=[[Tumors]] esxpressing [[transcription factors]] of [[pluripotency]]|E02=[[Tumors]] with primitive [[embryonic]] [[ectoderm]], [[mesoderm]], and/or [[endoderm]] differentiation|E03=[[Tumors]] with extraembroyonic differentiation}}
{{familytree | | | | | | | | | |!| | | |!| | | |!| | }}
{{familytree | | | | | | | | | F01 | | F02 | | F03 | |F01=[[Dysgerminoma]]/[[Embryonal carcinoma]]|F02=Immature [[teratoma]]|F03=[[Yolk sac tumor]]/[[Choriocarcinoma]]}}
{{familytree/end}}


===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.<ref name="El-MaarriRijlaarsdam2015">{{cite journal|last1=El-Maarri|first1=Osman|last2=Rijlaarsdam|first2=Martin A.|last3=Tax|first3=David M. J.|last4=Gillis|first4=Ad J. M.|last5=Dorssers|first5=Lambert C. J.|last6=Koestler|first6=Devin C.|last7=de Ridder|first7=Jeroen|last8=Looijenga|first8=Leendert H. J.|title=Genome Wide DNA Methylation Profiles Provide Clues to the Origin and Pathogenesis of Germ Cell Tumors|journal=PLOS ONE|volume=10|issue=4|year=2015|pages=e0122146|issn=1932-6203|doi=10.1371/journal.pone.0122146}}</ref>
===Mature teratoma===
===Mature teratoma===
*Mature teratomas are benign tumors originating from pathologic development of primordial germ cells.<ref name="VuralVural2015">{{cite journal|last1=Vural|first1=F.|last2=Vural|first2=B.|last3=Paksoy|first3=N.|title=Vaginal teratoma: A case report and review of the literature|journal=Journal of Obstetrics and Gynaecology|volume=35|issue=7|year=2015|pages=757–758|issn=0144-3615|doi=10.3109/01443615.2015.1004525}}</ref>
*[[Mature cystic teratoma|Mature teratomas]] are [[benign tumors]] originating from [[Pathology|pathologic]] development of [[primordial germ cells]].<ref name="VuralVural2015">{{cite journal|last1=Vural|first1=F.|last2=Vural|first2=B.|last3=Paksoy|first3=N.|title=Vaginal teratoma: A case report and review of the literature|journal=Journal of Obstetrics and Gynaecology|volume=35|issue=7|year=2015|pages=757–758|issn=0144-3615|doi=10.3109/01443615.2015.1004525}}</ref>
*It originates from a single germ cell tumor after the first phase of meiosis.<ref name="LinderMcCaw1975">{{cite journal|last1=Linder|first1=David|last2=McCaw|first2=Barbara Kaiser|last3=Hecht|first3=Frederick|title=Parthenogenic Origin of Benign Ovarian Teratomas|journal=New England Journal of Medicine|volume=292|issue=2|year=1975|pages=63–66|issn=0028-4793|doi=10.1056/NEJM197501092920202}}</ref>
*It originates from a single [[germ cell]] [[tumor]] after the first phase of [[Meiosis I|meiosis]].<ref name="LinderMcCaw1975">{{cite journal|last1=Linder|first1=David|last2=McCaw|first2=Barbara Kaiser|last3=Hecht|first3=Frederick|title=Parthenogenic Origin of Benign Ovarian Teratomas|journal=New England Journal of Medicine|volume=292|issue=2|year=1975|pages=63–66|issn=0028-4793|doi=10.1056/NEJM197501092920202}}</ref>
*These tumors contain the well-differentiated component of three germ layers.<ref name="VuralVural2015">{{cite journal|last1=Vural|first1=F.|last2=Vural|first2=B.|last3=Paksoy|first3=N.|title=Vaginal teratoma: A case report and review of the literature|journal=Journal of Obstetrics and Gynaecology|volume=35|issue=7|year=2015|pages=757–758|issn=0144-3615|doi=10.3109/01443615.2015.1004525}}</ref>
*These [[tumors]] contain the well-[[Differentiation|differentiated]] component of three [[germ layers]].<ref name="VuralVural2015">{{cite journal|last1=Vural|first1=F.|last2=Vural|first2=B.|last3=Paksoy|first3=N.|title=Vaginal teratoma: A case report and review of the literature|journal=Journal of Obstetrics and Gynaecology|volume=35|issue=7|year=2015|pages=757–758|issn=0144-3615|doi=10.3109/01443615.2015.1004525}}</ref>
*Their usual location is the embryonic fusion line overhead and neck, mediastinum, a and presacral area and tend to present at a greater extent in the midline.  
*Their usual location is the [[embryonic]] fusion line overhead and [[neck]], [[mediastinum]], a and presacral area and tend to present at a greater extent in the midline.  
===Dysgerminoma===
===Dysgerminoma===
*Dysgerminoma arises from primordial germ cells, which are gonadal cells that are normally involved in the gametogenesis.<ref name="El-MaarriRijlaarsdam2015">{{cite journal|last1=El-Maarri|first1=Osman|last2=Rijlaarsdam|first2=Martin A.|last3=Tax|first3=David M. J.|last4=Gillis|first4=Ad J. M.|last5=Dorssers|first5=Lambert C. J.|last6=Koestler|first6=Devin C.|last7=de Ridder|first7=Jeroen|last8=Looijenga|first8=Leendert H. J.|title=Genome Wide DNA Methylation Profiles Provide Clues to the Origin and Pathogenesis of Germ Cell Tumors|journal=PLOS ONE|volume=10|issue=4|year=2015|pages=e0122146|issn=1932-6203|doi=10.1371/journal.pone.0122146}}</ref>
*[[Dysgerminoma]] arises from [[primordial germ cells]], which are [[gonadal]] [[cells]] that are normally involved in the [[gametogenesis]].<ref name="El-MaarriRijlaarsdam2015">{{cite journal|last1=El-Maarri|first1=Osman|last2=Rijlaarsdam|first2=Martin A.|last3=Tax|first3=David M. J.|last4=Gillis|first4=Ad J. M.|last5=Dorssers|first5=Lambert C. J.|last6=Koestler|first6=Devin C.|last7=de Ridder|first7=Jeroen|last8=Looijenga|first8=Leendert H. J.|title=Genome Wide DNA Methylation Profiles Provide Clues to the Origin and Pathogenesis of Germ Cell Tumors|journal=PLOS ONE|volume=10|issue=4|year=2015|pages=e0122146|issn=1932-6203|doi=10.1371/journal.pone.0122146}}</ref>
*The majority of dysgerminomas in women present in the stage 1A.<ref name="pmid22407668">{{cite journal |vauthors=A L Husaini H, Soudy H, El Din Darwish A, Ahmed M, Eltigani A, A L Mubarak M, Sabaa AA, Edesa W, A L-Tweigeri T, Al-Badawi IA |title=Pure dysgerminoma of the ovary: a single institutional experience of 65 patients |journal=Med. Oncol. |volume=29 |issue=4 |pages=2944–8 |date=December 2012 |pmid=22407668 |doi=10.1007/s12032-012-0194-z |url=}}</ref>
*The majority of [[Dysgerminoma|dysgerminomas]] in women present in the stage 1A.<ref name="AL HusainiSoudy2012">{{cite journal|last1=AL Husaini|first1=Hamed|last2=Soudy|first2=Hussein|last3=Darwish|first3=Alaa El Din|last4=Ahmed|first4=Mohamed|last5=Eltigani|first5=Amin|last6=AL Mubarak|first6=Mustafa|last7=Sabaa|first7=Amal Abu|last8=Edesa|first8=Wael|last9=AL-Tweigeri|first9=Taher|last10=Al-Badawi|first10=Ismail A.|title=Pure dysgerminoma of the ovary: a single institutional experience of 65 patients|journal=Medical Oncology|volume=29|issue=4|year=2012|pages=2944–2948|issn=1357-0560|doi=10.1007/s12032-012-0194-z}}</ref>
*Bilateral invovlement occurs in 10%  to 15% of the cases.
 
*In < 15% of the affected cases, elements of other germ cell tumors can also be found.<ref name="pmid7279343">{{cite journal |vauthors=Gordon A, Lipton D, Woodruff JD |title=Dysgerminoma: a review of 158 cases from the Emil Novak Ovarian Tumor Registry |journal=Obstet Gynecol |volume=58 |issue=4 |pages=497–504 |date=October 1981 |pmid=7279343 |doi= |url=}}</ref>
*[[Bilateral]] invovlement occurs in 10%  to 15% of the cases.
*The progression to [disease name] usually involves the [molecular pathway].
*In < 15% of the affected cases, elements of other [[germ cell]] [[tumors]] can also be found.<ref name="pmid7279343">{{cite journal |vauthors=Gordon A, Lipton D, Woodruff JD |title=Dysgerminoma: a review of 158 cases from the Emil Novak Ovarian Tumor Registry |journal=Obstet Gynecol |volume=58 |issue=4 |pages=497–504 |date=October 1981 |pmid=7279343 |doi= |url=}}</ref>
*The pathophysiology of [disease/malignancy] depends on the histological subtypes.
 
===Yolk sac tumor===
===Yolk sac tumor===
*Theae tumors develop from differentiation of primitive germ cells in the direction of yolk sac or vitelline structures.<ref name="Young2014">{{cite journal|last1=Young|first1=Robert H.|title=The Yolk Sac Tumor|journal=International Journal of Surgical Pathology|volume=22|issue=8|year=2014|pages=677–687|issn=1066-8969|doi=10.1177/1066896914558265}}</ref>
*These [[tumors]] develop from [[differentiation]] of [[Primordial germ cells|primitive germ cells]] in the direction of [[yolk sac]] or [[Vitelline arteries|vitelline structures]].<ref name="Young2014">{{cite journal|last1=Young|first1=Robert H.|title=The Yolk Sac Tumor|journal=International Journal of Surgical Pathology|volume=22|issue=8|year=2014|pages=677–687|issn=1066-8969|doi=10.1177/1066896914558265}}</ref>
*They tend to grow very rapidly.<ref name="ShaabanRezvani2014">{{cite journal|last1=Shaaban|first1=Akram M.|last2=Rezvani|first2=Maryam|last3=Elsayes|first3=Khaled M.|last4=Baskin|first4=Henry|last5=Mourad|first5=Amr|last6=Foster|first6=Bryan R.|last7=Jarboe|first7=Elke A.|last8=Menias|first8=Christine O.|title=Ovarian Malignant Germ Cell Tumors: Cellular Classification and Clinical and Imaging Features|journal=RadioGraphics|volume=34|issue=3|year=2014|pages=777–801|issn=0271-5333|doi=10.1148/rg.343130067}}</ref>
*They tend to grow very rapidly.<ref name="ShaabanRezvani2014">{{cite journal|last1=Shaaban|first1=Akram M.|last2=Rezvani|first2=Maryam|last3=Elsayes|first3=Khaled M.|last4=Baskin|first4=Henry|last5=Mourad|first5=Amr|last6=Foster|first6=Bryan R.|last7=Jarboe|first7=Elke A.|last8=Menias|first8=Christine O.|title=Ovarian Malignant Germ Cell Tumors: Cellular Classification and Clinical and Imaging Features|journal=RadioGraphics|volume=34|issue=3|year=2014|pages=777–801|issn=0271-5333|doi=10.1148/rg.343130067}}</ref>
*Bilateral involvement occurs in less than 5% of the cases.
*[[Bilateral]] involvement occurs in less than 5% of the cases.
*In 10% of the cases, the contralateral ovary carries a dermoid cyst.
*In 10% of the cases, the [[contralateral]] ovary carries a [[dermoid cyst]].
*In 40% of cases, they are accompanied by other types of germ cell tumors.<ref name="KojimaharaNakahara2013">{{cite journal|last1=Kojimahara|first1=Takanobu|last2=Nakahara|first2=Kenji|last3=Takano|first3=Tadao|last4=Yaegashi|first4=Nobuo|last5=Nishiyama|first5=Hiroshi|last6=Fujimori|first6=Keiya|last7=Sato|first7=Naoki|last8=Terada|first8=Yukihiro|last9=Tase|first9=Toru|last10=Yokoyama|first10=Yoshihito|last11=Mizunuma|first11=Hideki|last12=Shoji|first12=Tadahiro|last13=Sugiyama|first13=Toru|last14=Kurachi|first14=Hirohisa|title=Yolk Sac Tumor of the Ovary: A Retrospective Multicenter Study of 33 Japanese Women by Tohoku Gynecologic Cancer Unit (TGCU)|journal=The Tohoku Journal of Experimental Medicine|volume=230|issue=4|year=2013|pages=211–217|issn=1349-3329|doi=10.1620/tjem.230.211}}</ref>
*In 40% of cases, they are accompanied by other types of [[germ cell]] [[tumors]].<ref name="KojimaharaNakahara2013">{{cite journal|last1=Kojimahara|first1=Takanobu|last2=Nakahara|first2=Kenji|last3=Takano|first3=Tadao|last4=Yaegashi|first4=Nobuo|last5=Nishiyama|first5=Hiroshi|last6=Fujimori|first6=Keiya|last7=Sato|first7=Naoki|last8=Terada|first8=Yukihiro|last9=Tase|first9=Toru|last10=Yokoyama|first10=Yoshihito|last11=Mizunuma|first11=Hideki|last12=Shoji|first12=Tadahiro|last13=Sugiyama|first13=Toru|last14=Kurachi|first14=Hirohisa|title=Yolk Sac Tumor of the Ovary: A Retrospective Multicenter Study of 33 Japanese Women by Tohoku Gynecologic Cancer Unit (TGCU)|journal=The Tohoku Journal of Experimental Medicine|volume=230|issue=4|year=2013|pages=211–217|issn=1349-3329|doi=10.1620/tjem.230.211}}</ref>
 
==Genetics==
==Genetics==
*Dysgerminomas may be associated with gain or loss of complete or partial chromosomal materials such as:<ref name="pmid10850452">{{cite journal |vauthors=Kraggerud SM, Szymanska J, Abeler VM, Kaern J, Eknaes M, Heim S, Teixeira MR, Tropé CG, Peltomäki P, Lothe RA |title=DNA copy number changes in malignant ovarian germ cell tumors |journal=Cancer Res. |volume=60 |issue=11 |pages=3025–30 |date=June 2000 |pmid=10850452 |doi= |url=}}</ref>
*[[Ovarian]] [[germ cell]] [[tumors]] may be associated with [[cytogenetic]] abnormalities.
*Immature teratomas may be associated with [[chromosomal]] changes such as:<ref name="pmid10850452">{{cite journal |vauthors=Kraggerud SM, Szymanska J, Abeler VM, Kaern J, Eknaes M, Heim S, Teixeira MR, Tropé CG, Peltomäki P, Lothe RA |title=DNA copy number changes in malignant ovarian germ cell tumors |journal=Cancer Res. |volume=60 |issue=11 |pages=3025–30 |date=June 2000 |pmid=10850452 |doi= |url=}}</ref>
**[[Gain]] of all or parts of
***1p
***16p
***19
***22q
*[[Dysgerminoma|Dysgerminomas]] may be associated with gain or loss of complete or partial [[chromosomal]] materials such as:<ref name="pmid10850452">{{cite journal |vauthors=Kraggerud SM, Szymanska J, Abeler VM, Kaern J, Eknaes M, Heim S, Teixeira MR, Tropé CG, Peltomäki P, Lothe RA |title=DNA copy number changes in malignant ovarian germ cell tumors |journal=Cancer Res. |volume=60 |issue=11 |pages=3025–30 |date=June 2000 |pmid=10850452 |doi= |url=}}</ref>
**Gain of:
**Gain of:
***1p
***1p
Line 42: Line 61:
***21q
***21q
***22q
***22q
***Whole of chromosome 7
***Whole of [[chromosome 7]]
***Whole of chromosome 8  
***Whole of [[chromosome 8]]
***Whole of chromosomes 17
***Whole of [[chromosome 17]]
***Whole of chromosomes 19
***Whole of [[chromosome 19]]
**Losses from 13q
**Losses from 13q
*Yolk sac tumor is associated with gaining of the 12p chromosome in 75% of the cases.<ref name="pmid10850452">{{cite journal |vauthors=Kraggerud SM, Szymanska J, Abeler VM, Kaern J, Eknaes M, Heim S, Teixeira MR, Tropé CG, Peltomäki P, Lothe RA |title=DNA copy number changes in malignant ovarian germ cell tumors |journal=Cancer Res. |volume=60 |issue=11 |pages=3025–30 |date=June 2000 |pmid=10850452 |doi= |url=}}</ref>
*Yolk sac [[tumor]] is associated with gaining of the 12p [[chromosome]] in 75% of the cases.<ref name="pmid10850452">{{cite journal |vauthors=Kraggerud SM, Szymanska J, Abeler VM, Kaern J, Eknaes M, Heim S, Teixeira MR, Tropé CG, Peltomäki P, Lothe RA |title=DNA copy number changes in malignant ovarian germ cell tumors |journal=Cancer Res. |volume=60 |issue=11 |pages=3025–30 |date=June 2000 |pmid=10850452 |doi= |url=}}</ref>
*Immature teratomas may be associated with chromosomal changes such as:<ref name="pmid10850452">{{cite journal |vauthors=Kraggerud SM, Szymanska J, Abeler VM, Kaern J, Eknaes M, Heim S, Teixeira MR, Tropé CG, Peltomäki P, Lothe RA |title=DNA copy number changes in malignant ovarian germ cell tumors |journal=Cancer Res. |volume=60 |issue=11 |pages=3025–30 |date=June 2000 |pmid=10850452 |doi= |url=}}</ref>
**It may also be associated with [[chromosomal]] changes such as:
**Gain of all or parts of
***Gain of 1q
***1p
***16p
***19
***22q
*Endodermal sinus tumor may be associated with chromosomal changes such as:<ref name="pmid10850452">{{cite journal |vauthors=Kraggerud SM, Szymanska J, Abeler VM, Kaern J, Eknaes M, Heim S, Teixeira MR, Tropé CG, Peltomäki P, Lothe RA |title=DNA copy number changes in malignant ovarian germ cell tumors |journal=Cancer Res. |volume=60 |issue=11 |pages=3025–30 |date=June 2000 |pmid=10850452 |doi= |url=}}</ref>
**Gain of  
***12p
***1q
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==
==Associated Conditions==
Conditions associated with mature teratoma include:
[[Conditions]] associated with [[Mature cystic teratoma|mature teratoma]] include:
*Anti-NMDA receptor encephalitis (although very rarely)<ref name="DalmauGleichman2008">{{cite journal|last1=Dalmau|first1=Josep|last2=Gleichman|first2=Amy J|last3=Hughes|first3=Ethan G|last4=Rossi|first4=Jeffrey E|last5=Peng|first5=Xiaoyu|last6=Lai|first6=Meizan|last7=Dessain|first7=Scott K|last8=Rosenfeld|first8=Myrna R|last9=Balice-Gordon|first9=Rita|last10=Lynch|first10=David R|title=Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodies|journal=The Lancet Neurology|volume=7|issue=12|year=2008|pages=1091–1098|issn=14744422|doi=10.1016/S1474-4422(08)70224-2}}</ref>
*[[Anti-NMDA receptor encephalitis]] (although very rarely)<ref name="DalmauGleichman2008">{{cite journal|last1=Dalmau|first1=Josep|last2=Gleichman|first2=Amy J|last3=Hughes|first3=Ethan G|last4=Rossi|first4=Jeffrey E|last5=Peng|first5=Xiaoyu|last6=Lai|first6=Meizan|last7=Dessain|first7=Scott K|last8=Rosenfeld|first8=Myrna R|last9=Balice-Gordon|first9=Rita|last10=Lynch|first10=David R|title=Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodies|journal=The Lancet Neurology|volume=7|issue=12|year=2008|pages=1091–1098|issn=14744422|doi=10.1016/S1474-4422(08)70224-2}}</ref>
*Rarely, they produce prolactin and is associated with prolactinoma.<ref name="KallenbergPesce1991">{{cite journal|last1=Kallenberg|first1=GA|last2=Pesce|first2=CM|last3=Norman|first3=B|last4=Ratner|first4=RE|last5=Silverberg|first5=SG|title=Ectopic hyperprolactinemia resulting from an ovarian teratoma|journal=International Journal of Gynecology & Obstetrics|volume=34|issue=2|year=1991|pages=194–195|issn=00207292|doi=10.1016/0020-7292(91)90266-8}}</ref>
*Rarely, they contain [[pituitary]] [[cells]] capable of [[prolactin]] production and is associated with [[prolactinoma]].<ref name="KallenbergPesce1991">{{cite journal|last1=Kallenberg|first1=GA|last2=Pesce|first2=CM|last3=Norman|first3=B|last4=Ratner|first4=RE|last5=Silverberg|first5=SG|title=Ectopic hyperprolactinemia resulting from an ovarian teratoma|journal=International Journal of Gynecology & Obstetrics|volume=34|issue=2|year=1991|pages=194–195|issn=00207292|doi=10.1016/0020-7292(91)90266-8}}</ref>
Polyembryoma may be associated with [[Klinefelter syndrome]].<ref name="pmid12679648">{{cite journal |vauthors=Beresford L, Fernandez CV, Cummings E, Sanderson S, Ming-Yu W, Giacomantonio M |title=Mediastinal polyembryoma associated with Klinefelter syndrome |journal=J. Pediatr. Hematol. Oncol. |volume=25 |issue=4 |pages=321–3 |date=April 2003 |pmid=12679648 |doi= |url=}}</ref>


==Gross Pathology==
==Gross Pathology==
{| {{table}}
{| {{table}} cellpadding="4" cellspacing="0" style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;"
| align="center" style="background: #4479BA;" | {{fontcolor|#FFF|''' Ovarian germ cell tumor subtype'''}}
| align="center" style="background: #4479BA;" | {{fontcolor|#FFF|''' Ovarian germ cell tumor subtype'''}}
| align="center" style="background: #4479BA;" | {{fontcolor|#FFF|'''Features on Gross Pathology'''}}
| align="center" style="background: #4479BA;" | {{fontcolor|#FFF|'''Features on Gross Pathology'''}}
|-
|-
| '''Dysgerminoma'''||
| '''Dysgerminonma'''||
* Unilateral (bilateral in 10% to 20% of the cases)<ref name="ChenRuiz2003">{{cite journal|last1=Chen|first1=Vivien W.|last2=Ruiz|first2=Bernardo|last3=Killeen|first3=Jeffrey L.|last4=Cot�|first4=Timothy R.|last5=Wu|first5=Xiao Cheng|last6=Correa|first6=Catherine N.|last7=Howe|first7=Holly L.|title=Pathology and classification of ovarian tumors|journal=Cancer|volume=97|issue=S10|year=2003|pages=2631–2642|issn=0008-543X|doi=10.1002/cncr.11345}}</ref>
* Unilateral ([[bilateral]] in 10% to 20% of the cases)<ref name="pmid12733128">{{cite journal |vauthors=Chen VW, Ruiz B, Killeen JL, Coté TR, Wu XC, Correa CN |title=Pathology and classification of ovarian tumors |journal=Cancer |volume=97 |issue=10 Suppl |pages=2631–42 |date=May 2003 |pmid=12733128 |doi=10.1002/cncr.11345 |url=}}</ref>
 
* more common on the right side
* more common in the right side
* [[Solid]], white or grayish-withe [[Tumor|tumors]]
* Solid, withe od grayish-withe tumors
|-
| '''Embryonal Carcinoma'''||
* Unilateral, large [[mass]], averaging 17 cm <ref name="ShaabanRezvani2014">{{cite journal|last1=Shaaban|first1=Akram M.|last2=Rezvani|first2=Maryam|last3=Elsayes|first3=Khaled M.|last4=Baskin|first4=Henry|last5=Mourad|first5=Amr|last6=Foster|first6=Bryan R.|last7=Jarboe|first7=Elke A.|last8=Menias|first8=Christine O.|title=Ovarian Malignant Germ Cell Tumors: Cellular Classification and Clinical and Imaging Features|journal=RadioGraphics|volume=34|issue=3|year=2014|pages=777–801|issn=0271-5333|doi=10.1148/rg.343130067}}</ref>
* Smooth outer [[Surface area|surface]]
* Extensive area of [[necrosis]] and [[hemorrhage]]
|-
|-
|'''Endodermal sinus tumor or yolk sac tumors'''||
|'''Endodermal sinus tumor or yolk sac tumors'''||
* Mixed solid and cystic component<ref name="ShaabanRezvani2014">{{cite journal|last1=Shaaban|first1=Akram M.|last2=Rezvani|first2=Maryam|last3=Elsayes|first3=Khaled M.|last4=Baskin|first4=Henry|last5=Mourad|first5=Amr|last6=Foster|first6=Bryan R.|last7=Jarboe|first7=Elke A.|last8=Menias|first8=Christine O.|title=Ovarian Malignant Germ Cell Tumors: Cellular Classification and Clinical and Imaging Features|journal=RadioGraphics|volume=34|issue=3|year=2014|pages=777–801|issn=0271-5333|doi=10.1148/rg.343130067}}</ref>
* Mixed [[solid]] and [[cystic]] component<ref name="ShaabanRezvani2014">{{cite journal|last1=Shaaban|first1=Akram M.|last2=Rezvani|first2=Maryam|last3=Elsayes|first3=Khaled M.|last4=Baskin|first4=Henry|last5=Mourad|first5=Amr|last6=Foster|first6=Bryan R.|last7=Jarboe|first7=Elke A.|last8=Menias|first8=Christine O.|title=Ovarian Malignant Germ Cell Tumors: Cellular Classification and Clinical and Imaging Features|journal=RadioGraphics|volume=34|issue=3|year=2014|pages=777–801|issn=0271-5333|doi=10.1148/rg.343130067}}</ref>
* The solid portion is soft with grey to yellow color and areas of necrosis and/or hemorrhage
* The [[solid]] portion is soft with grey to yellow color and areas of [[necrosis]] and/or [[hemorrhage]]
* The cystic portion is in between solid components and result in a meshlike/honeycomb appearance
* The [[cystic]] portion is in between [[solid]] components and results in a meshlike/honeycomb [[appearance]]
* Unilateral and commonly affects the right ovary<ref name="KojimaharaNakahara2013">{{cite journal|last1=Kojimahara|first1=Takanobu|last2=Nakahara|first2=Kenji|last3=Takano|first3=Tadao|last4=Yaegashi|first4=Nobuo|last5=Nishiyama|first5=Hiroshi|last6=Fujimori|first6=Keiya|last7=Sato|first7=Naoki|last8=Terada|first8=Yukihiro|last9=Tase|first9=Toru|last10=Yokoyama|first10=Yoshihito|last11=Mizunuma|first11=Hideki|last12=Shoji|first12=Tadahiro|last13=Sugiyama|first13=Toru|last14=Kurachi|first14=Hirohisa|title=Yolk Sac Tumor of the Ovary: A Retrospective Multicenter Study of 33 Japanese Women by Tohoku Gynecologic Cancer Unit (TGCU)|journal=The Tohoku Journal of Experimental Medicine|volume=230|issue=4|year=2013|pages=211–217|issn=1349-3329|doi=10.1620/tjem.230.211}}</ref>
* Unilateral and commonly affects the right [[ovary]]<ref name="KojimaharaNakahara2013">{{cite journal|last1=Kojimahara|first1=Takanobu|last2=Nakahara|first2=Kenji|last3=Takano|first3=Tadao|last4=Yaegashi|first4=Nobuo|last5=Nishiyama|first5=Hiroshi|last6=Fujimori|first6=Keiya|last7=Sato|first7=Naoki|last8=Terada|first8=Yukihiro|last9=Tase|first9=Toru|last10=Yokoyama|first10=Yoshihito|last11=Mizunuma|first11=Hideki|last12=Shoji|first12=Tadahiro|last13=Sugiyama|first13=Toru|last14=Kurachi|first14=Hirohisa|title=Yolk Sac Tumor of the Ovary: A Retrospective Multicenter Study of 33 Japanese Women by Tohoku Gynecologic Cancer Unit (TGCU)|journal=The Tohoku Journal of Experimental Medicine|volume=230|issue=4|year=2013|pages=211–217|issn=1349-3329|doi=10.1620/tjem.230.211}}</ref>
|-
| '''Mixed germ cell tumors'''||
* Composed of more than one [[germ cell]] [[tumor]] element<ref name="ShaabanRezvani2014">{{cite journal|last1=Shaaban|first1=Akram M.|last2=Rezvani|first2=Maryam|last3=Elsayes|first3=Khaled M.|last4=Baskin|first4=Henry|last5=Mourad|first5=Amr|last6=Foster|first6=Bryan R.|last7=Jarboe|first7=Elke A.|last8=Menias|first8=Christine O.|title=Ovarian Malignant Germ Cell Tumors: Cellular Classification and Clinical and Imaging Features|journal=RadioGraphics|volume=34|issue=3|year=2014|pages=777–801|issn=0271-5333|doi=10.1148/rg.343130067}}</ref>
* Main components are:
** [[Dysgerminoma]]
** [[Teratoma]]
** [[Yolk sac tumor]]
* Other [[germ cell]] [[tumors]] may be present
|-
|-
| '''Embryonal Carcinoma'''||
| '''Polyembryoma'''||
* Unilateral, large mass, averaging 17 cm <ref name="ShaabanRezvani2014">{{cite journal|last1=Shaaban|first1=Akram M.|last2=Rezvani|first2=Maryam|last3=Elsayes|first3=Khaled M.|last4=Baskin|first4=Henry|last5=Mourad|first5=Amr|last6=Foster|first6=Bryan R.|last7=Jarboe|first7=Elke A.|last8=Menias|first8=Christine O.|title=Ovarian Malignant Germ Cell Tumors: Cellular Classification and Clinical and Imaging Features|journal=RadioGraphics|volume=34|issue=3|year=2014|pages=777–801|issn=0271-5333|doi=10.1148/rg.343130067}}</ref>
* Large, unilateral [[tumor]] with microcystic surface<ref name="OlivaYoung2014">{{cite journal|last1=Oliva|first1=Esther|last2=Young|first2=Robert H.|title=Germ cell tumours of the ovary: selected topics|journal=Diagnostic Histopathology|volume=20|issue=9|year=2014|pages=364–375|issn=17562317|doi=10.1016/j.mpdhp.2014.07.003}}</ref>
* Smooth outer surface
* Bulky [[appearance]]
* Extensive area of necrosis and hemorrhage
* Soft and reddish-brown color
* [[hemorrhage]] in cut [[Surface area|surfaces]]
|-
|-
| '''Teratoma'''||
| '''Teratoma'''||
'''Teratoma-mature'''
'''Teratoma-mature'''
* The majority are 5 to 10 cm in diameter.<ref name="Yayla AbideBostancı Ergen2018">{{cite journal|last1=Yayla Abide|first1=Çiğdem|last2=Bostancı Ergen|first2=Evrim|title=Retrospective analysis of mature cystic teratomas in a single center and review of the literature|journal=Journal of Turkish Society of Obstetric and Gynecology|volume=15|issue=2|year=2018|pages=95–98|issn=1307699X|doi=10.4274/tjod.86244}}</ref>
* The majority are 5 to 10 cm in diameter.<ref name="Yayla AbideBostancı Ergen2018">{{cite journal|last1=Yayla Abide|first1=Çiğdem|last2=Bostancı Ergen|first2=Evrim|title=Retrospective analysis of mature cystic teratomas in a single center and review of the literature|journal=Journal of Turkish Society of Obstetric and Gynecology|volume=15|issue=2|year=2018|pages=95–98|issn=1307699X|doi=10.4274/tjod.86244}}</ref>
* Unilocular in the magority of cases (88%)
* Unilocular in the majority of cases (88%)
* Predominantly cystic
* Predominantly [[cystic]]
* Cystic content may contain sebaseous material that is semiliquide in room temperature
* [[Cystic]] content may contain [[sebaceous]] material that is semi-liquid in [[room temperature]]
* Teeth may be found in Rokitansky’s protuberance - a well-defined, nipple-like structure covered with hair
* [[Teeth]] may be found in Rokitansky’s protuberance - a well-defined, [[nipple]]-like structure covered with [[hair]]
'''Teratoma-immature'''
'''Teratoma-immature'''
* Usually appear larger than mature teratomas<ref name="OutwaterSiegelman2001">{{cite journal|last1=Outwater|first1=Eric K.|last2=Siegelman|first2=Evan S.|last3=Hunt|first3=Jennifer L.|title=Ovarian Teratomas: Tumor Types and Imaging Characteristics|journal=RadioGraphics|volume=21|issue=2|year=2001|pages=475–490|issn=0271-5333|doi=10.1148/radiographics.21.2.g01mr09475}}</ref>
* Usually appear larger than mature [[Teratoma|teratomas]]<ref name="OutwaterSiegelman2001">{{cite journal|last1=Outwater|first1=Eric K.|last2=Siegelman|first2=Evan S.|last3=Hunt|first3=Jennifer L.|title=Ovarian Teratomas: Tumor Types and Imaging Characteristics|journal=RadioGraphics|volume=21|issue=2|year=2001|pages=475–490|issn=0271-5333|doi=10.1148/radiographics.21.2.g01mr09475}}</ref>
* May be solid or with a prominent solid element
* May be [[solid]] or with a prominent [[solid]] element
* Cystic cavities may be filled with serous or mucinous or fatty-sebaceous fluide.
* [[Cystic]] [[cavities]] may be filled with [[serous]] or [[mucinous]] or fatty-[[sebaceous]] fluid.
* Ths capsular component may not always be well-defined
* The [[Capsule|capsular]] component may not always be well-defined
'''Teratoma-monodermal'''
'''Teratoma-monodermal'''
* Struma ovarii: amber-colored thyroid tissue with areas of hemorrhage, necrosis, and fibrosis <ref name="OutwaterSiegelman2001">{{cite journal|last1=Outwater|first1=Eric K.|last2=Siegelman|first2=Evan S.|last3=Hunt|first3=Jennifer L.|title=Ovarian Teratomas: Tumor Types and Imaging Characteristics|journal=RadioGraphics|volume=21|issue=2|year=2001|pages=475–490|issn=0271-5333|doi=10.1148/radiographics.21.2.g01mr09475}}</ref>
* [[Struma ovarii]]: amber-colored [[thyroid]] [[tissue]] with areas of [[hemorrhage]], [[necrosis]], and [[fibrosis]] <ref name="OutwaterSiegelman2001">{{cite journal|last1=Outwater|first1=Eric K.|last2=Siegelman|first2=Evan S.|last3=Hunt|first3=Jennifer L.|title=Ovarian Teratomas: Tumor Types and Imaging Characteristics|journal=RadioGraphics|volume=21|issue=2|year=2001|pages=475–490|issn=0271-5333|doi=10.1148/radiographics.21.2.g01mr09475}}</ref>
* Carcinoid tumor: a solid mass
* [[Carcinoid tumors|Carcinoid tumor]]: a [[solid]] [[mass]]
|-
|-
|}
|}


==Microscopic Pathology==
==Microscopic Pathology==
{| {{table}}
{| {{table}} cellpadding="4" cellspacing="0" style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;"
| align="center" style="background: #4479BA;" | {{fontcolor|#FFF|''' Ovarian germ cell tumor subtype'''}}
| align="center" style="background: #4479BA;" | {{fontcolor|#FFF|''' Ovarian germ cell tumor subtype'''}}
| align="center" style="background: #4479BA;" | {{fontcolor|#FFF|'''Features on Histopathological Microscopic Analysis'''}}
| align="center" style="background: #4479BA;" | {{fontcolor|#FFF|'''Features on Histopathological Microscopic Analysis'''}}
Line 126: Line 137:
|-
|-
|''' Dysgerminomas'''||
|''' Dysgerminomas'''||
* large, uniform, clear cells arranged in sheets <ref name="ShaabanRezvani2014">{{cite journal|last1=Shaaban|first1=Akram M.|last2=Rezvani|first2=Maryam|last3=Elsayes|first3=Khaled M.|last4=Baskin|first4=Henry|last5=Mourad|first5=Amr|last6=Foster|first6=Bryan R.|last7=Jarboe|first7=Elke A.|last8=Menias|first8=Christine O.|title=Ovarian Malignant Germ Cell Tumors: Cellular Classification and Clinical and Imaging Features|journal=RadioGraphics|volume=34|issue=3|year=2014|pages=777–801|issn=0271-5333|doi=10.1148/rg.343130067}}</ref>
* large, uniform, clear [[cells]] arranged in sheets <ref name="ShaabanRezvani2014">{{cite journal|last1=Shaaban|first1=Akram M.|last2=Rezvani|first2=Maryam|last3=Elsayes|first3=Khaled M.|last4=Baskin|first4=Henry|last5=Mourad|first5=Amr|last6=Foster|first6=Bryan R.|last7=Jarboe|first7=Elke A.|last8=Menias|first8=Christine O.|title=Ovarian Malignant Germ Cell Tumors: Cellular Classification and Clinical and Imaging Features|journal=RadioGraphics|volume=34|issue=3|year=2014|pages=777–801|issn=0271-5333|doi=10.1148/rg.343130067}}</ref>
* Uniform cells has an "fried egg appearance"(large cytoplasm and small nucleus) that resemble primordial germ cells
* Uniform [[cells]] has an "fried egg [[appearance]]"(large [[cytoplasm]] and small [[nucleus]]) that resemble [[primordial germ cells]]
* The stroma contains lymphocytes and septa like components.
* The [[stroma]] contains [[lymphocytes]] and [[septa]] like components.
| [[File:Dysgerminoma.jpg|thumb|none|400px|Micrograph a seminoma, a tumor that is histologically indistinguishable from dysgerminoma.]]
| [[File:Dysgerminoma of the ovary.jpeg|thumb|none|400px|Contributed by CoRus13 in wikimedia.commons]]


|-
|'''Endodermal sinus tumor or yolk sac tumors'''||
* Schiller-Duval bodies (resemble renal glomeruli) - key feature <ref name="ShaabanRezvani2014">{{cite journal|last1=Shaaban|first1=Akram M.|last2=Rezvani|first2=Maryam|last3=Elsayes|first3=Khaled M.|last4=Baskin|first4=Henry|last5=Mourad|first5=Amr|last6=Foster|first6=Bryan R.|last7=Jarboe|first7=Elke A.|last8=Menias|first8=Christine O.|title=Ovarian Malignant Germ Cell Tumors: Cellular Classification and Clinical and Imaging Features|journal=RadioGraphics|volume=34|issue=3|year=2014|pages=777–801|issn=0271-5333|doi=10.1148/rg.343130067}}</ref>
| [[Image:800px-Mixed_germ_cell_tumour_-_high_mag.jpg|thumb|none|300px|Micrograph showing the yolk sac component of a mixed germ cell tumor.]]
|-
|-
|''' Embryonal carcinoma'''||
|''' Embryonal carcinoma'''||
* Pseudoglandular pattern of primiticve cells <ref name="ShaabanRezvani2014">{{cite journal|last1=Shaaban|first1=Akram M.|last2=Rezvani|first2=Maryam|last3=Elsayes|first3=Khaled M.|last4=Baskin|first4=Henry|last5=Mourad|first5=Amr|last6=Foster|first6=Bryan R.|last7=Jarboe|first7=Elke A.|last8=Menias|first8=Christine O.|title=Ovarian Malignant Germ Cell Tumors: Cellular Classification and Clinical and Imaging Features|journal=RadioGraphics|volume=34|issue=3|year=2014|pages=777–801|issn=0271-5333|doi=10.1148/rg.343130067}}</ref>
* Pseudoglandular pattern of [[Primitive (integral)|primitive]] [[cells]] <ref name="ShaabanRezvani2014">{{cite journal|last1=Shaaban|first1=Akram M.|last2=Rezvani|first2=Maryam|last3=Elsayes|first3=Khaled M.|last4=Baskin|first4=Henry|last5=Mourad|first5=Amr|last6=Foster|first6=Bryan R.|last7=Jarboe|first7=Elke A.|last8=Menias|first8=Christine O.|title=Ovarian Malignant Germ Cell Tumors: Cellular Classification and Clinical and Imaging Features|journal=RadioGraphics|volume=34|issue=3|year=2014|pages=777–801|issn=0271-5333|doi=10.1148/rg.343130067}}</ref>
* Nuclei are:
* [[Nuclei]] are:
** Large
** Large
** Croweded
** Croweded
** Pleomorphic
** Pleomorphic
** With prominent nucleoli
** With prominent [[nucleoli]]
| [[Image:800px-Embryonal_carcinoma_-_high_mag.jpg‎|300px|thumb|none| Embryonal carcinoma]]
| [[Image:800px-Embryonal_carcinoma_-_high_mag.jpg‎|300px|thumb|none| Contributed by Nephron in wikimedia.commons]]
|-
|'''Endodermal sinus tumor or yolk sac tumors'''||
* Schiller-Duval bodies (resemble renal [[glomeruli]]) - key feature <ref name="ShaabanRezvani2014">{{cite journal|last1=Shaaban|first1=Akram M.|last2=Rezvani|first2=Maryam|last3=Elsayes|first3=Khaled M.|last4=Baskin|first4=Henry|last5=Mourad|first5=Amr|last6=Foster|first6=Bryan R.|last7=Jarboe|first7=Elke A.|last8=Menias|first8=Christine O.|title=Ovarian Malignant Germ Cell Tumors: Cellular Classification and Clinical and Imaging Features|journal=RadioGraphics|volume=34|issue=3|year=2014|pages=777–801|issn=0271-5333|doi=10.1148/rg.343130067}}</ref>
| [[Image:800px-Mixed_germ_cell_tumour_-_high_mag.jpg|thumb|none|300px|Micrograph showing the yolk sac component of a mixed germ cell tumor. Contributed by Nephrone in wikimedia.commons]]
|-
|'''Polyemryoma'''||
* Usually as a part of mixed [[germ cell]] [[tumor]]<ref name="ShaabanRezvani2014">{{cite journal|last1=Shaaban|first1=Akram M.|last2=Rezvani|first2=Maryam|last3=Elsayes|first3=Khaled M.|last4=Baskin|first4=Henry|last5=Mourad|first5=Amr|last6=Foster|first6=Bryan R.|last7=Jarboe|first7=Elke A.|last8=Menias|first8=Christine O.|title=Ovarian Malignant Germ Cell Tumors: Cellular Classification and Clinical and Imaging Features|journal=RadioGraphics|volume=34|issue=3|year=2014|pages=777–801|issn=0271-5333|doi=10.1148/rg.343130067}}</ref>
* Contains small [[embryo]]-like bodies with central germ disks
* Germ disk [[cavity]] has two part:
** Embryonal carcinoma [[epithelia]]
** Two cavities:
*** [[Dorsal cavity]] that resembles the [[amniotic cavity]]
*** [[Ventral cavity]] that resembles the [[yolk sac]] cavity
| [[Image:TestispolyembryomaPerez37n.jpg|thumb|none|300px|Micrograph showing the embryoma component of a mixed germ cell tumor. Attributed by "courtesy of PathologyOutlines.com"]]
|-
|-
|'''Teratoma'''||
|'''Teratoma'''||
'''Mature teratoma'''
'''Mature teratoma'''
* The sections show ovarian parenchyma with a lesion consisting of benign dermal, gastrointestinal, and neural elements.<ref name= wpp>Mature teratoma. http://librepathology.org/wiki/index.php/Teratoma#Mature_teratoma. URL Accessed on November 12, 2015</ref>
* The sections show [[ovarian]] [[parenchyma]] with a [[lesion]] consisting of [[benign]] [[dermal]], [[gastrointestinal]], and [[neural]] elements.<ref name="wpp">Mature teratoma. http://librepathology.org/wiki/index.php/Teratoma#Mature_teratoma. URL Accessed on November 12, 2015</ref>
* The neural elements show focal degenerative changes with macrophages and giant cells  
* The [[neural]] elements show focal [[degenerative]] changes with [[macrophages]] and [[giant cells]]
* Siderophages are present.
* Siderophages are present.
* In general, mature teratoma usually appears as a well-established organization of tissues mimicking the relationship observed in normal organs such as:<ref name="pmid15761467">{{cite journal |vauthors=Ulbright TM |title=Germ cell tumors of the gonads: a selective review emphasizing problems in differential diagnosis, newly appreciated, and controversial issues |journal=Mod. Pathol. |volume=18 Suppl 2 |issue= |pages=S61–79 |date=February 2005 |pmid=15761467 |doi=10.1038/modpathol.3800310 |url=}}</ref>
* In general, mature [[teratoma]] usually appears as a well-established organization of [[tissues]] mimicking the relationship observed in normal organs such as:<ref name="pmid15761467">{{cite journal |vauthors=Ulbright TM |title=Germ cell tumors of the gonads: a selective review emphasizing problems in differential diagnosis, newly appreciated, and controversial issues |journal=Mod. Pathol. |volume=18 Suppl 2 |issue= |pages=S61–79 |date=February 2005 |pmid=15761467 |doi=10.1038/modpathol.3800310 |url=}}</ref>
** respiratory epithelial layer surrounded by smooth muscle and cartilage
** [[Respiratory epithelium|respiratory epithelial]] layer surrounded by [[smooth muscle]] and [[cartilage]]
* Usually, there is scant mitosis in the tumor cells usually limited to the normal proliferative zone of the body part that they produce.
* Usually, there is scant [[mitosis]] in the [[Tumor cell|tumor cells]] usually limited to the normal proliferative zone of the body part that they produce.
* No cytologic atypia is present.
* No [[Cytological|cytologic]] [[atypia]] is present.
* Different type of tissues may be observed in the mature teratomas of the ovary such as:
* Different type of tissues may be observed in the mature [[Teratoma|teratomas]] of the ovary such as:
**Choroid plexus
**[[Choroid plexus]]
**Thyroid tissues
**[[Thyroid]] tissues
**Pituitary tissues, although not commonly.<ref name="KallenbergPesce1991">{{cite journal|last1=Kallenberg|first1=GA|last2=Pesce|first2=CM|last3=Norman|first3=B|last4=Ratner|first4=RE|last5=Silverberg|first5=SG|title=Ectopic hyperprolactinemia resulting from an ovarian teratoma|journal=International Journal of Gynecology & Obstetrics|volume=34|issue=2|year=1991|pages=194–195|issn=00207292|doi=10.1016/0020-7292(91)90266-8}}</ref>
**[[Pituitary]] tissues, although not commonly.<ref name="KallenbergPesce1991">{{cite journal|last1=Kallenberg|first1=GA|last2=Pesce|first2=CM|last3=Norman|first3=B|last4=Ratner|first4=RE|last5=Silverberg|first5=SG|title=Ectopic hyperprolactinemia resulting from an ovarian teratoma|journal=International Journal of Gynecology & Obstetrics|volume=34|issue=2|year=1991|pages=194–195|issn=00207292|doi=10.1016/0020-7292(91)90266-8}}</ref>
***Rarely, they produce prolactin and is associated with prolactinoma.
***Rarely, they produce [[prolactin]] and is associated with [[prolactinoma]].
'''Immature teratoma'''
'''Immature teratoma'''
* Tissues originating from the two or three embroyanl layers are present.<ref name="ShaabanRezvani2014">{{cite journal|last1=Shaaban|first1=Akram M.|last2=Rezvani|first2=Maryam|last3=Elsayes|first3=Khaled M.|last4=Baskin|first4=Henry|last5=Mourad|first5=Amr|last6=Foster|first6=Bryan R.|last7=Jarboe|first7=Elke A.|last8=Menias|first8=Christine O.|title=Ovarian Malignant Germ Cell Tumors: Cellular Classification and Clinical and Imaging Features|journal=RadioGraphics|volume=34|issue=3|year=2014|pages=777–801|issn=0271-5333|doi=10.1148/rg.343130067}}</ref>
* [[Tissues]] originating from the two or three embryonal layers are present.<ref name="ShaabanRezvani2014">{{cite journal|last1=Shaaban|first1=Akram M.|last2=Rezvani|first2=Maryam|last3=Elsayes|first3=Khaled M.|last4=Baskin|first4=Henry|last5=Mourad|first5=Amr|last6=Foster|first6=Bryan R.|last7=Jarboe|first7=Elke A.|last8=Menias|first8=Christine O.|title=Ovarian Malignant Germ Cell Tumors: Cellular Classification and Clinical and Imaging Features|journal=RadioGraphics|volume=34|issue=3|year=2014|pages=777–801|issn=0271-5333|doi=10.1148/rg.343130067}}</ref>
* There is a mixture of mature and immature tissue (primitive cells).
* There is a mixture of mature and immature [[tissue]] (primitive cells).
* The presence of primitive elements is necessary to make the diagnosis.
* The presence of primitive elements is necessary to make the [[diagnosis]].
|[[File:Teratoma.jpg|thumb|none|300px|Teratoma]]
|[[File:Mature Cystic Teratoma of the Ovary Bone Tissue (4047143950).jpg|thumb|none|300px|Mature cystic teratoma of the ovary: Bone Tissue
Pathological and histological images courtesy of Ed Uthman at flickr. Contributed by wikimedia commons]]
|-
|-
|}
|}


==Immunohistochemistry==
==Immunohistochemistry==
===Dysgerminoma===
* [[Dysgerminoma]] is positive for:<ref name="PectasidesPectasides2008">{{cite journal|last1=Pectasides|first1=D.|last2=Pectasides|first2=E.|last3=Kassanos|first3=D.|title=Germ cell tumors of the ovary|journal=Cancer Treatment Reviews|volume=34|issue=5|year=2008|pages=427–441|issn=03057372|doi=10.1016/j.ctrv.2008.02.002}}</ref>
** OCT4 (this [[marker]] is a key [[diagnostic]] factor for the [[diagnosis]] of dysgerminoma)
===Embryonal carcinoma===
*These [[Tumor|tumors]] are positive for:<ref name="ShaabanRezvani2014">{{cite journal|last1=Shaaban|first1=Akram M.|last2=Rezvani|first2=Maryam|last3=Elsayes|first3=Khaled M.|last4=Baskin|first4=Henry|last5=Mourad|first5=Amr|last6=Foster|first6=Bryan R.|last7=Jarboe|first7=Elke A.|last8=Menias|first8=Christine O.|title=Ovarian Malignant Germ Cell Tumors: Cellular Classification and Clinical and Imaging Features|journal=RadioGraphics|volume=34|issue=3|year=2014|pages=777–801|issn=0271-5333|doi=10.1148/rg.343130067}}</ref>
** [[CD30]]
** EMA
** OCT3/4
===Endodermal sinus tumor===
* [[Yolk sac tumor|Yolk sac tumors]] are positive for:<ref name="PectasidesPectasides2008">{{cite journal|last1=Pectasides|first1=D.|last2=Pectasides|first2=E.|last3=Kassanos|first3=D.|title=Germ cell tumors of the ovary|journal=Cancer Treatment Reviews|volume=34|issue=5|year=2008|pages=427–441|issn=03057372|doi=10.1016/j.ctrv.2008.02.002}}</ref><ref name="CaoGuo2009">{{cite journal|last1=Cao|first1=Dengfeng|last2=Guo|first2=Shuangping|last3=Allan|first3=Robert W.|last4=Molberg|first4=Kyle H.|last5=Peng|first5=Yan|title=SALL4 Is a Novel Sensitive and Specific Marker of Ovarian Primitive Germ Cell Tumors and Is Particularly Useful in Distinguishing Yolk Sac Tumor From Clear Cell Carcinoma|journal=The American Journal of Surgical Pathology|volume=33|issue=6|year=2009|pages=894–904|issn=0147-5185|doi=10.1097/PAS.0b013e318198177d}}</ref>
** [[AFP]]
*** Absence of [[AFP]] does not exclude the [[diagnosis]].
** [[Cytokeratin]] (AE1/AE3)
** Placental-like [[alkaline phosphatase]] in 50% of the individuals.
** SALL4 ([[nuclear]]) in > 90% of the cases.
** GPC3
===Non-gestational chriocarcinoma===
*These [[tumors]] [[stain]] for [[keratins]] strongly.<ref name="pmid12548163">{{cite journal |vauthors=Ordi J, Romagosa C, Tavassoli FA, Nogales F, Palacin A, Condom E, Torné A, Cardesa A |title=CD10 expression in epithelial tissues and tumors of the gynecologic tract: a useful marker in the diagnosis of mesonephric, trophoblastic, and clear cell tumors |journal=Am. J. Surg. Pathol. |volume=27 |issue=2 |pages=178–86 |date=February 2003 |pmid=12548163 |doi= |url=}}</ref>
** AE1
** AE3
** CAM5
*[[Trophoblastic]] [[cells]] are positive for [[CD10]].
*[[Tumor]] may be positive for:
** GATA3 ([[nuclear]]) in 80% of the cases<ref name="BanetGown2015">{{cite journal|last1=Banet|first1=Natalie|last2=Gown|first2=Allen M.|last3=Shih|first3=Ie-Ming|last4=Kay Li|first4=Qing|last5=Roden|first5=Richard B.S.|last6=Nucci|first6=Marisa R.|last7=Cheng|first7=Liang|last8=Przybycin|first8=Christopher G.|last9=Nasseri-Nik|first9=Niloofar|last10=Wu|first10=Lee-Shu-Fune|last11=Netto|first11=George J.|last12=Ronnett|first12=Brigitte M.|last13=Vang|first13=Russell|title=GATA-3 Expression in Trophoblastic Tissues|journal=The American Journal of Surgical Pathology|volume=39|issue=1|year=2015|pages=101–108|issn=0147-5185|doi=10.1097/PAS.0000000000000315}}</ref>
** SALL4 ([[nuclear]]) in 70% of the cases<ref name="MiettinenWang2014">{{cite journal|last1=Miettinen|first1=Markku|last2=Wang|first2=Zengfeng|last3=McCue|first3=Peter A.|last4=Sarlomo-Rikala|first4=Maarit|last5=Rys|first5=Janusz|last6=Biernat|first6=Wojciech|last7=Lasota|first7=Jerzy|last8=Lee|first8=Yi-Shan|title=SALL4 Expression in Germ Cell and Non–Germ Cell Tumors|journal=The American Journal of Surgical Pathology|volume=38|issue=3|year=2014|pages=410–420|issn=0147-5185|doi=10.1097/PAS.0000000000000116}}</ref>
** PLAP and EMA in 50% of the cases<ref name="pmid2457424">{{cite journal |vauthors=Niehans GA, Manivel JC, Copland GT, Scheithauer BW, Wick MR |title=Immunohistochemistry of germ cell and trophoblastic neoplasms |journal=Cancer |volume=62 |issue=6 |pages=1113–23 |date=September 1988 |pmid=2457424 |doi= |url=}}</ref>
===Polyembryoma===
* [[Embryoid body]] of the [[tumor]] may be positive for Glypican3.<ref name="PredaNicolae2011">{{cite journal|last1=Preda|first1=Ovidiu|last2=Nicolae|first2=Alina|last3=Aneiros-Fernández|first3=José|last4=Borda|first4=Angela|last5=Nogales|first5=Francisco F|title=Glypican 3 is a sensitive, but not a specific, marker for the diagnosis of yolk sac tumours|journal=Histopathology|volume=58|issue=2|year=2011|pages=312–314|issn=03090167|doi=10.1111/j.1365-2559.2010.03735.x}}</ref>
===Teratoma===
===Teratoma===
* Usually, teratomas are diagnosed histologically and routine use of immunohistochemistry is not needed. However it may be needed in the diagnosis of immature and monodermal types.
* Usually, [[Teratoma|teratomas]] are [[Diagnose|diagnosed]] [[histologically]] and routine use of [[immunohistochemistry]] is not needed. However it may be needed in the [[diagnosis]] of immature and monodermal types.
* Neuronal elements of mature or immature teratomas are immunohistochemistically positive for:<ref name="TakayamaMatsumura2015">{{cite journal|last1=Takayama|first1=Yoshiyasu|last2=Matsumura|first2=Nozomi|last3=Nobusawa|first3=Sumihito|last4=Ikota|first4=Hayato|last5=Minegishi|first5=Takashi|last6=Yokoo|first6=Hideaki|title=Immunophenotypic features of immaturity of neural elements in ovarian teratoma|journal=Virchows Archiv|volume=468|issue=3|year=2015|pages=337–343|issn=0945-6317|doi=10.1007/s00428-015-1891-8}}</ref>
* [[Neuronal]] elements of mature or immature [[Teratoma|teratomas]] are positive for:<ref name="TakayamaMatsumura2015">{{cite journal|last1=Takayama|first1=Yoshiyasu|last2=Matsumura|first2=Nozomi|last3=Nobusawa|first3=Sumihito|last4=Ikota|first4=Hayato|last5=Minegishi|first5=Takashi|last6=Yokoo|first6=Hideaki|title=Immunophenotypic features of immaturity of neural elements in ovarian teratoma|journal=Virchows Archiv|volume=468|issue=3|year=2015|pages=337–343|issn=0945-6317|doi=10.1007/s00428-015-1891-8}}</ref>
** Glial fibrillary acidic protein (GFAP)
** [[Glial fibrillary acidic protein]] (GFAP)
** neuron specific enolase (NSE)
** neuron specific enolase (NSE)
** S-100
** [[S-100 protein|S-100]]
* Monodermal teratoma<ref name="OutwaterSiegelman2001">{{cite journal|last1=Outwater|first1=Eric K.|last2=Siegelman|first2=Evan S.|last3=Hunt|first3=Jennifer L.|title=Ovarian Teratomas: Tumor Types and Imaging Characteristics|journal=RadioGraphics|volume=21|issue=2|year=2001|pages=475–490|issn=0271-5333|doi=10.1148/radiographics.21.2.g01mr09475}}</ref>
* Monodermal [[teratoma]]<ref name="OutwaterSiegelman2001">{{cite journal|last1=Outwater|first1=Eric K.|last2=Siegelman|first2=Evan S.|last3=Hunt|first3=Jennifer L.|title=Ovarian Teratomas: Tumor Types and Imaging Characteristics|journal=RadioGraphics|volume=21|issue=2|year=2001|pages=475–490|issn=0271-5333|doi=10.1148/radiographics.21.2.g01mr09475}}</ref>
** Carcionid tumor may be positive for serotonin and hormonal peptides.
** [[Carcinoid tumors|Carcinoid tumor]] may be positive for [[serotonin]] and [[hormonal]] [[peptides]].
===Dysgerminoma===
* Dysgerminoma is positive for:<ref name="PectasidesPectasides2008">{{cite journal|last1=Pectasides|first1=D.|last2=Pectasides|first2=E.|last3=Kassanos|first3=D.|title=Germ cell tumors of the ovary|journal=Cancer Treatment Reviews|volume=34|issue=5|year=2008|pages=427–441|issn=03057372|doi=10.1016/j.ctrv.2008.02.002}}</ref>
** OCT4
 
===Yolk sac tumor===
* Yolk sac tumors are positive for:<ref name="PectasidesPectasides2008">{{cite journal|last1=Pectasides|first1=D.|last2=Pectasides|first2=E.|last3=Kassanos|first3=D.|title=Germ cell tumors of the ovary|journal=Cancer Treatment Reviews|volume=34|issue=5|year=2008|pages=427–441|issn=03057372|doi=10.1016/j.ctrv.2008.02.002}}</ref><ref name="CaoGuo2009">{{cite journal|last1=Cao|first1=Dengfeng|last2=Guo|first2=Shuangping|last3=Allan|first3=Robert W.|last4=Molberg|first4=Kyle H.|last5=Peng|first5=Yan|title=SALL4 Is a Novel Sensitive and Specific Marker of Ovarian Primitive Germ Cell Tumors and Is Particularly Useful in Distinguishing Yolk Sac Tumor From Clear Cell Carcinoma|journal=The American Journal of Surgical Pathology|volume=33|issue=6|year=2009|pages=894–904|issn=0147-5185|doi=10.1097/PAS.0b013e318198177d}}</ref>
** AFP
*** Absence of AFP does not exclude the diagnosis.
** Cytokeratin
** Placental-like alkaline phosphatase in 50% of the individuals.
** SALL4 (nuclear) in > 90% of the cases.
** GPC3


==References==
==References==

Latest revision as of 17:20, 26 March 2019

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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] Monalisa Dmello, M.B,B.S., M.D. [3]

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

Pathogenesis


 
 
 
 
 
 
 
Germ cell
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Pathogenesis
 
 
 
 
 
 
 
Malignant transformation
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Mature teratoma
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Tumors esxpressing transcription factors of pluripotency
 
Tumors with primitive embryonic ectoderm, mesoderm, and/or endoderm differentiation
 
Tumors with extraembroyonic differentiation
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Dysgerminoma/Embryonal carcinoma
 
Immature teratoma
 
Yolk sac tumor/Choriocarcinoma
 

Mature teratoma

Dysgerminoma

  • Bilateral invovlement occurs in 10% to 15% of the cases.
  • In < 15% of the affected cases, elements of other germ cell tumors can also be found.[6]

Yolk sac tumor

Genetics

Associated Conditions

Conditions associated with mature teratoma include:

Polyembryoma may be associated with Klinefelter syndrome.[13]

Gross Pathology

Ovarian germ cell tumor subtype Features on Gross Pathology
Dysgerminonma
  • Unilateral (bilateral in 10% to 20% of the cases)[14]
  • more common on the right side
  • Solid, white or grayish-withe tumors
Embryonal Carcinoma
Endodermal sinus tumor or yolk sac tumors
Mixed germ cell tumors
Polyembryoma
Teratoma

Teratoma-mature

  • The majority are 5 to 10 cm in diameter.[16]
  • Unilocular in the majority of cases (88%)
  • Predominantly cystic
  • Cystic content may contain sebaceous material that is semi-liquid in room temperature
  • Teeth may be found in Rokitansky’s protuberance - a well-defined, nipple-like structure covered with hair

Teratoma-immature

Teratoma-monodermal

Microscopic Pathology

Ovarian germ cell tumor subtype Features on Histopathological Microscopic Analysis Image
Dysgerminomas
Contributed by CoRus13 in wikimedia.commons
Embryonal carcinoma
Contributed by Nephron in wikimedia.commons
Endodermal sinus tumor or yolk sac tumors
  • Schiller-Duval bodies (resemble renal glomeruli) - key feature [8]
Micrograph showing the yolk sac component of a mixed germ cell tumor. Contributed by Nephrone in wikimedia.commons
Polyemryoma
Micrograph showing the embryoma component of a mixed germ cell tumor. Attributed by "courtesy of PathologyOutlines.com"
Teratoma

Mature teratoma

Immature teratoma

  • Tissues originating from the two or three embryonal layers are present.[8]
  • There is a mixture of mature and immature tissue (primitive cells).
  • The presence of primitive elements is necessary to make the diagnosis.
Mature cystic teratoma of the ovary: Bone Tissue Pathological and histological images courtesy of Ed Uthman at flickr. Contributed by wikimedia commons

Immunohistochemistry

Dysgerminoma

Embryonal carcinoma

Endodermal sinus tumor

Non-gestational chriocarcinoma

Polyembryoma

Teratoma

References

  1. ↑ 1.0 1.1 El-Maarri, Osman; Rijlaarsdam, Martin A.; Tax, David M. J.; Gillis, Ad J. M.; Dorssers, Lambert C. J.; Koestler, Devin C.; de Ridder, Jeroen; Looijenga, Leendert H. J. (2015). "Genome Wide DNA Methylation Profiles Provide Clues to the Origin and Pathogenesis of Germ Cell Tumors". PLOS ONE. 10 (4): e0122146. doi:10.1371/journal.pone.0122146. ISSN 1932-6203.
  2. ↑ Carcangiu, M. L. (2014). WHO Classification of Tumours of Female Reproductive Organs. Lyon: International Agency for Research on Cancer. ISBN 978-92-832-4487-5.
  3. ↑ 3.0 3.1 Vural, F.; Vural, B.; Paksoy, N. (2015). "Vaginal teratoma: A case report and review of the literature". Journal of Obstetrics and Gynaecology. 35 (7): 757–758. doi:10.3109/01443615.2015.1004525. ISSN 0144-3615.
  4. ↑ Linder, David; McCaw, Barbara Kaiser; Hecht, Frederick (1975). "Parthenogenic Origin of Benign Ovarian Teratomas". New England Journal of Medicine. 292 (2): 63–66. doi:10.1056/NEJM197501092920202. ISSN 0028-4793.
  5. ↑ AL Husaini, Hamed; Soudy, Hussein; Darwish, Alaa El Din; Ahmed, Mohamed; Eltigani, Amin; AL Mubarak, Mustafa; Sabaa, Amal Abu; Edesa, Wael; AL-Tweigeri, Taher; Al-Badawi, Ismail A. (2012). "Pure dysgerminoma of the ovary: a single institutional experience of 65 patients". Medical Oncology. 29 (4): 2944–2948. doi:10.1007/s12032-012-0194-z. ISSN 1357-0560.
  6. ↑ Gordon A, Lipton D, Woodruff JD (October 1981). "Dysgerminoma: a review of 158 cases from the Emil Novak Ovarian Tumor Registry". Obstet Gynecol. 58 (4): 497–504. PMID 7279343.
  7. ↑ Young, Robert H. (2014). "The Yolk Sac Tumor". International Journal of Surgical Pathology. 22 (8): 677–687. doi:10.1177/1066896914558265. ISSN 1066-8969.
  8. ↑ 8.0 8.1 8.2 8.3 8.4 8.5 8.6 8.7 8.8 8.9 Shaaban, Akram M.; Rezvani, Maryam; Elsayes, Khaled M.; Baskin, Henry; Mourad, Amr; Foster, Bryan R.; Jarboe, Elke A.; Menias, Christine O. (2014). "Ovarian Malignant Germ Cell Tumors: Cellular Classification and Clinical and Imaging Features". RadioGraphics. 34 (3): 777–801. doi:10.1148/rg.343130067. ISSN 0271-5333.
  9. ↑ 9.0 9.1 Kojimahara, Takanobu; Nakahara, Kenji; Takano, Tadao; Yaegashi, Nobuo; Nishiyama, Hiroshi; Fujimori, Keiya; Sato, Naoki; Terada, Yukihiro; Tase, Toru; Yokoyama, Yoshihito; Mizunuma, Hideki; Shoji, Tadahiro; Sugiyama, Toru; Kurachi, Hirohisa (2013). "Yolk Sac Tumor of the Ovary: A Retrospective Multicenter Study of 33 Japanese Women by Tohoku Gynecologic Cancer Unit (TGCU)". The Tohoku Journal of Experimental Medicine. 230 (4): 211–217. doi:10.1620/tjem.230.211. ISSN 1349-3329.
  10. ↑ 10.0 10.1 10.2 Kraggerud SM, Szymanska J, Abeler VM, Kaern J, Eknaes M, Heim S, Teixeira MR, Tropé CG, Peltomäki P, Lothe RA (June 2000). "DNA copy number changes in malignant ovarian germ cell tumors". Cancer Res. 60 (11): 3025–30. PMID 10850452.
  11. ↑ Dalmau, Josep; Gleichman, Amy J; Hughes, Ethan G; Rossi, Jeffrey E; Peng, Xiaoyu; Lai, Meizan; Dessain, Scott K; Rosenfeld, Myrna R; Balice-Gordon, Rita; Lynch, David R (2008). "Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodies". The Lancet Neurology. 7 (12): 1091–1098. doi:10.1016/S1474-4422(08)70224-2. ISSN 1474-4422.
  12. ↑ 12.0 12.1 Kallenberg, GA; Pesce, CM; Norman, B; Ratner, RE; Silverberg, SG (1991). "Ectopic hyperprolactinemia resulting from an ovarian teratoma". International Journal of Gynecology & Obstetrics. 34 (2): 194–195. doi:10.1016/0020-7292(91)90266-8. ISSN 0020-7292.
  13. ↑ Beresford L, Fernandez CV, Cummings E, Sanderson S, Ming-Yu W, Giacomantonio M (April 2003). "Mediastinal polyembryoma associated with Klinefelter syndrome". J. Pediatr. Hematol. Oncol. 25 (4): 321–3. PMID 12679648.
  14. ↑ Chen VW, Ruiz B, Killeen JL, Coté TR, Wu XC, Correa CN (May 2003). "Pathology and classification of ovarian tumors". Cancer. 97 (10 Suppl): 2631–42. doi:10.1002/cncr.11345. PMID 12733128.
  15. ↑ Oliva, Esther; Young, Robert H. (2014). "Germ cell tumours of the ovary: selected topics". Diagnostic Histopathology. 20 (9): 364–375. doi:10.1016/j.mpdhp.2014.07.003. ISSN 1756-2317.
  16. ↑ Yayla Abide, Çiğdem; Bostancı Ergen, Evrim (2018). "Retrospective analysis of mature cystic teratomas in a single center and review of the literature". Journal of Turkish Society of Obstetric and Gynecology. 15 (2): 95–98. doi:10.4274/tjod.86244. ISSN 1307-699X.
  17. ↑ 17.0 17.1 17.2 Outwater, Eric K.; Siegelman, Evan S.; Hunt, Jennifer L. (2001). "Ovarian Teratomas: Tumor Types and Imaging Characteristics". RadioGraphics. 21 (2): 475–490. doi:10.1148/radiographics.21.2.g01mr09475. ISSN 0271-5333.
  18. ↑ Mature teratoma. http://librepathology.org/wiki/index.php/Teratoma#Mature_teratoma. URL Accessed on November 12, 2015
  19. ↑ Ulbright TM (February 2005). "Germ cell tumors of the gonads: a selective review emphasizing problems in differential diagnosis, newly appreciated, and controversial issues". Mod. Pathol. 18 Suppl 2: S61–79. doi:10.1038/modpathol.3800310. PMID 15761467.
  20. ↑ 20.0 20.1 Pectasides, D.; Pectasides, E.; Kassanos, D. (2008). "Germ cell tumors of the ovary". Cancer Treatment Reviews. 34 (5): 427–441. doi:10.1016/j.ctrv.2008.02.002. ISSN 0305-7372.
  21. ↑ Cao, Dengfeng; Guo, Shuangping; Allan, Robert W.; Molberg, Kyle H.; Peng, Yan (2009). "SALL4 Is a Novel Sensitive and Specific Marker of Ovarian Primitive Germ Cell Tumors and Is Particularly Useful in Distinguishing Yolk Sac Tumor From Clear Cell Carcinoma". The American Journal of Surgical Pathology. 33 (6): 894–904. doi:10.1097/PAS.0b013e318198177d. ISSN 0147-5185.
  22. ↑ Ordi J, Romagosa C, Tavassoli FA, Nogales F, Palacin A, Condom E, Torné A, Cardesa A (February 2003). "CD10 expression in epithelial tissues and tumors of the gynecologic tract: a useful marker in the diagnosis of mesonephric, trophoblastic, and clear cell tumors". Am. J. Surg. Pathol. 27 (2): 178–86. PMID 12548163.
  23. ↑ Banet, Natalie; Gown, Allen M.; Shih, Ie-Ming; Kay Li, Qing; Roden, Richard B.S.; Nucci, Marisa R.; Cheng, Liang; Przybycin, Christopher G.; Nasseri-Nik, Niloofar; Wu, Lee-Shu-Fune; Netto, George J.; Ronnett, Brigitte M.; Vang, Russell (2015). "GATA-3 Expression in Trophoblastic Tissues". The American Journal of Surgical Pathology. 39 (1): 101–108. doi:10.1097/PAS.0000000000000315. ISSN 0147-5185.
  24. ↑ Miettinen, Markku; Wang, Zengfeng; McCue, Peter A.; Sarlomo-Rikala, Maarit; Rys, Janusz; Biernat, Wojciech; Lasota, Jerzy; Lee, Yi-Shan (2014). "SALL4 Expression in Germ Cell and Non–Germ Cell Tumors". The American Journal of Surgical Pathology. 38 (3): 410–420. doi:10.1097/PAS.0000000000000116. ISSN 0147-5185.
  25. ↑ Niehans GA, Manivel JC, Copland GT, Scheithauer BW, Wick MR (September 1988). "Immunohistochemistry of germ cell and trophoblastic neoplasms". Cancer. 62 (6): 1113–23. PMID 2457424.
  26. ↑ Preda, Ovidiu; Nicolae, Alina; Aneiros-Fernández, José; Borda, Angela; Nogales, Francisco F (2011). "Glypican 3 is a sensitive, but not a specific, marker for the diagnosis of yolk sac tumours". Histopathology. 58 (2): 312–314. doi:10.1111/j.1365-2559.2010.03735.x. ISSN 0309-0167.
  27. ↑ Takayama, Yoshiyasu; Matsumura, Nozomi; Nobusawa, Sumihito; Ikota, Hayato; Minegishi, Takashi; Yokoo, Hideaki (2015). "Immunophenotypic features of immaturity of neural elements in ovarian teratoma". Virchows Archiv. 468 (3): 337–343. doi:10.1007/s00428-015-1891-8. ISSN 0945-6317.

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