Ovarian germ cell tumor pathophysiology: Difference between revisions

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==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 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>
*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>
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* Bulky [[appearance]]
* Bulky [[appearance]]
* Soft and reddish-brown color
* Soft and reddish-brown color
* [[hemorrhage]] in cut surfaces
* [[hemorrhage]] in cut [[Surface area|surfaces]]
|-
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| '''Teratoma'''||
| '''Teratoma'''||
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* Unilocular in the majority of cases (88%)
* Unilocular in the majority of cases (88%)
* Predominantly [[cystic]]
* Predominantly [[cystic]]
* [[Cystic]] content may contain sebaceous material that is semi-liquid 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]] fluid.
* [[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]]
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** Embryonal carcinoma [[epithelia]]
** Embryonal carcinoma [[epithelia]]
** Two cavities:
** Two cavities:
*** Dorsal cavity that resembles the amniotic cavity
*** [[Dorsal cavity]] that resembles the [[amniotic cavity]]
*** Ventral cavity that resembles the [[yolk sac]] cavity
*** [[Ventral cavity]] that resembles the [[yolk sac]] cavity
|  
|  
|-
|-
|'''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:Teratoma.jpg|thumb|none|300px|Teratoma]]
|-
|-
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==Immunohistochemistry==
==Immunohistochemistry==
===Dysgerminoma===
===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>
* [[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)
** OCT4 (this [[marker]] is a key [[diagnostic]] factor for the [[diagnosis]] of dysgerminoma)
===Embryonal carcinoma===
===Embryonal carcinoma===
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** OCT3/4
** OCT3/4
===Endodermal sinus tumor===
===Endodermal sinus tumor===
* Yolk sac [[Tumor|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>
* [[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]]
** [[AFP]]
*** Absence of AFP does not exclude the [[diagnosis]].
*** Absence of [[AFP]] does not exclude the [[diagnosis]].
** [[Cytokeratin]] (AE1/AE3)
** [[Cytokeratin]] (AE1/AE3)
** Placental-like alkaline phosphatase in 50% of the individuals.
** Placental-like [[alkaline phosphatase]] in 50% of the individuals.
** SALL4 ([[nuclear]]) in > 90% of the cases.
** SALL4 ([[nuclear]]) in > 90% of the cases.
** GPC3
** GPC3
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** AE3  
** AE3  
** CAM5
** CAM5
*Trophoblastic cells are positive for CD10.
*[[Trophoblastic]] [[cells]] are positive for [[CD10]].
*Tumor may be positive for:
*[[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>
** 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>
** 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>
** 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===
===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>
* [[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 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]].


==References==
==References==

Revision as of 20:07, 14 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

Physiology

The normal physiology of [name of process] can be understood as follows:

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

Yolk sac tumor

Genetics

Associated Conditions

Conditions associated with mature teratoma include:

Gross Pathology

Ovarian germ cell tumor subtype Features on Gross Pathology
Dysgerminonma
  • Unilateral (bilateral in 10% to 20% of the cases)[13]
  • 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.[15]
  • 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
Micrograph a seminoma, a tumor that is histologically indistinguishable from dysgerminoma.
Embryonal carcinoma
Embryonal carcinoma
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.
Polyemryoma
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.
Teratoma

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. ↑ 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 (December 2012). "Pure dysgerminoma of the ovary: a single institutional experience of 65 patients". Med. Oncol. 29 (4): 2944–8. doi:10.1007/s12032-012-0194-z. PMID 22407668. Vancouver style error: missing comma (help)
  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. ↑ Chen, Vivien W.; Ruiz, Bernardo; Killeen, Jeffrey L.; Cot�, Timothy R.; Wu, Xiao Cheng; Correa, Catherine N.; Howe, Holly L. (2003). "Pathology and classification of ovarian tumors". Cancer. 97 (S10): 2631–2642. doi:10.1002/cncr.11345. ISSN 0008-543X. replacement character in |last4= at position 4 (help)
  14. ↑ 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.
  15. ↑ 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.
  16. ↑ 16.0 16.1 16.2 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.
  17. ↑ Mature teratoma. http://librepathology.org/wiki/index.php/Teratoma#Mature_teratoma. URL Accessed on November 12, 2015
  18. ↑ 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.
  19. ↑ 19.0 19.1 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.
  20. ↑ 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.
  21. ↑ 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.
  22. ↑ 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.
  23. ↑ 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.
  24. ↑ 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.
  25. ↑ 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.
  26. ↑ 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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