Ovarian germ cell tumor pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Monalisa Dmello, M.B,B.S., M.D. [2]

Dysgerminomas

• On gross examination,
• dysgerminomas present with a smooth, bosselated (knobby) external surface, and is soft, fleshy and either cream-coloured, gray, pink or tan when cut.
• Microscopic examination
• typically reveals uniform cells that resemble primordial germ cells. Typically, thestroma contains lymphocytes and about 20% of patients have sarcoid-like granulomas.

EST can have a multitude of morphologic patterns including: reticular, endodermal sinus-like, microcystic, papillary, solid, glandular, alveolar, polyvesicular vitelline, enteric and hepatoid. Schiller-Duval bodies on histology are pathognomonic and seen in the context of the endodermal sinus-like pattern.

The gross examination usually shows a two to three centimetre pale grey, poorly defined tumour with associated haemorrhage and necrosis. The microscopic features include: indistinct cell borders, mitoses, a variable architecture (tubulopapillary, glandular, solid, embryoid bodies - ball of cells surrounded by empty space on three sides), nuclear overlap, and necrosis. Solid (55%), glandular (17%), and papillary (11%) are the most common primary patterns (predominant architectural pattern occupying at least 50%). Other less common primary patterns included nested (3%), micropapillary (2%), anastomosing glandular (1%), sieve-like glandular (<1%), pseudopapillary (<1%), and blastocyst-like (<1%).

Gross Patholgy

Ovarian germ cell tumor subtype	Features on Gross Pathology
Dysgerminoma	They present with a smooth, bosselated (knobby) external surface, and is soft, fleshy and either cream-coloured, gray, pink or tan when cut
Endodermal sinus tumor or yolk sac tumors	Mean 15 cm, smooth and glistening external surface, cystic cut surface with hemorrhage and necrosis
Embryonal Carcinoma	* A poorly defined, pale grey tumor with associated haemorrhage and necrosis.
Teratoma	Teratoma-mature Solid or cystic Cystic content may contain greasy material composed of keratin, hair and teeth Teeth may be found in Rokitansky’s protuberance - a well-defined, nipple-like structure covered with hair
Choriocarcinoma	Hemorrhagic, soft, tan with necrosis http://www.pathologyoutlines.com/topic/ovarytumorchorio.html

Microscopic Pathology

Ovarian germ cell tumor subtype	Features on Histopathological Microscopic Analysis	Image
Dysgerminomas	Uniform cells that resemble primordial germ cells The stroma contains lymphocytes and about 20% of patients have sarcoid-like granulomas	Squamous cell carcinoma of vulva
Endodermal sinus tumor or yolk sac tumors	Basaloid cells - similar in appearance to basal cells Moderate blue/grey cytoplasm. Dark ovoid/ellipsoid nucleus with uniform chromatin Palisading of cells at the edge of the cell nests Artefactual separation of cells (forming the nests) from the underlying stroma - key feature Surrounded by blue (myxoid) stroma - key feature	Basal cell carcinoma of vulva
Embryonal Carcinoma	Presence of intraepidermal lateral spread (most characteristic feature) Dermal invasion Desmoplasia Epidermal hyperplasia Appearance of epithelioid cells with occasional spindle cells	Vulvar melanoma |-	Teratoma
Choriocarcinoma