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Dysgerminoma : Intro & Gross

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Clinical: Dysgerminoma accounts for about 33% of all malignant germ cell tumors of the ovary (2nd most common after immature teratoma). It comprises only 1-2% of all ovarian cancers. Most patients are children or young women with an average age of 22 years. The usual presentation is with a rapidly growing abdominal mass and pelvic pain. Symptoms may simulate pregnancy. Majority of cases (two-thirds) are Stage IA at presentation (tumor limited to one ovary with intact capsule or one fallopian tube surface; no malignant cells in ascites or peritoneal washings). Involvement of the contralateral ovary is seen grossly (10% of cases) or microscopically (another 10% of cases).

Serum Tumor Markers: LDH levels are usually elevated. About 3-5% of dysgerminomas produce hCG causing estrogenic symptoms (irregular menstruation, isosexual pseudoprecocity, pseudopregnancy) or rarely androgenic symptoms. Serum levels of CA-125, PLAP, and NSE may be elevated.

Gross: Dysgerminomas are large (average size 15 cm), lobulated, solid, soft fleshy tumors with yellow-tan or gray-white appearance. The cut surface shows areas of cystic change, hemorrhage and necrosis. The tumors arising in a background of gonadoblastoma often show calcification.

The image shows dysgerminoma of the ovary in a 39 y/o female. Image copyright: pathorama.ch

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