Pediatric Ovarian Dysgerminoma

  • Etiology: Germ cell tumor of ovary
  • Imaging:
    — Solid lobulated vascular mass with fibrovascular septa
    — Bilateral disease in 10-15%
  • DDX:
  • Complications:
  • Treatment: Surgical
  • Clinical:
    — Elevated LDH is tumor marker but 5% are B-hCG positive
    — Most common germ cell tumor of ovary (second most common is yolk sac tumor which has elevated AFP)
    — Second most common malignant germ cell tumor – 33% of malignant germ cell tumors
    — Seen in adolescence and early adulthood with 41% from 10-19 years and 41% from 20-29 years

Radiology Cases of Ovarian Dysgerminoma

US and CT of ovarian dysgerminoma with torsion
Transverse and sagittal US of the pelvis (above) shows an echogenic and inhomgenous solid mass superior to the bladder. Neither ovary could be visualized. Axial CT with contrast of the abdomen shows a solid non-enhancing midline mass. The mass was found to be tossed in the operating room.

Surgery Cases of Ovarian Dysgerminoma

Surgical image of ovarian dysgerminoma causing ovarian torsion
Surgical image (above) shows a mass arising from the left ovary. Surgical image (below) shows the left adnexal pedicle to be twisted in the center of the image. The mass and the left ovary and the fallopian tube were found to be torsed.

Gross Pathology Cases of Ovarian Dysgerminoma

Gross pathology image of ovarian dysgerminoma
The surgical specimen measured 11 x 8 x 5 cm in size and was oval in shape with a tan outer surface. The lesion was soft but solid with extensive hemorrhage and necrosis. Gross pathological image of the cut specimen shows extensive hemorrhage and necrosis.

Histopathology Cases of Ovarian Dysgerminoma

Histopathology image of ovarian dysgerminoma
Histopathological image H&E stained section shows a largely necrotic tumor comprised of sheets of relatively uniform cells and scattered lymphocytes. Around rare blood vessels, a few viable neoplastic cells were characterized by prominent nucleoli and abundant cytoplasm.
Histopathology image of ovarian dysgerminoma
Histopathological image H&E stained section shows a largely necrotic tumor comprised of sheets of relatively uniform cells and scattered lymphocytes. Around rare blood vessels, a few viable neoplastic cells were characterized by prominent nucleoli and abundant cytoplasm.
Histopathology image of ovarian dysgerminoma
Histopathological image H&E stained section shows the uniformity of the neoplastic cells with prominent nucleoli and abundant, clear cytoplasm; scattered small clusters of lymphocytes are present.