title: Ovarian malignant germ cell tumors: cellular classification and clinical and imaging features.
abstract: Ovarian malignant germ cell tumors (OMGCTs) are heterogeneous tumors that are derived from the primitive germ cells of the embryonic gonad. OMGCTs are rare, accounting for about 2.6% of all ovarian malignancies, and typically manifest in adolescence, usually with abdominal pain, a palpable mass, and elevated serum tumor marker levels, which may serve as an adjunct in the initial diagnosis, monitoring during therapy, and posttreatment surveillance. Dysgerminoma, the most common malignant germ cell tumor, usually manifests as a solid mass. Immature teratomas manifest as a solid mass with scattered foci of fat and calcifications. Yolk sac tumors usually manifest as a mixed solid and cystic mass. Capsular rupture or the bright dot sign, a result of increased vascularity and the formation of small vascular aneurysms, may be present. Embryonal carcinomas and polyembryomas rarely manifest in a pure form and are more commonly part of a mixed germ cell tumor. Some OMGCTs have characteristic features that allow a diagnosis to be confidently made, whereas others have nonspecific features, which make them difficult to diagnose. However, imaging features, the patient's age at presentation, and tumor markers may help establish a reasonable differential diagnosis. Malignant ovarian germ cell tumors spread in the same manner as epithelial ovarian neoplasms but are more likely to involve regional lymph nodes. Preoperative imaging may depict local extension, peritoneal disease, and distant metastases. Suspicious areas may be sampled during surgery. Because OMGCTs are almost always unilateral and are chemosensitive, fertility-sparing surgery is the standard of care.
authors.affiliation: From the Department of Diagnostic Radiology (A.M.S., M.R.) and Department of Radiology, Primary Children's Medical Center (H.B.), University of Utah, 30 N 1900 E, Room 1A71, Salt Lake City, UT 84132; Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Diagnostic Radiology, VA Pittsburgh Healthcare System, Pittsburgh, Pa (A.M.); Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Ore (B.R.F.); Department of Pathology, University of Utah School of Medicine, Salt Lake City, Utah (E.A.J.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.).
authors.forename: Akram M
authors.initials: AM
authors.lastname: Shaaban
authors.forename: Maryam
authors.initials: M
authors.lastname: Rezvani
authors.forename: Khaled M
authors.initials: KM
authors.lastname: Elsayes
authors.forename: Henry
authors.initials: H
authors.lastname: Baskin
authors.forename: Amr
authors.initials: A
authors.lastname: Mourad
authors.forename: Bryan R
authors.initials: BR
authors.lastname: Foster
authors.forename: Elke A
authors.initials: EA
authors.lastname: Jarboe
authors.forename: Christine O
authors.initials: CO
authors.lastname: Menias
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000970:Antineoplastic Agents / Q000627:therapeutic use; D014408:Biomarkers, Tumor; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000032:analysis; D003131:Combined Modality Therapy; D003952:Diagnostic Imaging / Q000379:methods*; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging / Q000379:methods; D008875:Middle Aged; D009373:Neoplasms, Germ Cell and Embryonal / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology / Q000628:therapy; D010051:Ovarian Neoplasms / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology / Q000628:therapy; D010534:Peritoneal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000175:diagnosis; D011379:Prognosis; D014057:Tomography, X-Ray Computed; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor; D018997:Chorionic Gonadotropin, beta Subunit, Human; D000509:alpha-Fetoproteins