eMedicine Specialties > Obstetrics and Gynecology > Gynecologic Oncology

Ovarian Dysgerminomas

Author: Allan Y Wu, MD, Director, The Midwest Women's Specialty Group; Adjunct Clinical Professor, Department of Molecular Biology, The Terre Haute Center for Medical Education, Indiana University School of Medicine
Coauthor(s): Chad M Michener, MD, Assistant Professor, Obstetrics/ Gynecology and Women's Health Institute, Section of Gynecologic Oncology, The Cleveland Clinic
Contributor Information and Disclosures

Updated: Oct 7, 2008

Introduction

Background

The 3 major types of ovarian tumors are epithelial, sex cord, and germ cell. Epithelial cell tumors represent the majority of all ovarian neoplasms (82%). Conversely, germ cell tumors (GCTs) are rare, comprising approximately 20% of all ovarian tumors, both benign and malignant. Approximately 3-5% of ovarian GCTs are malignant. The most commonly occurring GCT is the dysgerminoma, which accounts for only 1-5% of all ovarian cancers.

Although rare, dysgerminomas are important irrespective of incidence because they affect women of reproductive age (ie, <30 y). In fact, dysgerminomas make up two thirds of all malignant ovarian neoplasms in women younger than 20 years. Moreover, once diagnosed, dysgerminomas respond highly to the prescribed treatments, rescuing patients from infertility and early mortality.

Pathophysiology

Typically, germ cells are encapsulated at birth within the primordial follicle. If they somehow escape encapsulation, cell death usually occurs. If the germ cells survive, rapid growth ensues because no cellular contexts can provide normal contact inhibition, hence GCT formation. All dysgerminomas are considered malignant, but only one third of dysgerminomas behave aggressively. The exact etiology of dysgerminomas has not been determined.

Frequency

United States

The incidence of dysgerminomas has remained unchanged over the last 30 years.

The frequencies of the most common malignant ovarian neoplasms in women of reproductive age are as follows: epithelial (42%); dysgerminoma and other GCTs (30%); metastatic Krukenberg (14%); and sex cord stromal, ie, Sertoli-Leydig cell tumors ([SLCT] 13%).

International

No data are available.

Mortality/Morbidity

The 5-year survival rate is 96% if the tumor is confined to the ovary and 63% if extension occurs beyond the ovaries. Pregnancy does not alter the prognosis of most ovarian malignancies, but complications such as torsion and rupture may increase the incidence of spontaneous abortion or preterm delivery.

Race

To date, no racial predilection exists for ovarian germ cell tumors.

Sex

These tumors mostly occur in women, although the disease also occurs in pseudohermaphrodites and patients with gonadal dysgenesis (see Medical/Legal Pitfalls). Testicular seminomas are the male histologic counterparts to dysgerminomas.

Age

Although most ovarian cancers occur during the menopausal and perimenopausal years (ie, 50-59 y), dysgerminomas tend to occur frequently in the pediatric population. Dysgerminomas are most commonly observed in younger women. Seventy-five percent of dysgerminomas occur in patients in the third and fourth decades of life, with the mean age being 22 years.

Clinical

History

No specific symptoms are diagnostic of dysgerminoma tumors. Many of the presenting symptoms are universal for any adnexal/ovarian mass.

• Most common presenting symptoms include the following:
  • Pelvic fullness
  • Pain
  • Early satiety
  • Urinary frequency
  • Dysuria
• Vague abdominal symptoms (eg, dyspepsia, digestive disturbances) are less common.
• These tumors usually present as a unilateral mass and can occur during pregnancy.

Physical

The physical examination should include a thorough abdominal and pelvic examination on a gynecology table with stirrups. The examiner also must perform a careful rectovaginal examination because some enlarged adnexal masses can be detected from this approach.

Causes

The exact etiology for this tumor type has not been elucidated.

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