Anaplastic dysgerminoma

Abstract

A rare case of rapidly evolving dysgerminma produced death by tumor in less than two months after onset of symptoms. It is important to recall that dysgerminoma possesses considerable malignant potential, which infrequently is manifested by rapidly progressive disease. Certain risk factors, present in the pathological specimen, serve to indicate the aggressive potential of such neoplasms.Cancer 42:1886-1889, 1978.T IS WELL KNOWN that ovarian germinoma I (dysgerminoma) carries an excellent prognosis, with a ten year survival of 88%.6 Perhaps less recognized is that each series of dysgerminoma cases contains a small number of patients who are characterized by early metastases and rapidly evolving disease, with short survivals, and death due to disseminatedIn order to recall that dysgerminoma can, on occasion, display considerable biologic malignancy, we report an unusual case of pure dysgerminoma that produced death by overwhelming tumor growth in forty-six days following diagnosis.tUmOr~3. 4,6,16,18,19 CASE REPORT A 17-year-old girl was admitted to the hospital because of right lower quadrant abdominal pain of ten days duration. Abdominal distension, associated with nausea and vomiting had begun five days prior to admission. A pregnancy test (Gravindex) was twice negative. Vital signs on admission included a temperature of 37.6 C, pulse 140, respirations 32, blood pressure 90/50. Physical findings were limited to the abdomen, which was distended. A poorly defined mass was present in the right lower quadrant, which extended to the midline. Tenderness and rebound were noted, and the admitting impression was ruptured appendix with abscess formation. Exploratory laporotomy revealed a 15 cm right ovarian tumor and 2000 cc of ascites. Right pelvic, iliac, and aortic lymph nodes contained metastatic tumor. Post-operatively, the patient's abdominal distension failed to clear, and the course was complicated by recurrent fevers to 39.0 C. Multiple blood and urine cultures were negative. Enlarged supraclavicular lymph nodes were found on the tenth hospital day, and 2000 rads in ten fractions over 20 days was delivered to the supraclavicular regions. Because of continuing abdominal distension and pain, as well as a decreasing platelet count, radiation therapy to the abdomen was not completed. The total abdominal dose was 975 rads in 8 fractions over 22 days. The patient continued to deteriorate and expired on the forty-sixth hospital day. A postmortem examination was performed. PATHOLOGIC OBSERVATIONS Gross PathologyThe right ovary was replaced by a 15 X 1 1 x 5 cm rounded, nodular mass, limited by a thin fibrous capsule, which was penetrated by neoplasm. Cut surface revealed a firm, grey-white tumor marked by multiple foci of necrosis and hemorrhage. Multiple, enlarged lymph nodes from the pelvic and aortic regions showed neoplastic involvement. Also received were a normal appearing uterus and left adnexal structures. HistopathologyApproximately 50 blocks were selected to include capsule, adjacent structures, and necrotic a...

Dysgerminoma of the Ovary

“…However, poorly defined cell membranes, cytoplasmic autolysis, amphophilic to eosinophilic cytoplasm, nuclear crowding, smudged or pleomorphic nuclei, and retraction of cells from the stroma may significantly alter the appearance. Almost certainly such features are artifactual due to suboptimal fixation and have led to some of these tumors being designated “anaplastic dysgerminoma” in the past48; the latter is a term we do not use. Another probable result of poor preservation is vacuolization and sometimes a signet ring cell appearance, an aspect of dysgerminoma not previously emphasized but described in rare seminomas 18…”