Tumors of the Ovary, Maldeveloped Gonads, Fallopian Tube, and Broad Ligament

Germ cell tumors of the gonads: a selective review emphasizing problems in differential diagnosis, newly appreciated, and controversial issues

“…117 Endometrioid-like yolk sac tumor occurs in younger patients (mean, 22 years) 116 than those with endometrioid adenocarcinoma (mean, 56 years) and the latter is frequently associated with endometriosis or an endometrioid adenofibroma. 6 The frequently elevated serum AFP level in patients with glandular yolk sac tumors 116 contrasts with the normal level in cases of endometrioid adenocarcinomas. This differential is complicated by the fact that rarely yolk sac tumor arises on the background of a somatic ovarian neoplasm, which is most commonly endometrioid adenocarcinoma, 118 but these tumors occur in an older age group than yolk sac tumors and have a number of helpful pathological distinguishing features, most important of which is the associated conventional carcinoma.…”

“…3,4 On the other hand, mixed germ cell tumors of the ovary are uncommon, representing less than 1% of ovarian germ cell tumors. 5,6 In comparing gonadal teratomas, the behavior in the testis, but less so in the ovary, depends to a great extent on whether the patient is prepubertal or postpubertal. Prepubertal testicular teratomas are benign, yet their morphologically similar counterparts in the postpubertal testis are malignant, whether mature or immature.…”

“…Teratomas in the ovary occur over a broad age range, albeit with a proclivity for the reproductive years, 6 whereas those in the postpubertal testis are almost always restricted to patients between 20 and 40 years of age. [7][8][9] DNA quantification shows that mature ovarian teratomas are diploid, and cytogenetic study demonstrates that they almost always have a normal 46,XX karyotype, 10,11 whereas mature teratomas of the postpubertal testis are hyperdiploid to hypotriploid with complex cytogenetic abnormalities including invariable 12p amplification, often in the form of an isochromosome [i (12p)].…”

“…6 This tumor is essentially morphologically identical in the two gonads, and so this discussion considers some of the diagnostic problems posed by seminoma and dysgerminoma together.…”

“…This is the third most common form of ovarian germ cell tumor (B1% of cases) 6 and is a common component of mixed germ cell tumors of the testis (Table 1). Most of the ovarian yolk sac tumors occur as pure neoplasms, whereas pure yolk sac tumors of the testis are rare in adults but the most common testicular germ cell tumor in children, peaking at 1.5 years of age and representing about 70% of pediatric testicular germ cell tumors.…”