Ovarian dysgerminoma

Introduction to ovarian dysplasia Ovarian dysplasia (dysgerminomaofovary) is a malignant tumor that reflects primordial germ cells. The pathological morphology and tissue origin are similar to those of testicular seminoma (seminoma). Therefore, the two tumors have the same name, germinoma. Both are called homologans. According to the results of examination of the gonads and contralateral gonads of the tumor, as well as the determination of sex chromatin and chromosomes, it was confirmed that the majority of the gonads of the tumor were poorly developed testicular tissues. Because testicular seminoma is very similar in pathological morphology to ovarian dysplasia, and the patient's phenotype is female, it is often diagnosed as ovarian dysplasia. basic knowledge The proportion of illness: 0.001% Susceptible people: women Mode of infection: non-infectious Complications: chronic lymphadenitis

Ovarian dysplasia etiology

(1) Causes of the disease

Ovarian dysplasia is derived from primordial germ cells that have not been differentiated, hence the name dysplasia.

(two) pathogenesis

The dysgerminoma is mostly unilateral, with 50% occurring on the right side, 33% to 35% on the left side, and 10% to 17% being bilateral.

1. The gross tumor is a solid nodule with smooth surface; the cut surface is gray powder or light brown, and the larger tumor may have hemorrhage and necrosis; the hemorrhage, necrosis or cystic area often indicates the combination of choriocarcinoma or yolk sac Tumor, focal calcification may have the possibility of collateral cell carcinoma. When externally taking the material, it should be carefully observed and taken separately in different areas of the naked eye.

2. The tumor tissue consists of round or polygonal large cells distributed in pieces, islands or beams; the diameter of the cells is 15 ~ 25m, the boundaries between cells are clear; the nucleus is large and round, the nuclear membrane is clear, empty Foamy, nucleoli distinct, eosinophilic (Fig. 1); poorly differentiated tumor cells with distinct atypia, interstitial composed of unequal amounts of fibrous connective tissue and lymphocytes, occasionally formed by lymphoid follicles with germinal centers; Granuloma-like nodules composed of tissue cells and multinucleated giant cells can be seen.

3. Histochemistry is similar to germ cell tumors in other parts of the testicular seminoma and mediastinum. Tumor cells are identical in physiology and ultrastructure to primordial germ cells. The cytoplasm of tumor cells is rich in glycogen, PAS. Positive with alkaline phosphatase, immunohistochemical staining for cytokeratin negative, can be used to differentiate with embryonal cancer or yolk sac tumor; placenta specific alkaline phosphatase (PLAP) positive, can be used Identification with other non-germ cell tumors.

4. Endocrine 6% to 8% of anaplastic cell tumors contain individual or small clusters of trophoblasts, and form a subtype of this tumor, these syncytiotrophic cells HCG (chorionic gonadotropin) immunoreactive, and even the blood of patients Increased HCG levels and residual ovarian interstitial luteinization, asexual cell tumors containing syncytiotrophoblasts, whose biological behavior is similar to that of pure-type dysplasia, while choriocarcinoma is more malignant.

5. The relationship between dysgerminoma and amphoteric malformation In patients with ovarian dysplasia, because a small number of manifestations of hermaphroditism, some authors studied the relationship between dysgerminoma and amphoteric malformation, Fathalla collected 36 reports of hermaphroditism and In patients with squamous cell tumor or seminoma, according to the results of examination of the gonads and contralateral gonads of the tumor, as well as the determination of sex chromatin and chromosomes, it is proved that the majority of the gonads of the tumor are poorly developed testicular tissues. Because testicular seminoma and ovarian dysplasia are very similar in pathological morphology, and the patient's phenotype is female, which is often diagnosed as ovarian dysplasia, it should be called gonadal cell tumor, and Teter analyzed 55 cases. In patients with gonadal dysplasia confirmed by laparotomy, 35 cases of karyotype XX or XO did not have a gonadal tumor, and 20 cases of karyotype were XY or XO/XY mosaic type, 10 of which had gonadal tumors, accounting for 50 %, therefore, he believes that patients with gonad dysplasia have a tendency to develop tumors when their karyotype has a Y chromosome, so it is seen in patients with ovarian dysplasia. A small number of patients with hermaphroditism, the karyotype and gonads are mostly male, and are hermaphroditism with Y chromosome.

Ovarian dysplasia prevention

It is very important to maintain a good attitude, to maintain a good mood, to have an optimistic, open-minded spirit, and to be confident in the fight against disease. Don't be afraid, only in this way can you mobilize your subjective initiative and improve your body's immune function.

Ovarian dysplasia complications Complications chronic lymphadenitis

Ovarian dysplasia is very common due to rapid growth, and lymph node metastasis is quite common. Although most of the pelvic and abdominal metastases are surface-planted, they can also directly infiltrate the mucosal layer of the viscera. The reported figures vary widely, ranging from 20% to 66%. Of the 8 patients with metastasis in Peking Union Medical College Hospital, 6 were para-aortic lymph node metastases, accounting for 75% of metastatic cases. The reason may be due to insufficient exploration during surgery. In particular, lymph node metastasis is easily missed, so some reports have a low metastasis rate, and the metastasis pathway is mostly through lymphatic vessels and direct implantation. Therefore, the para-aortic lymph nodes and local pelvic organs are common metastatic sites, followed by mediastinal lymph nodes and clavicle. In the upper lymph nodes and omentum, individual cases can be transferred to the lungs, liver and brain.

Symptoms of ovarian dysplasia Common symptoms Abdominal pubic male genital malformation pelvic mass amenorrhea without menstrual cramps

Pelvic mass is the most common symptom, often accompanied by abdominal distension, sometimes tumor torsion and rupture, may have acute abdominal pain, ascites is relatively rare, because the tumor grows faster, so the course is shorter, most patients have normal menstruation and fertility Only in a small number of patients with hermaphroditism, there are primary menstrual symptoms or poor development of secondary sexual characteristics, clitoris, hairy and other male characteristics. Of the 18 patients with dysplasia in Peking Union Medical College Hospital, 3 are Gonadal dysplasia of the XY karyotype.

Examination of ovarian dysplasia

Tumor marker examination, immunohistochemistry.

B-ultrasound, CT, laparoscopy, histopathological examination.

Diagnosis and differentiation of ovarian dysplasia

Diagnostic criteria

For the nature of ovarian tumors in young patients, germ cell tumors should be considered first. Regarding the type of germ cell tumors, serum tumor markers can be helpful for identification. If serum AFP and HCG are negative, the masses grow fast and the course is short, but It is not very malignant, and there is no obvious ascites. Generally, the health is good. The diagnosis of dysgerminoma can be considered. The serum LDH of squamous cell tumors is elevated. Casey has reported 9 cases of ovarian dysplasia. 8 cases of preoperative serum LDH increased, 248 ~ 3245U / L (normal value of 100 ~ 180U / L), due to dystrophic cell tumors more common retroperitoneal lymph node metastasis, can be used for B-ultrasound or CT observation of lymph nodes.

Diagnostics should also pay attention to the following two situations:

1. Mixed morphological squamous cell tumors are often mixed with other types of malignant germ cell tumors, such as immature teratoma, embryonic cancer or choriocarcinoma, 35 cases of dysgerminoma in Peking Union Medical College Hospital, 18 cases of simple type There are 17 cases of mixed type, almost half of them. Some of the mixed type are mainly dysplasia, which contains a small amount or a small amount of other ingredients, and some are mainly other types of malignant germ cell tumors, containing only a small number of asexual cells. Tumor composition, serum tumor markers AFP and HCG detection, is helpful for the diagnosis of mixed type. If it is positive, the possibility of mixed type should be considered. Pathological specimens should be sliced for comprehensive pathological sampling, which is also an important diagnostic step. Fox One group of dysgerminomas had been examined for 40 wax blocks. Only one of them showed teratoma components. In the Abell group, 19 of the primary tumors were examined by wax blocks, all of which were asexual cells. Tumor, and there are yolk sac tumors and teratomas in the sections of intraperitoneal metastases. Two specimens of the first surgical resection of Peking Union Medical College Hospital are dysplasia, reoperation and pathology after tumor recurrence. The results of the examination were asexual cell tumors and yolk sac tumors. It can be seen that if the materials are not comprehensive, other tumor components that are present at the same time cannot be found.

2. Sexual deformity If there is primary amenorrhea, secondary sexual characteristics or even masculine signs, attention should be paid to the possibility of hermaphroditism:

1 Take oral mucosal cells to find chromatin.

2 for blood cell culture, check the type of sex chromosomes.

3 endocrine assays, such as vaginal cytology check blood LH, testosterone, urine 17-hydroxy, 17-ketone and so on.

4 Carefully examine the histological morphology of the lateral gonads and contralateral gonads.

Differential diagnosis

Mixed tumors contain yolk sac tumors, immature teratoma and choriocarcinoma, which are much more malignant than dysplastic cell tumors. If they are not identified, they cannot correctly estimate their prognosis, which will hinder the correct summary of asexuality. The characteristics and development of cell tumors are different in terms of treatment. Amphoteric cell tumors are highly sensitive tumors for radiation therapy. Radiation is very effective for advanced or recurrent apoptotic tumors, while other types of malignant germ cell tumors The effect is very poor, so the nature of the tumor type is more conducive to the selection of the correct treatment.

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