Histologic Types

■ Germ cell—8% of all ovarian cancers; include teratomas, dysgermino-mas, choriocarcinomas

■ Gonadal-stromal—1% of all ovarian cancers; include granulosa-theca cell tumors, Sertoli- Leydig tumors

Ovarian Germ Cell Tumors (GCTs)

Eight percent of ovarian cancers are GCTs. GCTs arise from totipotential germ cells that normally are able to differentiate into the three germ cell tissues. Ninety-five percent are benign.

Clinical Presentation

■ Abdominal pain with rapidly enlarging palpable pelvic/abdominal mass

■ Acute abdomen

■ Vaginal bleeding

■ Usually found in children or young women

Types of Ovarian GCTs

Dysgerminoma (Most Common) (arises from totally undifferentiated totipotential germ cells)

■ Affects women in teens to early 20s

■ 20% associated with pregnancy

Endodermal Sinus Tumor (arises from extraembryonic tissues)

■ Most aggressive GCT

■ Characteristic Schiller-Duval bodies

Immature Teratoma (arises from embryonic tissues)

■ Mixture of cells representing all three germ layers

Embryonal and Choriocarcinoma (arise from trophoblasts)

■ Tumors may cause sexual precocity or abnormal uterine bleeding.

Mixed GCTs

■ Dysgerminoma and endodermal sinus tumor is the most common combination.

Treatment of Ovarian GCTs

■ Unilateral adnexectomy and complete surgical staging

■ Adjuvant chemotherapy:

■ Recommended for all but stage I, grade I immature teratoma

BEP Therapy

Side Effects

Pulmonary fibrosis Blood dyscrasias Nephrotoxicity

Prognosis of Ovarian GCTs

Prognosis is generally good because most are discovered early. Five-year survival is 85% for dysgerminomas, 75% for immature teratomas, and 65% for endodermal sinus tumors.

Ovarian Sex Cord-Stromal Tumors

One percent of ovarian cancers: They arise from the sex cords of the embryonic gonad before they differentiate into male or female. They are functional tumors that secrete estrogen or testosterone. They usually affect older women.

Types of Sex Cord-Stromal Tumors Granulosa-Theca Cell Tumor

■ Secretes estrogens that can cause feminization, precocious puberty, or postmenopausal bleeding

■ Association with endometrial cancer

■ Inhibin is the tumor marker.

Up to 80% survival with incomplete resection GCTs are very chemo-sensitive.

Sertoli-Leydig Cell Tumor

■ Secretes testosterone

■ Presents with virilization, hirsutism, and menstrual disorders as a result of the testosterone

■ Testosterone is the tumor marker.

Treatment of Ovarian Sex Cord-Stromal Tumors

Surgical Treatment

■ Unilateral oophorectomy in young women with low-stage/grade neo-plasia

Adjuvant Therapy

■ Data are inconclusive, but chemotherapy and radiation play a small role at present.

TABLE 23-1. Ovarian Tumors and Their Serum Markers

Ovarian Tumor

Serum Tumor Marker

Fallopian cell carcinoma is the least common gynecologic malignancy.

In any postmenopausal bleeding or discharge that cannot be explained by endometrial biopsy, fallopian cell carcinoma should be considered.

TABLE 23-1. Ovarian Tumors and Their Serum Markers

Ovarian Tumor

Serum Tumor Marker

Dysgerminoma

LDH

Endodermal sinus tumor

AFP

Embryonal and choriocarcinoma

Beta-hCG

Epithelial ovarian tumor

CA-125

GCT

Inhibin

Sertoli-Leydig cell tumor

Testosterone

| FALLOPIAN CELL CARCINOMA |

Fallopian cell carcinomas usually are adenocarcinomas. They spread through the peritoneal fluid in a similar fashion to ovarian cancer. It is very rare and can affect any age.

Classic Presenting Triad

■ Vaginal bleeding

■ Leukorrhea

Many are diagnosed during a laparotomy for other indications.

Hydrops tubae perfluens is the pathognomonic finding, defined as cramping pain relieved with watery discharge.

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