Dysgerminomas

Dysgerminoma is the most common malignant ovarian germ cell tumor, arising from primordial germ cells. It is the ovarian counterpart of seminoma of the testis and predominantly affects adolescents and young women. Bilateral involvement occurs in a minority of cases. The tumor is usually confined to the ovary at presentation, but can spread to retroperitoneal lymph nodes.

Clinical features typically include a pelvic mass and abdominal discomfort; systemic symptoms are uncommon. Serum markers are helpful but not specific: LDH is often elevated; human chorionic gonadotropin (hCG) may be raised in rare cases when syncytiotrophoblastic giant cells are present; alpha-fetoprotein (AFP) is usually normal.

Grossly, dysgerminomas are solid, well-circumscribed ovarian masses. Histology shows sheets of uniform large cells with clear cytoplasm and central nuclei, arranged in nests separated by fibrous septa infiltrated by lymphocytes. The tumor has a characteristic “fried egg” appearance. Immunohistochemistry typically reveals positivity for placental-like alkaline phosphatase (PLAP), OCT3/4, and often CD117 (c-KIT).

Staging follows FIGO criteria. Management aims to preserve fertility when possible. For young patients with unilateral disease, unilateral salpingo-oophorectomy with thorough surgical staging is standard. Stage I disease may be treated with surveillance after surgery, while higher stage or bilateral disease usually requires adjuvant chemotherapy, most commonly a BEP regimen (bleomycin, etoposide, cisplatin). Radiotherapy is used less frequently due to fertility considerations and effectiveness with chemotherapy.

Prognosis is favorable, especially for early-stage disease, with high long-term survival rates after appropriate treatment. Recurrences can occur, necessitating additional therapy and careful follow-up with clinical exams, imaging, and tumor markers.