What are Germ Cell Tumors?
Germinogenic neoplasms arise from the primary germ cells of embryonic gonads and their derivatives, and from 3 germ layers – ectoderm, mesoderm and endoderm.
Dysgerminoma (seminoma of the ovary) is a malignant tumor of the ovary, due to the pronounced similarity with the corresponding testicular tumor. Dysgerminomas make up about 1-2% of ovarian tumors, most often detected between the ages of 10 and 30 years, in about 5% of cases up to 10 years and very rarely after 50 years. Dysgerminoma is about 3% among malignant tumors.
Dysgerminoma is the most common malignant tumor in pregnancy. Consists of cells morphologically similar to primordial follicles. Dysherminomas are believed to originate from primary germ cell elements. Normally, at the time of birth, all the sex cells are in the composition of primordial follicles; the sex cells that do not form follicles die. If this does not happen, the germ cells acquire the ability to uncontrolled proliferation and give rise to a tumor. Dysgerminoma occurs in adolescents and young women with general and genital infantilism with late menarche. Often there are abnormalities of the external genital organs. The tumor is usually unilateral. Bilateral dysgerminoma is often combined with gonoblastoma.
A typical dysgerminoma is represented by a round or ovoid solid tumor with a smooth whitish fibrous capsule. The tumor can reach a considerable size, completely replacing the tissue of the ovary, dysgerminoma with small nodes has a different consistency.
On a section tumor tissue is yellowish, pale brown with a pink shade. Large tumors are usually variegated due to hemorrhages and foci of necrosis of various periods.
Symptoms of Germ Cell Tumors
Clinical manifestations have no specific signs. Hormonal activity dysgerminoma is not peculiar.
Complaints of patients with non-specific, sometimes dull nagging pain in the lower abdomen, general malaise, dysuric phenomena, weakness, drowsiness, fatigue, and the menstrual cycle are often disturbed: prolonged amenorrhea can be replaced by uterine bleeding. Dysgerminoma is prone to rapid growth, metastatic spread and germination in neighboring organs. Metastasis usually occurs through the lymphogenous pathway with damage to the lymph nodes of the common iliac artery, the distal part of the abdominal aorta, and supraclavicular lymph nodes. Hematogenous metastases occur in the terminal stage of the disease, usually in the liver, lungs, and bones. Manifestations of metastases dysgerminoma similar to the picture of the primary tumor.
Diagnosis of Germ Cell Tumors
The diagnosis is established on the basis of the clinical course of the disease, data from a two-handed gynecological examination, ultrasound imaging with a DDC and a morphological study of a remote macropreparation. During a gynecological examination, the tumor is usually located behind the uterus, often one-sided, rounded, with indistinct contours, dense, lumpy, ranging in size from 5 to 15 cm (often reaches large sizes), initially mobile, painless.
The big help is rendered by ultrasonography with TsDK. On echograms, the tumor has an echopositive medium echogenicity, often a lobular structure. Inside the neoplasm, there are frequent areas of degenerative changes, the contours are uneven, the shape is irregular.
In the Doppler study, multiple areas of vascularization are determined both around the periphery and in the central structures of the tumor: with a low resistance index (IL below 0.4).
Treatment of Germ Cell Tumors
Treatment of dysgerminomas is surgical only, followed by radiotherapy. It is advisable to use laparotomic access. With a unilateral tumor, with no signs of spread beyond the affected ovary in young women who plan to have further children, it can be limited to removing the appendages of the uterus of the affected side. In perimenopausal patients, the uterus is extirpated with appendages, and the omentum is removed. During the operation can not violate the integrity of the capsule, because it greatly impairs the prognosis.
When the tumor spreads beyond the limits of the ovary, a more radical operation is shown – removal of the uterus with appendages and the omentum, followed by radiotherapy. Enlarged lymph nodes to be removed, and their area – radiotherapy. Both the primary tumor and the metastatic nodules respond well to radiotherapy. Pure forms of dysgermine are highly sensitive to radiation therapy, which determines the relatively favorable prognosis of the disease.
With the right treatment, complete recovery is possible. Currently, 5-year survival of patients with unilateral encapsulated dysherminoma without metastasis reaches 90%. In prognostic terms unfavorable metastases and germination beyond the ovary, large size and bilateral localization of dysgerminoma.