Dysgerminoma and Ovarian Germ Cell Tumours
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Direct answer
Dysgerminoma is the commonest malignant ovarian germ cell tumour, typically affecting girls and young women, and it is highly radiosensitive and chemosensitive. Ovarian germ cell tumours also include yolk sac tumour, immature teratoma and choriocarcinoma, each with a characteristic tumour marker. Early-stage disease in young women is treated with fertility-sparing surgery, followed by chemotherapy when indicated.
What you must remember
- Dysgerminoma: the commonest malignant germ cell tumour, often raising LDH, and very sensitive to chemotherapy and radiotherapy.
- Yolk sac tumour: produces alpha-fetoprotein and shows Schiller-Duval bodies, and is treated with bleomycin, etoposide and cisplatin (BEP).
- Immature teratoma: contains immature neural tissue graded from zero to three, and the grade guides the need for chemotherapy.
- Choriocarcinoma: produces beta-hCG and is rare as a primary ovarian tumour, so gestational sources must be excluded.
- Mature cystic teratoma: the commonest benign germ cell tumour, containing skin appendages, sebum and sometimes teeth.
- Dysgenetic gonad: dysgerminoma arises in dysgenetic gonads, so Y chromosome material calls for prophylactic gonadectomy.
- Fertility-sparing surgery: unilateral salpingo-oophorectomy with staging preserves the uterus and contralateral ovary in early disease.
- Follow-up: tumour markers guide monitoring, and a rising value suggests relapse.
Germ cell tumours marker by marker
Germ cell tumours are classified by histology, and each subtype has a characteristic marker and treatment principle. Clinical clues in a young woman often point towards the subtype, and the table summarises each with its clue and the usual treatment.
| Subtype | Marker | Treatment principle | Clinical clue |
|---|---|---|---|
| Dysgerminoma | LDH; beta-hCG in a minority | Fertility-sparing surgery in stage I, then chemotherapy for advanced disease | Solid, often unilateral adnexal mass in a girl or young woman |
| Yolk sac tumour | AFP | Surgery and BEP chemotherapy | Rapidly growing mass in a girl or young woman |
| Immature teratoma | No specific marker | Surgery; chemotherapy guided by the grade of immature tissue | Mass with solid areas on imaging |
| Choriocarcinoma | Beta-hCG | Chemotherapy, after a gestational source has been excluded | Raised hCG with pregnancy excluded |
| Mature cystic teratoma | None | Benign; ovary-sparing cystectomy | Cystic mass with echogenic fat or hair on imaging |
Marker trends are followed after treatment, and a rising value suggests relapse, which prompts restaging. Histology, grade and stage, rather than the marker level alone, determine the intensity of treatment, and a normal marker does not rule out relapse.
Traps in germ cell tumours
Germ cell questions often test fertility preservation and marker matching.
- Trap: Performing radical surgery in a young woman with early dysgerminoma Correct: fertility-sparing unilateral salpingo-oophorectomy with staging is the principle for stage I disease.
- Trap: Following a yolk sac tumour with CA-125 Correct: follow AFP, which tracks disease and response.
- Trap: Ignoring Y chromosome material in a dysgenetic gonad Correct: gonadectomy is advised, because dysgerminoma and gonadoblastoma can arise in these gonads.
- Trap: Assuming a raised hCG in a young woman is always gestational Correct: pregnancy is excluded first, and a germ cell tumour can secrete hCG.
Frequently asked questions
Which tumour marker is most useful in dysgerminoma?
Serum LDH is the most useful marker in dysgerminoma because it is commonly raised and tracks tumour burden. Beta-hCG is raised only in a minority of cases, typically those with syncytiotrophoblast giant cells.
Why does yolk sac tumour raise AFP?
Yolk sac tumour cells produce alpha-fetoprotein, so serum AFP is raised in most cases. It is used to monitor response and relapse after treatment, alongside the characteristic Schiller-Duval bodies seen on histology.
Is fertility preservation possible in ovarian germ cell tumours?
Yes, in stage I disease fertility can be preserved by unilateral salpingo-oophorectomy with staging, which keeps the uterus and contralateral ovary. Adjuvant chemotherapy is then added when indicated by stage and histology.
Which chemotherapy is standard for malignant ovarian germ cell tumours?
The standard regimen for malignant ovarian germ cell tumours is BEP, which combines bleomycin, etoposide and cisplatin. Treatment intensity still depends on stage, histology and marker levels, since dysgerminoma is highly responsive.