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Benign and malignant ovarian masses
Published in David M. Luesley, Mark D. Kilby, Obstetrics & Gynaecology, 2016
Most patients with ovarian yolk sac tumours have elevated levels of alpha-fetoprotein (AFP), but normal levels do not exclude this diagnosis. Embryonal carcinomas are extremely rare. They usually secrete beta-human chorionic gonadotrophin (b-hCG) and may secrete AFP. Ovarian choriocar-cinoma secretes b-hCG and polyembryoma secretes b-hCG and AFP. These are also very rare tumours. The commoner immature teratoma and pure dysgerminoma do not secrete these tumour markers.
Ovarian Masses
Published in S Paige Hertweck, Maggie L Dwiggins, Clinical Protocols in Pediatric and Adolescent Gynecology, 2022
Dana Elborno, Sari Kives, S. Paige Hertweck
Germ cell tumorsBenignGonadoblastomaEmbryonic originMature teratoma (dermoid)PolyembryomaMalignantEmbryonic differentiationEmbryonal carcinomaEmbryonic somatic originImmature teratomaExtramembryonic originEndodermal sinus tumor(yolk sac tumor)ChoriocarcinomaPluripotent germinal stateDysgerminoma
Case report and review of literature: immature teratoma with islets of a yolk-sac tumour: could it be omitted for years?
Published in Journal of Obstetrics and Gynaecology, 2023
Žana Stanić, Zlatko Hrgović, Rajko Fureš, Anis Cerovac
Patients who do not present with pain, and experience steadier growth of a tumour, as it was the case with our patient, represent a more challenging diagnostic group. It has been suggested that alpha feto-protein (AFP) can be applied as a feasible tumour marker for the YST component of the tumour, because its level was elevated in >90% of YSTs (Chen et al.2019). However, in our patient, the amount of secreted AFP was in normal range despite clear evidence of YST islets on histology (Perry et al.2020). Combination of predominantly IMTs with islets of an YST, as it was documented in our patient, is extremely rare. Until now we did not find any published report on this combination. In literature, there are several reports about patients with MOGCT comprised with IMT, YST and embryonal carcinoma lines, occasionally referred to as the ‘polyembryoma’ (Ulbright 2005). Generally, it is recommended for the IMT patients of stage I and G1 to be treated with surgery alone, because the prognosis is good (RCOG 2016). The primary goal to be as conservative as possible is usually achieved with unilateral oophorectomy, peritoneal washing, omental biopsy, and selective removal of enlarged lymph nodes. Normal contralateral ovary should not be biopsied. Systematic lymphadenectomy is discouraged, while it did not provide better outcomes (RCOG 2016). A combination of fertility-sparing surgical strategies and chemotherapy (BEP protocol) has been proven to preserve fertility, with a 94% 5-year survival rate (Cerovac et al.2018). The most frequent sites of recurrence are the peritoneal cavity, the retroperitoneal lymph nodes and lungs. Therefore, the long-term follow-up strategy should include assessment of tumour markers at each visit. CT imaging of the pelvis, abdomen, and chest (if abnormal at presentation) should be performed 3 months after completion of chemotherapy and then as clinically indicated (RCOG 2016).