clinico pathological description of germ cell tumors of ovary

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SUBTYPE % OF OGCT BENIGN OR
MALIGNANT
UNI- OR BI-LATERAL TUMOUR MARKERS
EXPRESSED
ROUTE OF SPREAD
DYSGERMINOMA 35-50 MALIGNANT 10-15 % ARE
BILATERAL
LDH
hCG
LYMPHATIC
ENDODERMAL SINUS TUMOR 20 MALIGNANT USUALLY
UNILATERAL
AFP
ALPHA 1
ANTITRYPSIN
INTRA-
PERITONEALLY AND
HEMATOGENOUS
EMBYRONAL CARCINOMA RARE MALIGNANT USUALLY
UNILATERAL
AFP
hCG
INTRA-
PERITONEALLY
POLYEMBYROMA RARE MALIGNANT AFP
hCG
CHORIOCARCINOMA VERY RARE MALIGNANT USUALLY
UNILATERAL
hCG
TERATOMA IMMATURE-20% OF
MALIGNANT GCT
MALIGNANT
OR BENIGN
12-15% BILATERAL IMMATURE
TERATOMA
SOMETIMES
SECREAT AFP,LDH
AND CA-125
MIXED GCT 10-15 DEPENDENT ON
CELL TYPE
PRESENT

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GRADE SCULLY NORRIS
0 Well differentiated All mature ;rare mitoses
1 Well differentiated;
rare embryonal tissue
Some immature and neuroepithelium
2 Moderate embryonal;
atypia and mitosis
Immature and neuroepithelium <3hpf
3 Large embryonal;atypia and mitosis Immature and neuroepithelium >4hpf

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Syncitiotrophoblast
Cytotrophoblast

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SURGERY
COMPLETE STAGING
SURGERY
FERTILITY SPARING
SURGERY AND
COMPREHENSIVE
SURGERY
FERTILITY NOT
DESIRED
FERTILITY DESIRED

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PATHOLOGIC
DIAGNOSIS
CHEMOTHERAPY
ANY STAGE EMBRYONAL TUMOUR
OR
ANY STAGE ENDODERMALSINUS TUMOR
OR
STAGE II-IV DYSGERMINOMA
OR
STAGE I GRADE 2 OR 3 OR STAGE II –IV
IMMATURE TERATOMA
OR
ANY STAGE NON GESTATIONAL
CHORIOCARCINOMA
STAGE I DYSGERMINOMA
OR
STAGE I ,GRADE I
IMMATURE TERATOMA
OBSERVATION

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YEAR 1 YEAR 2 YEAR 3 YEAR 4-5 AFTER 5 YEARS
DYSGERMINOMA-
PHYSICAL EXAM
AND
SERUM TUMOR
MARKERS
RADIGRAPHIC IMAGING
NON DYSGERMINOMA-
PHYSICAL EXAM
AND
SERUM TUMOR
MARKERS
RADIGRAPHIC IMAGING
Every 2-3 mo
Abdominal/Pelvic CT
(Every 3-4 mo)
Every 2 mo
Chest/Abdominal/Pel
vic CT (Every 3-4 mo)
Every 3-4 mo
Abdominal/Pelvic CT
(every 6 mo)
Every 2 mo
Abdominal/Pelvic CT
(every 4-6 mo)
Every 6 mo
Abdominal/Pelvic CT
(Annually)
Every 4-6 mo
Abdominal/Pelvic CT
(every 6-12 mo)
Every 6 mo
Abdominal/Pelvic CT
(Annually)
Every 6 mo
Abdominal/Pelvic CT
(every 6-12 mo)
Annually
As indicated clinically
Annually
As indicated clinically
SURVEILLANCE

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