Ovarian Neoplasms ~ Germ Cell Tumors

Tumors derived from the primitive germ cells of the embryonic gonad.

Germ Cell Tumors

What is the most common Teratoma mass?

Dermoid

Rare types of Germ Cell Tumors:

• Dysgerminoma

• Embryonal cell carcinoma

• Choriocarcinoma

• Transdermal sinus tumor

Germ Cell Tumors are found ___________.

Unilaterally

What age group is most affected by Germ Cell Tumors?

Adolescents

Germ Cell Tumors are associated with:

• Elevated Alpha-fetoprotein (AFP)

• Elevated hCG levels

3 categories of Teratomas:

• Mature ~ benign

• Immature ~ malignant

• Monodermal ~ highly specialized

A dermoid is considered a …

Mature Teratomas

Dermoid tumors have an _________ tissue origin. {EX}

Ectodermal

• Teeth, bones, fat, hair

75% of dermoids are _________.

Unilateral

Dermoids are frequently ___________ & usually_______.

Pedunculated, small

What is the sonographic appearance of dermoid?

• Cystic to complex

  • Hyperechoic contents

  • Calcific contents

  • May have shadowing present

  • Confused with bowel

What is the “Tip of the Iceberg” Sign?

• Typical ultrasound description of dermoid

  • Highly echogenic

  • High degree of acoustic shadowing

• Visible part of structure is a small part of the whole mass

What is this US image?

What is this US image?

Dermoid

What is this US image?

Dermoid

What is this US image?

Dermoid

What are the dermoid typical features?

• Cystic with linear strands

• Solid echogenic mass

• Predominatntly cystic

Immature Teratomas affect _________ tissue - all __ germ layer elements.

Embryonic, 3 {ectoderm, mesoderm, endoderm}

What age group is most affected by Immature Teratomas?

• Prepubertal

• Adolescents

• Young women

Immature Teratomas are ___________ tumors.

Malignant

Immature Teratomas are _______ but can grow _________ and become very _________.

Small, rapidly, large

With Immature Teratomas, what is common?

• Spread

• Metastases

What is the sonographic appearance of Immature Teratomas?

• Cystic to complex

• Usually solid with internal echoes

What is Struma Ovarii?

• Mature thyroid tissue

• Thyrotoxicosis – hyperthyroidism

  • Central blood flow

What is Carcinoid - Argentaffinoma?

• Carcinoid syndrome

  • Usually result of carcinoid tumor of GI tract

  • May be ovarian in origin

What are the symptoms for a Monodermal Teratoma?

• Serotonin secretion

• Distinctive episodic flushing of the skin

• Cramps

• NVD

What is this US image?

Monodermal Teratoma

Monodermal Teratoma =

Specialized mass

Dysgerminoma is a ________ mass.

Malignant

Dysgerminoma is ______ and is found _________ 15% of the time.

Rare, bilateral

What is the sonographic appearance of a Dysgerminoma?

• Solid & hyperechoic

• Multilobulated appearance

• Hemorrhage & necrosis

  • May have speckle pattern of calcifications

What is this US image?

Dysgerminoma

What is this US image?

Dysgerminoma