Germ cell, Sex Cord Stromal, and Metastatic Ovarian Tumours (Lecture 7b)

TRUE or FALSE: Germ cell tumours are most commonly benign.

TRUE: 95% are benign. However, most common malignancy is in children and young adults

What is the most common germ cell tumour?

Teratoma/dermoid

What is the difference between a dermoid and a teratoma?

- Dermoid: composed of only ectoderm

- Teratoma: composed of all 3 germ layers (ecto, meso, and endoderm)

TRUE or FALSE: The potential for malignancy of a teratoma is directly related its tissue maturity.

FALSE: The potential for malignancy of a teratoma is INVERSELY related its tissue maturity.

Ex. More differentiated tissue = less chance of malignancy

Mature (cystic) teratoma/dermoid (type of tumour, age group, CP, SF)

- Type of tumour: germ cell

- Age group: reproductive

- CP: asymptomatic

- SF: depends on composition (hair, skin, teeth, etc), variable size, cystic/complex/solid, "tip of iceberg" sign, fat/fluid levels, hair/fluid levels, dermoid plug, dermoid mesh

What is the difference in sonographic appearance between a dermoid plug and dermoid mesh?

- Dermoid plug: contains hair, teeth, or fat and casts acosutic shadows

- Dermoid mesh: hair fibres that appear as multiple linear hyperechoic interfaces (lines and dots) seen floating in cyst

What is a "tip of the iceberg" sign? What condition is it associated with?

- Tip of the iceberg sign: condensed material is seen anterior in neoplasm, making most of the posterior aspect of the teratoma is hidden

- Associated w/ teratomas/dermoids

Struma ovarii (what is it, type of tumour, age group, CP, SF)

- Teratoma composed of thyroid tissue (50%+ of thyroid tissue) that is mostly benign

- Type: germ cell

- Age group: reproductive (same as teratoma)

- CP: possibly hyperthyroidism

- SF: Variable echo, vascularity b/c it's thyroid tissue (NOT malignancy)

Solid (Immature) teratoma (what is it, type of tumour, age group, CP, SF)

- Immature tissue from all 3 germ cells, making it malignant

- Type: germ cell

- Age group: less than 20 (young adults)

- CP: possibly inc. AFP

SF: solid, thick septations w/ vascularity

Dysgerminoma (type of tumour, age group, SF, D/D)

- Rare, malignant tumours

- Type: germ cell

- Age group: less than 30 yrs old

- SF: unilateral, solid/homogenous, vascular, large, irregular borders, complex from hemmorhage/necrosis

- D/D: pedunculated fibroid

What is the most common benign and malignant ovarian neoplasm seen in pregnancy?

- Mature cystic teratoma (benign)

- Dysgerminomas (malignant)

Yolk sac tumour/endodermal sinus tumour (type of tumour, age group, CP, SF)

- Rare, malignant tumours

- Type: germ cell

- Age group: less than 20 yrs old

- CP: inc AFP, possibly inc. CA 125

- SF: vascularized w/ necrotic areas, unilateral

Which germ cell tumours are malignant?

- Immature teratoma

- Dysgerminoma

- Yolk sac/endodermal sinus tumour

Which germ cell tumours are possibly associated with an increase in AFP?

- Yolk sac tumour

- Immature teratoma

List all the germ cell tumours. (HINT: 5)

- Mature (cystic) teratoma/dermoid

- Struma ovarii

- Immature (solid) teratoma

- Dysgerminoma

- Yolk sac tumour/endodermal sinus tumour

Granulosa cell tumour (what is it, type of tumour, CP, SF)

- Tumour arising from granulosa cells (cells surrounding antrum), causing hypersecretion of estrogen (low malignant potential)

- Type: sex cord stromal

- CP: premenstrual = early puberty, reproductive age = oligomenorrhea/amenorrhea, PMP = bleeding

- SF: unilateral, solid, large, well vascularized, inc. heterogenous as it grows, swiss-cheese appearance

Sertoli-Leydig tumour/arrhenoblastoma/androblastoma (what is it, type of tumour, age group, CP, SF)

- Usually benign tumour from Sertoli & Leydig cells, causing increased androgen production

- Type: sex cord stromal

- Age group: less than 30 yrs

- CP: a/oligomenorrhea, acne, hirsutism, clitoral enlargement, abdo swelling, pain

- SF: unilateral, solid, variable echo, areas of necrosis/hemorrhage

Thecoma (what is it, type of tumour, age group, CP, SF)

- Abundance of theca cells (outer layer of follicle)

- Type: sex cord stromal

- Age group: post menopausal

- CP: amenorrhea, infertility (other signs of estrogen production)

- SF: hypoechoic, posterior enhancement

Fibroma (what is it, type of tumour, age group, CP, SF)

- Abundance of fibrous tissue

- Type: sex cord stromal

- Age group: peri/post menopausal

- CP: asymptomatic

- SF: hypoechoic, posterior enhancement

What is Meigs syndrome?

triad of ovarian fibroma, ascites, and pleural effusion

List the sex cord stromal tumours (HINT: 4)

- Granulosa cell tumour

- Sertoli-Leydig tumour

- Thecoma

- Fibroma

Krunkenberg tumour (what is it, type of tumour, SF)

- Malignancy in ovary that metastasized from primary site (m/c GI)

- Type: metastatic

- SF: bilateral, asymmetrical ovaries, complex echo, internal vascularity

Lymphoma SF (HINT: 4)

- Solid

- Hypoechoic

- Bilateral enlarged ovaries

- Well-vascularized