Dysgerminoma of the ovary is a rare form of ovarian cancer, originating from germ cells, the reproductive cells within the ovary. It primarily affects adolescents and young adults, typically women under the age of 30.
Understanding Dysgerminoma
Dysgerminoma is classified as a germ cell tumor of the ovary, arising from primordial germ cells. It is considered the ovarian counterpart to seminoma in the testis. These tumors are typically solid and can grow rapidly, sometimes reaching a diameter of up to 50 cm.
Dysgerminomas are usually multi-lobulated and can present with a smooth external surface. On examination, the cut surface often appears soft, fleshy, and can be cream-colored, gray, pink, or tan. While rare, dysgerminomas are the most common type of malignant ovarian germ cell tumor. Approximately 10-17% of these tumors can affect both ovaries, and about 15% may contain other malignant germ cell variants.
Recognizing Symptoms and Diagnosis
Patients with dysgerminoma often experience non-specific symptoms. These can include:
Abdominal pain
Swelling or a palpable mass in the abdomen or pelvis
Pelvic fullness
Early satiety
Urinary frequency or painful urination
In some instances, the rapid growth of the tumor can lead to complications like ovarian torsion or rupture, causing acute symptom changes.
Diagnosis typically begins with a physical examination, where a doctor may feel for any abnormal abdominal masses. Imaging tests play a significant role in identifying the tumor and assessing its characteristics. Transvaginal ultrasonography can initially determine if a mass is ovarian and evaluate for features suggestive of malignancy, such as thickened septations or solid and cystic components.
Further imaging, such as computed tomography (CT) scans of the chest, abdomen, and pelvis, is often used to detect any spread of the cancer. Magnetic resonance imaging (MRI) may also be employed for a more detailed assessment, particularly if the mass’s origin is unclear. MRI often reveals a large, predominantly solid, multi-lobulated mass with distinct fibrovascular septa.
Blood tests are also performed to check for specific tumor markers. Lactate dehydrogenase (LDH) levels are most commonly elevated in dysgerminoma cases. Less frequently, beta-human chorionic gonadotropin (hCG) can be elevated, especially if syncytiotrophoblastic giant cells are present. Alpha-fetoprotein (AFP) levels are even less commonly elevated. A definitive diagnosis, however, requires a biopsy or surgical removal of the tumor, followed by a pathological examination of the tissue.
Treatment and Prognosis
The primary treatment for dysgerminoma typically involves surgical removal of the tumor. For early-stage disease confined to one ovary (Stage I), a unilateral salpingo-oophorectomy (removal of one ovary and fallopian tube) is often performed to preserve fertility, a key consideration for young women.
After surgery, adjuvant therapies like chemotherapy are often considered, particularly for advanced stages (Stage Ib-IV) or if there’s concern about residual disease. The bleomycin, etoposide, and platinum (BEP) regimen is a common and effective platinum-based chemotherapy. While radiation therapy has been used historically, its use has largely decreased due to the high success rates of chemotherapy and to avoid long-term complications like sterility and early menopause.
The prognosis for dysgerminoma is generally favorable, especially when detected at an early stage. The 5-year survival rate for Stage I tumors is approximately 96%. Even in cases of recurrence, which typically occur within the first 2-3 years after initial treatment, chemotherapy is often highly successful in achieving salvage.
Regular follow-up care is important for detecting any recurrence. This includes serial pelvic examinations and monitoring of tumor markers like LDH, hCG, and AFP. For those who undergo fertility-sparing surgery and chemotherapy, many young women resume regular menstrual function, and pregnancies after treatment are possible.