Ovarian
germ cell tumors are reviewed with emphasis on recent developments. In the primitive
germ cell tumor group the recently recognized subtypes of
yolk sac tumor, the hepatoid and glandular variants are described. Hepatoid
tumors, which resemble
hepatocellular carcinomas, are usually admixed with other patterns of yolk sac
neoplasia but when the hepatoid component predominates, distinction from metastatic
hepatocellular carcinoma may be difficult. Glandular
yolk sac tumors include those with a cribriform pattern as well as
tumors that may be confused with
endometrioid carcinoma. Within the
teratoma category, a recent paper exploring the occasional relation between
immature teratomas and
dermoid cysts is reviewed. Problems caused by some of the monodermal
teratomas are also highlighted.
Struma ovarii may be the source of many diagnostic problems. It may be cystic and microscopic examination may reveal inconspicuous numbers of clearly recognizable thyroid follicles, resulting in
confusion with other cystic ovarian
tumors. In noncystic strumas many patterns, such as solid or pseudotubular, may be seen and the presence of cells with abundant clear or eosinophilic cytoplasm may add to the diagnostic difficulty, particularly if other teratomatous elements are lacking. Immunohistochemical staining for
thyroglobulin may be crucial in establishing the diagnosis of a struma in these situations. The problem of identifying reliable criteria for
malignancy of
struma ovarii is explored on the basis of recent information. The two most recently recognized subtypes of
carcinoid tumor, strumal and mucinous, are reviewed as are primary neuroectodermal and sebaceous
tumors of the ovary. Unusual clinical features of
germ cell tumors are discussed under three main categories: endocrine syndromes, paraendocrine and
paraneoplastic syndromes, and miscellaneous. Included in these categories are disorders such as
sexual precocity in association with
germ cell tumors containing syncytiotrophoblast cells, endocrine abnormalities associated with the recently described functioning ovarian
tumors with peripheral
steroid cell proliferation,
hyperthyroidism with
struma ovarii, the
carcinoid syndrome,
autoimmune hemolytic anemia associated with
dermoid cysts, complications of
dermoid cyst rupture, which may simulate disseminated
carcinomatosis, and
ascites and
Meigs' syndrome associated with
struma ovarii.