16.9.1Ovarian Teratoma

•Mature form: Frequency 31%; surgical total resection followed by observation (relapse risk 18%); if partial resection is performed chemotherapy is necessary

•Immature form: Frequency 10% (for Staging see Testicular Teratoma); one third of patients with high AF level, unilateral tumor in 50–79%; management depends on stage; chemotherapy in stages II and III

16.9.2 Ovarian Dysgerminoma

• Histologically similar to seminoma in man

• Frequency 20%; bilateral occurrence in 20% of patients

• Therapy: Chemotherapy, commonly radiotherapy

• Ninety percent long-term remission

16.9.2.1 Macroscopic Features

• Involvement of the ovary is diffuse

• Homogeneous, gray-pink mass with occasional necrosis, hemorrhage, and cysts

• Sometimes huge tumor more than 15 inches in diameter

• Bilateral involvement in 10%

16.9.2.2 Microscopic Features

• Round cells with clear cytoplasm; nuclei with one or more prominent nucleoli

• Mitotic cells are usually detectable

• Structure: cell nests separated by fibrous stroma

• Sometimes polynuclear giant cells which react immunohistochemically for chorionic gonadotropin

16.9.2.3 Therapy

•In localized, encapsulated tumor: unilateral salpingo-oophorectomy and biopsy of the contralateral ovary, exploration of para-aortic lymph nodes with biopsy, lavage of the pelvic area followed by cytological analysis

•Advanced stage or relapse: chemotherapy; irradiation subsequently used; ovarian dysgerminoma is highly sensitive to chemotherapy and radiation therapy

16.9.3Ovarian Yolk Sac Tumor

•Frequency 16%

•AFP level is often high

•Due to high relapse rate, chemotherapy is necessary even in stage I

•Long-term survival rate is 80%