Wallach's Interpretation of Diagnostic Tests: Pathways to Arriving at a Clinical Diagnosis (263 page)

   
CA 19-9
is a mucin protein that may be elevated in ovarian cancer but is also positive in gastric cancers. It may be used to follow recurrence in a patient with known CA19-9–positive ovarian cancer.

   
OVA1
is a panel that includes five serum biomarkers to assess the likelihood of malignancy in patients with an adnexal mass. Two markers are up-regulated (CA 125 II, beta-2 microglobulin) and three down-regulated (transferrin, transthyretin, apolipoprotein A1). An algorithm determines the patient’s risk for ovarian cancer. OVA1 is commercially available through Quest Diagnostics.

   
Pathologic diagnosis
of tumor type and grade forms the basis for treatment and prognosis. These tumors are staged according to the International Federation of Gynecology and Obstetrics (FIGO)/TNM system. For a complete review of the pathology of epithelial ovarian carcinomas, (see Crum and Lee).
¹
Diagnostic Gynecologic and Obstetric Pathology
. Philadelphia, PA: W B Saunders Co, 2005.

OVARIAN GERM CELL TUMORS

   Definition

Ovarian germ cell neoplasms originate from the germ cells of the ovary and comprise 5% of the malignant ovarian neoplasms. These tumors may be malignant or benign and include teratomas (mature, dermoid, and immature), dysgerminomas, endodermal sinus (yolk sac) tumors, embryonal carcinomas, and nongestational choriocarcinoma (see eBook Figure 8-10).

   Clinical Presentation

Patients presenting with ovarian germ cell neoplasms are usually between 10 and 30 years of age. They are more frequent in Asian/Pacific Islander and Hispanic women than in Caucasians. Presenting symptoms include effects of hCG production by the tumor (precocious puberty, abnormal vaginal bleeding), abdominal enlargement, ascites, or abdominal pain (including acute abdomen due to torsion).

   Laboratory Findings

The definitive diagnosis requires histologic evaluation at the time of surgical excision. A presumptive diagnosis may be made with an adnexal mass on pelvic imaging (CT, MRI, or ultrasound) and elevation of an associated tumor marker. Tumor markers are also used to monitor patients post–surgical resection for recurrence. These include the following:

   
hCG
is increased in embryonal cell carcinomas, ovarian choriocarcinomas, mixed germ cell tumors, and some dysgerminomas.

   
AFP
is increased in endodermal sinus tumors, embryonal cell carcinomas, mixed germ cell tumors, and some immature teratomas.

   
Lactate dehydrogenase (LDH)
is increased in dysgerminomas.

   
Pathologic diagnosis
of tumor type and grade forms the basis for treatment and prognosis. Malignant germ cell neoplasms are staged according to the FIGO/TNM system. For a complete review of the pathology of ovarian germ cell tumors (see Crum and Lee).
¹
Diagnostic Gynecologic and Obstetric Pathology
. Philadelphia, PA: W B Saunders Co, 2005.

Reference

1.  Crum CP, Lee KR (eds).
Diagnostic Gynecologic and Obstetric Pathology
. Philadelphia, PA: WB Saunders Co,; 2005.

OVARIAN SEX CORD-STROMAL NEOPLASMS

   Definition