Ovarian Germ Cell Tumors

Abstract

Germ cell tumors account for approximately 30 % of primary ovarian neoplasms, comprising the second most common tumor type after epithelial tumors. However, vast majority of them are benign and the group represents only 2–3 % of ovarian malignancies. While the intraoperative diagnosis of the most common mature cystic teratoma (dermoid cyst) is usually straightforward, frozen section evaluation of malignant germ cell tumors is often more challenging given their rarity and the clinical implications of the diagnosis. Most malignant germ cell tumors occur in young patients—children and young adults less than 30 years of age, hence preservation of fertility is of great importance. Thanks to recent advances in adjuvant chemotherapy, fertility-sparing surgery—intact removal of tumor, pelvic washings, surgical examination, and removal/biopsy of any suspicious areas from omentum and regional lymph nodes—now became the standard of care for this group of tumors. The frozen section pathologist has a crucial role in recognizing these neoplasms and distinguishing them from their mimics—most importantly the more aggressive epithelial ovarian cancers—to guide appropriate surgical management.