Archives of pathology & laboratory medicine · 2026
Embryonal Carcinoma Involving the Ovary: A Morphologic Study of 55 Tumors Almost Never Pure, But Common Within Malignant Mixed Germ Cell Tumors.
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Zanfagnin Valentina, Oliva Esther, Young Robert H
Аннотация
CONTEXT.—: Embryonal carcinoma (ECA) of the ovary is rare, particularly in pure form, with very limited available information.
OBJECTIVE.—: To expand on knowledge by reviewing our experience.
DESIGN.—: We report 55 tumors with an ECA component in patients from ages 3 to 57 years (median, 20.5 years), with emphasis on their pathologic features.
RESULTS.—: The tumors ranged from 2.5 cm to 31 cm (average, 15.4 cm), being predominantly solid and cystic with hemorrhagic necrosis. In all cases, the ECA was a component of a malignant mixed germ cell tumor (MMGCT) and represented less than 15% in 22 tumors (40%), 16% to 50% in 22 (40%), 51% to 75% in 6 (11%), and greater than 75% in 5 (9%). Components admixed with the ECA included yolk sac tumor (n = 49; 89%), immature teratoma (n = 34; 62%), dysgerminoma (n = 20; 36%), and choriocarcinoma (n = 5; 9%). The most common microscopic patterns of the ECA were glandular (n = 24; 45%), solid (n = 19; 35%), papillary (n = 5; 9%), and micropapillary (n = 1; 2%). Embryoid bodies, or remnants thereof, were present in 16 tumors (29%), and 6 (11%) had a diffuse embryoma pattern. Apoptotic bodies were commonly found. A lymphocytic infiltrate and granulomas were seen in 25 tumors (45%) and in 4 tumors (7%).
CONCLUSIONS.—: Pure ovarian ECA is rare; none were identified in our series. Many purported pure examples are likely undersampled MMGCTs or other tumor types (yolk sac tumor, dysgerminoma [particularly when poorly fixed], small cell carcinoma of hypercalcemic type, juvenile granulosa cell tumor, and high-grade surface epithelial carcinomas). The diagnosis can be made on the basis of morphologic criteria and, in problematic cases, supported by immunohistochemistry.
OBJECTIVE.—: To expand on knowledge by reviewing our experience.
DESIGN.—: We report 55 tumors with an ECA component in patients from ages 3 to 57 years (median, 20.5 years), with emphasis on their pathologic features.
RESULTS.—: The tumors ranged from 2.5 cm to 31 cm (average, 15.4 cm), being predominantly solid and cystic with hemorrhagic necrosis. In all cases, the ECA was a component of a malignant mixed germ cell tumor (MMGCT) and represented less than 15% in 22 tumors (40%), 16% to 50% in 22 (40%), 51% to 75% in 6 (11%), and greater than 75% in 5 (9%). Components admixed with the ECA included yolk sac tumor (n = 49; 89%), immature teratoma (n = 34; 62%), dysgerminoma (n = 20; 36%), and choriocarcinoma (n = 5; 9%). The most common microscopic patterns of the ECA were glandular (n = 24; 45%), solid (n = 19; 35%), papillary (n = 5; 9%), and micropapillary (n = 1; 2%). Embryoid bodies, or remnants thereof, were present in 16 tumors (29%), and 6 (11%) had a diffuse embryoma pattern. Apoptotic bodies were commonly found. A lymphocytic infiltrate and granulomas were seen in 25 tumors (45%) and in 4 tumors (7%).
CONCLUSIONS.—: Pure ovarian ECA is rare; none were identified in our series. Many purported pure examples are likely undersampled MMGCTs or other tumor types (yolk sac tumor, dysgerminoma [particularly when poorly fixed], small cell carcinoma of hypercalcemic type, juvenile granulosa cell tumor, and high-grade surface epithelial carcinomas). The diagnosis can be made on the basis of morphologic criteria and, in problematic cases, supported by immunohistochemistry.