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Disgerminoma of the ovary

1938; Elsevier BV; Volume: 35; Issue: 6 Linguagem: Inglês

10.1016/s0002-9378(38)90374-6

1097-6868

Emil Novak, Laman A. Gray,

Testicular diseases and treatments

This paper is based upon the study of 17 cases of disgerminoma of the ovary which we have observed in our laboratory. While hitherto only 72 cases have been recorded in the literature, reports of cases of this tumor are now multiplying so rapidly that it may be considered not an exceedingly rare tumor type. Because of the fact that neither gynecologists nor pathologists have become generally familiar with the clinical and pathologic characteristics of ovarian disgerminoma, these have been fully discussed in our paper, together with the histogenesis of the tumor. The microscopic picture is so distinctive that the diagnosis should rarely present any difficulty, certainly far less than with granulosa cell carcinoma or arrhenoblastoma, both of which present many possible histologic variations and gradations. Since these tumors arise from cells dating back to the undifferentiated phase of gonadal development, it is not surprising that an exactly similar tumor, the well-known seminoma, occurs in the testis. Nor is it surprising that disgerminoma exhibits no endocrine activity, being made up of sexually indifferent cells. In this respect it differs from the feminizing granulosa cell carcinoma and the masculinizing arrhenoblastoma. Disgerminoma is often observed in sexually under-developed or pseudohermaphroditic individuals, but it has nothing to do with the production of these sex abnormalities, which persist even after removal of the tumor. While disgerminoma is undoubtedly a malignant type of tumor, there are marked variations in the degree of malignancy of individual tumors. The outlook is very favorable when the tumor is unilateral, with intact capsule, as shown in our own cases, since 9 of 10 such cases have remained well after operation. The results are much less favorable when the capsule has been broken through, with extensive infiltration of surrounding organs, and perhaps metastases. Even when there is considerable infiltration, with incomplete removal, some patients have been apparently cured by postoperative radiation, which we believe is a valuable adjunct in such cases. The general principles of the treatment of ovarian disgerminoma have been discussed in the paper, on the basis of what has been learned as to their varying malignancy.