Dysgerminoma : Differential Diagnosis
Image Description
Differential Diagnosis: The differential includes other germ cell tumors with solid or nested architecture. Various entities and the features supporting them over dysgerminoma are listed below:
Yolk Sac Tumor: heterogenous architecture, primitive nuclei, hyaline bodies, no lymphocytic infiltrate in fibrous septa, strong and diffuse positivity for cytokeratin and AFP, positivity for glypican-3, and negative for OCT4; CD117 not helpful as 50% of solid yolk sac tumors are positive as are most dysgerminomas.
Embryonal Carcinoma: quite rare in the ovaries, primitive-appearing cells with hyperchromatic nuclei, greater nuclear pleomorphism, at least focal papillary and glandular architecture, strong positivity for cytokeratin and CD30, negative for CD117 (most cases); OCT4 not helpful as both embryonal carcinoma and dysgerminoma are strongly positive.
Large Cell Lymphoma: more often bilateral and with extraovarian involvement, diffuse growth in sheets, no fibrous septa, greater pleomorphism, positivity for various lymphoid markers. (continued in the next image)
This image of dysgerminoma shows polygonal tumor cells with well-defined cytoplasmic borders, clear or lightly eosinophilic cytoplasm, large vesicular nuclei, prominent nucleoli, and brisk mitotic activity.
Yolk Sac Tumor: heterogenous architecture, primitive nuclei, hyaline bodies, no lymphocytic infiltrate in fibrous septa, strong and diffuse positivity for cytokeratin and AFP, positivity for glypican-3, and negative for OCT4; CD117 not helpful as 50% of solid yolk sac tumors are positive as are most dysgerminomas.
Embryonal Carcinoma: quite rare in the ovaries, primitive-appearing cells with hyperchromatic nuclei, greater nuclear pleomorphism, at least focal papillary and glandular architecture, strong positivity for cytokeratin and CD30, negative for CD117 (most cases); OCT4 not helpful as both embryonal carcinoma and dysgerminoma are strongly positive.
Large Cell Lymphoma: more often bilateral and with extraovarian involvement, diffuse growth in sheets, no fibrous septa, greater pleomorphism, positivity for various lymphoid markers. (continued in the next image)
This image of dysgerminoma shows polygonal tumor cells with well-defined cytoplasmic borders, clear or lightly eosinophilic cytoplasm, large vesicular nuclei, prominent nucleoli, and brisk mitotic activity.