Germ cell ovarian tumors – causes, symptoms, diagnosis, treatment, pathology

With germ cell ovarian cancer, germ cell refers
to the precursor cells that develop into eggs, ovarian refers to ovary of which there are
two that sit on either side of the uterus which is where the germ cells live. So, a germ cell ovarian cancer refers to situations
where these precursor germ cells become cancerous and form tumors. During fetal development, the entire body
derives from three layers, called germ layers, the ectoderm, mesoderm, and endoderm. These germ layers are made of germ cells,
and the germ cells migrate out and differentiate into all of the different types of tissues,
for example some ectodermal germ cells become cells of the brain and spinal cord, some mesodermal
form bone and muscle, and some endodermal cells become cells in the gastrointestinal
tract. Some very special germ cells, though, stay
as germ cells – meaning that unlike the cells that differentiate, these germ cells retain
their ability to turn into other cells types. They’re like ancient little shape-shifters. Normally, during development these germ cells
head to the ovary in women or testicle in men where they remain for decades, eventually
developing into eggs or sperm, respectively. Now, if those germ cells in the ovaries start
to divide uncontrollably, it can either form a benign tumor which means that it does not
invade nearby tissue or spread to other parts of the body, or it can be a malignant tumor
which means that it can both invade and spread to other tissues. Compared with benign tumor cells, malignant
tumor cells have key features like not having a clearly defined border or like a slightly
less organized nuclei. Now, there are four types of germ cell tumors
and each type is named after the type of cell that these pluripotent germ cells develop
into. The first, are teratomas, terato means monster
and oma is a tumor. So teratomas are monster tumors, and they
are called that because they contain all different types of tissues, including hair, eyes, teeth,
bone and neurons – kind of like a Frankenstein that’s got bits of this and that stitched
together. Now, there are two types of teratomas, the
first are mature cystic teratomas, which are the most common ovarian tumors in young women
and are formed from tissue that comes from any of the three germ layers. One example, is a struma ovarii tumor which
is made up of only thyroid tissue and can release thyroid hormone which leads to hyperthyroidism. The other type are immature teratomas, and
they develop specifically from neuroectoderm cells – which come from the ectoderm layer. Immature teratomas tend to be malignant and
metastasize quickly. The second subtype is a yolk sac tumor, also
called an endodermal sinus tumor, and it’s made of germ cells that differentiate into
yolk sac tissue. These are the most common germ cell tumor
in children, and the tumors can be very aggressive. Under the microscope, they form Schiller-Duval
bodies which are rings of cells around a central blood vessel. The third subtype is a choriocarcinoma and
it’s made of germ cells that turn into syncytiotrophoblast cells which are the ones that help form the
placenta. These tumors are usually small, bleed easily,
and often spread beyond the ovaries. The syncytiotrophoblast cells secrete high
levels of the hormone β-hCG, and that can cause ovarian cysts to form. The fourth subtype is a dysgerminoma and it’s
made of germ cells that turn into oocytes, which is the normal pattern, but then they
start to grow uncontrollably. It turns out that these are the most common
malignant types of ovarian tumors. Under the microscope, the germ cells have
a central nuclei surrounded by a clear cytoplasm. So, during ovulation the follicle ruptures
and releases an egg which inadvertently leads to epithelial cell damage. To fix that damage the epithelial cells have
to undergo cell division to replace and heal the tissue. Each time cells divide, there is a chance
of a mutation and the possibility of tumor formation. So this means that with more ovulatory cycles
there’s an increased risk of tumor formation. So things that are associated with a decreased
risk of ovarian cancer include things that reduce the number of ovulatory cycles like
pregnancy, breastfeeding, and oral contraceptive use. On the flip side, some things that are associated
with an increased risk include certain medical conditions like endometriosis and polycystic
ovarian syndrome. There are also genetic risk factors like having
the BRCA-1 or BRCA-2 mutation, which are both autosomal dominant mutations, which in addition
to ovarian cancer, carry with them an increased risk of breast cancer. There’s also hereditary nonpolyposis colorectal
cancer, also known as Lynch syndrome, which increases the risk of developing a number
of cancers, including ovarian cancer. Generally speaking, symptoms of ovarian cancers
can be subtle and nonspecific. Common early symptoms can include abdominal
distension, bloating, as well as abdominal or pelvic pain, which can come from an ovarian
torsion – where the ovary gets twisted. Occasionally, ovarian tumors can cause ascites,
abdominal masses, bowel obstruction, or dyspareunia, which is pain during sexual intercourse. A classic finding is a Sister Mary Joseph
nodule which happens when the cancer metastasis to the umbilicus. This finding is often linked with a few types
of cancer – one of which is ovarian cancer. Diagnosis of ovarian cancer typically involves
looking for specific tumor markers like B-hCG, as well as having a transvaginal ultrasound. Tumor biopsies are done to figure out whether
a growth is benign or malignant, and imaging with a CT or MRI scan can be done to look
for evidence of metastasis. Treatment of ovarian cancer typically involves
chemotherapy, surgery, and sometimes radiotherapy. Surgery might be enough for malignant tumors
confined to the ovary, whereas chemotherapy might be needed for disease that has spread. Carbohydrate antigen 125, called CA 125, is
a protein produced by various types of ovarian tumors, so tracking levels of this biomarker
in the blood can help monitor response to therapy and potential relapse. All right, as a quick recap: germ cell ovarian
cancers come from pluripotent germ cells that normally develop into sperm or egg. The four major types of germ cell tumors are:
fetal teratomas, both mature cystic and immature teratomas; yolk sac tumors, or endodermal
sinus tumor, choriocarcinoma or placental tissue tumors or and finally dysgerminomas
or oocyte tumors. A well known risk factor for ovarian cancers
is the cumulative amount of time a woman spends in ovulation, with protective factors being
pregnancy, breastfeeding, and oral contraceptive use.

61 comments

  1. lol hate to ask again but idk if you see commets on old vid but i just wanna know sooo bad could you possibly explain in a vid or a simple reply the effect of weed and ssri meds (prozac) like just a break down of it like how you usally do your vids….yea sorry to harrass you and junk but it would mean alot if you did reply in some way

  2. Hey guys…I started to watch your videos before one week and I really want to say It was so much helpful for me…the topics I can't learn even when I am studying for 2hours ur just explaining it superbly in 10mins …actually I hate to study medicine but after watching your videos I am started to love studying medicine….now I am a student but when I get a job in future and earn money….I am sure i will support you on patrons…..keep up the good work….great work actually!!!!….thank you so much guys….and sorry if my English knowledge is aweful I don't know much of an English…but I really want to say thank you for each and everyone on the team Osmosis…

  3. when i was studying for my exams i used your vids to prime before attacking hundred of pages of text, and i said to myself i would donate a few bucks to osmosis if i passed. I cleared the year and i wanted to know if you had a paypal i could send the money too ? i'm not really interested in the patreon thing.

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    i love you guys so so so much
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  5. Man… I know the USMLE Review Game has gotten SUPER-saturated with lots of competitors. BUT I hope you guys sneak by and make it big. This is some legitimate next generation teaching. It almost makes learning medicine a joke. I wish to God I had these videos when I was in school. The only terrifying thing is that as we get better and better at teaching this material the exam scores are only going to continue shooting through the roof!

    Stay Awesome Osmosis ✌

  6. Hi!, I really like your videos, and I was wondering if you could make one explaining hypothyroidism! Thank You!

  7. I'm learning about this theme and this video helped me to fully-understad some details 😀 thank you guys!

  8. You're so smart and I can't believe you can explain all of that and thank you for the information you share!

  9. Hi Osmosis Team. Any chance of you guys developing a Breast Cancer Video. Explaining the different types and treatment methods?

  10. I'm not sure but I think that the dysgerminoma is the most common malignant GERM CELL ovarian tumor. I think the serous cystadenocarcinoma is the most common malignant ovarian tumor. According to robbins

  11. amazing , you are THE BEST teacher EVER . plz can you make videos on pediatric? a whole patch of students is waiting for that

  12. this helped me like A LOT ! sobs and also my first time of seeing the person behind that voice haha amazing ! thank you superb team !

  13. Hey.. the voice doesn't match the person.. 🙂 ( had to mention)

    But seriously, yu guys have made things easier and better.. Thank yu so much.

  14. First of all thanks for your awesome videos! But i have to mention that the germ cells of the embryo derive from the extra-embryonal mesenchima and not from the three germ layers 😎

  15. I have a question on risk factor for GCTs.

    I understand how number of ovulation affects epithelial ovarian cancer b/c ovulation let ovarian epithelium to be damaged and heal continuously.

    But what does ovulation has to do with germ cell tumors? I can't find it on Google or wiki or obgy textbooks

  16. I’m 17 years old and my gynecologist found a dermoid tumor on my right ovary. She will send me to surgery and they will probably remove the ovary 🙁

  17. Hello ..I have one question….Does dermoid cyst arise from the abnormal growth of female oocyte?if it is true then ' ' 'How does single ova gives rise to teratoma?

  18. @4:00 you said dysgerminoma is most common malignant tumor in ovaries…? "Epithelial tumors are the most common malignant ovarian tumor…" – Robbins

  19. I had both malignant and non malignant germ cells. At least four major tumors were removed from me at various times during my life starting at age ten, with the last being removed in my mid forties.
    One was attached to my testis and grew to 10 cm and was malignant. The last and largest of the teratoma was removed several months later at the Mayo Clinic and it was 17.5 cm. Fortunately this particular teratoma was not malignant.
    My right testis was under developed in addition to being undescended. It was surgically brought down into place at age ten. It was at this time that the first couple of teratoma were found and removed from my abdomen. After the surgery the testis failed to mature and remained small until as an adult it started growing a malignant teratoma that filled the scrotum and then worked its way up into the abdominal cavity.
    My other testis also failed to fully mature to what one would call a normal adult size but other wise was normal. Not surprisingly my puberty was delayed until my late teens. I did marry and we did manage to have two children but it took many years to produce them. Which in its self not surprising as I wasn’t producing a great deal of sperm from my one small testis.
    I tend to see myself as being intersex and also deal with gender dysphoria. I clearly attribute to how I sexually developed to my lack of testicular development.
    I live my life as a happily married male/ female something with excess biological baggage that has haunted me during my life time.
    In all I’ve had over twenty surgeries, with many related to this condition. In addition I’ve had seven months of aggressive chemotherapy.

  20. The last part of the video was about epithelial ovarian cancer…and the name of the vido is "Germ cell ovarian tumors"… I don't think that epithelial cancer belongs to germ cell tumor.

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