Cancer Report

Cancer : Ovary: Germ cell tumors
Cancer Name Ovary: Germ cell tumors
Description Ovarian germ cell tumours (OGCT) are a type of ovarian neoplasm principally affecting young women. They are derived from primitive germ cells of the embryonic gonad, and may undergo germinomatous or embryonic differentiation. They differ in clinical presentation, histology and biology, and include both benign (predominantly) and malignant subtypes. Germ cell tumours (GCT) account for 15-20% of all ovarian neoplasms, and constitute the second largest group of ovarian neoplasms. Less than 5% of ovarian cancers are of germ cell origin. OGCT are subdivided into the clinicopathological entities listed in Table 1. Table 1 Subtypes and characteristics of ovarian germ cell tumours (data derived from Rice, 1999 and John Hopkins Pathology, 2001).
Clinics and Pathology
Etiology No factors have been associated with the aetiology of GCT, apart from an increased incidence associated with dysgenetic gonads. 5% of patients with dysgerminomas are associated with constitutional cytogenetic abnormalities involving the entirety or part of the Y chromosome; 46,XY (testicular feminisation), gonadal dysgenesis and mixed gonadal dysgenesis (45,X, 46,XY). However 95% of females with dysgerminomas are cytogenetically normal. In genetic syndromes with a high risk of cancer, rarely are GCT found. GCT may be found infrequently in individuals with Li-Fraumeni.
Epidemiology GCT predominantly affect young women, but they do sometimes occur in infants and older women. GCT account for over 60% of ovarian neoplasms in children and adolescents, one-third of which are malignant. The frequency of OGCT is invariable throughout the world. There does not appear to be a racial predisposition, in contrast to epithelial ovarian cancers. The incidence of OGCT increases in incidence from the age of 8-9 years, and peaks at 18 years (20 per million). The mean age of presentation of OGCT is 19 years. The incidence of OGCT is much lower than that of testicular germ cell tumours (TGCT). At 19 years of age the incidence of GCT in males is 44.5 per million, whereas it is only 10.4 per million in females. In the US, the incidence of GCT has not increased during the last thirty years.
  • Teratomas
    Teratomas develop from totipotential germ cells, and consequently contain all three germ cell layers: ectoderm, mesoderm and endoderm. Teratomas are classified into immature (malignant), mature (dermoid cyst) and monodermal (struma ovarii, carcinoid).
  • Dermoid cysts contain mature tissue, and upon gross examination skin, teeth, bone, hair, sebaceous glands and neural tissue predominate; whilst cartilage, respiratory and intestinal epithelium are also common. They are cystic tumours with a firm capsule.
  • Monodermal teratoma comprise mainly one tissue element. For example the most common type of monodermal teratoma, Struma ovarii, is comprised of at least 50% mature thyroid tissue (of any type). Argentaffin cells in dermoid cysts are usually the site of origin for ovarian carcinois, although this is rare.
  • Immature teratomas account for approximately 20% of all malignant GCT. They are classified as Grade I, II or III if they have 0 or1, 3 or less, or 4 or more low-power fields (x-40) containing immature neuroepithelium per section, respectively. Immature teratomas are solid tumours containing immature or embryonal tissues. Immature neuroepithelium is the predominant immature tissue found.

  • Dysgerminoma
    Dysgerminomas have a solid, lobulated, tan, flesh-like gross appearance with a smooth surface. Microscopically dysgerminoma cells are round and ovoid, contain abundant cytoplasm, irregularly shaped nuclei, >1 prominent nucleolus. These cells have a propensity to aggregate forming cords and sheets. Lymphocytic and granulocytic infiltration of the fibrous septa are often evident.

  • Endodermal Sinus Tumor (EST)
    Gross examination of EST, also known as yolk sac tumour, demonstrate smooth, glistening, hemorrhagic and necrotic surfaces. Histology reveals a wide range of patterns (microcystic, endodermal sinus, solid, alveolar-glandular, papillary, macrocystic, hepatoid, primitive endodermal). The classic pattern contains Schiller-Duval bodies (central capillary surrounded by simple papillae) and eosinophilic globules containing AFP. Intracellular and extracellular hyaline droplets (periodic acid-Schiff positive) are also seen in EST.

  • Embryonal Carcinoma
    Gross examination of embryonal carcinoma reveals a solid, haemorrhagic, necrotic tumour, resembling a larger form of EST. Embryonal glands, glandlike clefts (embryoid bodies), and syntrophoblastic giant cells are present microscopically.

  • Choriocarcinoma
    Choriocarcinoma is a very rare solid, haemorrhagic tumour, composed of malignant cytotropohoblast and syncytiotrophoblast. Nongestational and gestational choriocarcinoma have identical histologies.

  • Mixed Germ Cell Tumour
    As the name suggests, mixed germ cell tumours contain >1 histological type. Dysgerminoma with EST, and immature teratomas with EST are frequent combinations.

  • Polyembryoma
    Histological analysis of polyembryoma demonstrates erythroid bodies in different stages of presomite development.

  • Treatment The treatments used for OGCT have largely been based on those used for the more prevalent TGCT.

  • In young patients surgery should be conservative in order to preserve fertility. Consequently unilateral salpingo-oophorectomy is performed for all stages of dysgerminatous and nondysgerminatous GCT. Even if extra-ovarian disease is present, the contralateral ovary and uterus should not be removed as these tumours are curable with chemotherapy. However if fertility is not of concern, total abdominal hysterectomy and bilateral salpingo-oophorectomy, together with removal of as much tumour tissue as possible, is recommended for stage II, III and IV of dysgerminatous and nondysgerminatous GCT.

  • Chemotherapy is preferable, despite these tumours being highly radiosensitive (except EST and embryonal carcinoma), in order to preserve ovarian function. All patients irrespective of tumour histology, except those with immature teratomas (stage IA, grade1), receive post-operative chemotherapy, for adjuvant or curative purposes. Adjuvant chemotherapy is given to patients with completely resected stages I, II or III ESTs, mixed cell tumours, embryonal carcinomas, choriocarcinomas and immature teratomas due to high recurrence rates. All non-dysgerminomatous GCT receive the same chemotherapy regimes based on a combination cisplatin therapy. Combination therapies include vinblastine, bleomycin, and cisplatin (VBP); bleomycin, etoposide and cisplatin (BEP) and also etoposide and cisplatin (EP). Combination chemotherapy is given to patients with bulky residual disease, extra abdominal metastases, or those who failed primary treatment with a curative intent. Survival rates for nondysgerminatous ovarian germ cell malignancies has increased dramatically with the use of platinum-based combination chemotherapy. Approximately 15-25% of dysgerminomas recur, but these are usually treated with a curative outcome.
  • The survival rates for dysgerminomas presenting at early and advanced stages are 95% and >80% respectively.
  • The survival rates for stage I and II ESTs are reported to be 60-100%, whereas for those with stage III or IV disease the prognosis is less favourable (50-75%).
  • Survival rates for embryonal carcinoma are slightly higher than those for ESTs.
  • The prognosis of immature teratomas is governed by grade and stage. Grade 1, stage 1 have 100% survival rate, whereas stage III, grade 1 have only a 50% chance of survival. Meanwhile, most patients with mature teratomas show long survival times.
  • The prognosis is better for gestational choriocarcinoma than nongestational carcinoma.
  • The prognosis for mixed GCT is dictated by the proportion of the more malignant component and the stage.
  • Prognosis The prognosis of OGCT is excellent, as most cases are benign. When malignant they are very aggressive, but the prognosis is still good provided it is treated without delay with combination chemotherapy.
    Related Genes
    Gene Symbol K-RAS
    Description From COSMIC:
    Gene Symbol CDKN2A
    Description From COSMIC:
    Gene Symbol N-RAS
    Description From COSMIC:
    Gene Symbol KIT
    Description From COSMIC:
    Cytogenetics Morphological There is a paucity of cytogenetic data available on OGCT. Of 25 mature and immature teratomas displaying abnormal karyotypes, 16 had numerical changes only. Trisomy 3, 8, 12 and 14 were the most common numerical changes identified. Isochromosome 12p, i(12p) is the only recurrent structural rearrangement in OGCT, particularly in dysgerminomas and malignant GCT with a yolk sac component. I(12p) is more prevalent in TGCT, present in 80% of all such tumours. The presence of this anomaly in both testicular and ovarian GCT suggests that they may arise from a similar pathogenesis process. A representative example of isochromosome 12p, i(12p), is shown in Testicular Germ Cell tumor. Interphase cytogenetics using a chromosome 12 centromere and a 12p locus-specific probe can be used to detect this abnormality. Trisomy 12 has been found in several immature teratomas, supporting the importance of this chromosome in the onset of a subset of OGCT.

    Immature teratomas frequently have chromosomal abnormalities (63%), of which gains of chromosomes 3, 8, 12 and 14, losses of chromosomes 4 and 13, and several structural rearrangements including i(12p) are common. It has been proposed that cytogenetically abnormal immature teratomas are more likely to recur than their cytogenetically normal counterparts.

    Over 300 mature teratomas have undergone cytogenetic analysis and only 4% have had aberrant karyotypes, displaying numerical alterations only, none of which are recurrent. The few cases in which abnormalities have been identified were as follows: trisomy of chromosome 8 (2 cases), 13 (1 case), 15 (1 case), 20 (1 case) and double trisomy of chromosomes 7 and 12; losses of chromosomes 3, 6, 7, 11, 16, 17, 21 and 22; structural rearrangements involving +mar (2 cases), add(1)(q11) (1 case), der(6)(t1;6)(q11q22) (1 case), i(12)(p10) (1 case) and +del(20)(q11) (1 case).

    Mature teratomas that have undergo malignant transformation display multiple numerical and structural chromosomal anomalies principally involving chromosomes X, 1, 3, 4, 5, 9, 10 and 11. Several similarities were found when comparing the benign cystic and malignant component of an ovarian teratoma. It is noteworthy that the benign component had multiple anomalies (13 non-random structural and numerical changes), which raises the possibility that multiple anomalies in the benign component predispose the tumour to malignant transformation.

    Complex numerical and structural chromosome changes were apparent in mixed mesodermal tumors, but there is insufficient data to address whether this tumour subtype has a different composition of chromosomal abnormalities than the other subtypes. Abnormalities of chromosome 12 were found in two of six cases of ovarian choriocarcinomas. Monosomy 22 was identified as the sole anomaly in a mixed germ cell-sex cord stromal tumour in the ovary, by both karyotyping and CGH, which may suggest a common pathogenetic mechanism for both tumour types.

    From the cytogenetic data available to date, it appears that similarities exist between OGCT and TGCT. Isochromosome 12p, i(12p), gains of chromosomes 1, 8, 21 and loss of chromosomes 6 and 13 have been reported in both.

    Cytogenetics Molecular There have only been a limited number of studies employing comparative genomic hybridisation (CGH) to investigate OGCT, and no allelotype studies have been undertaken.

    27 ovarian GCT were analysed by CGH, of which 12 were dysgerminomas, 6 were ESTs, 3 were mixed GCT and the remainder were immature teratomas. The data was grouped for the dysgerminomas, ESTs and mixed GCT and the most frequent finding was gain of 12p, (14/19), 8 of which showed gain of 12p only, (which may result from i(12p)), 4 showed gains of the entirety of chromosome 12 and 2 showed high level amplification of 12p11-p12. 12p gain is a frequent finding in TGCT, and amplification of 12p11-p12 has also been found in a few such cases. Other recurrent abnormalities were found in this group which have also been previously reported as recurrent findings in TGCT. These include gain of entire chromosome 21 (42 % of malignant OGCT vs. 45% TGCT), gain of chromosome 8 (42% OGCT vs. 45% TGCT), gain of 1q (32% OGCT vs. 36 TGCT) and loss of chromosome 13 (26% OGCT vs. 38% TGCT). There did not appear to be a correlation between the pattern of chromosomal imbalances and histological subtype, except for distal 1p deletion, which was exclusively found in two ESTs. Meanwhile, only 1 of the 6 immature teratomas revealed an abnormality, gain of chromosome 14.

    A study summarised these findings according to histological entity. Every dysgerminoma (n=12) analysed showed chromosomal imbalances, with an average number of 10 changes per case. Gains were more common than losses. The most frequent anomalies were gains of 12p (8/12), 12q (9/12), 21q (8/12), 22q (7/12), 20q (6/12), 15q (5/12), 1p (4/12) and 6p (4/12) and the whole of chromosomes 19 (6/12), 7 (5/12), 8 (5/12) and 17 (5/12). Losses of chromosome 13 were seen in 7/12 of the cases. All 4 ESTs analysed displayed copy number changes, with an average of 6 per case. These included gain of 12p (3/4), 1q (3/4), 3p (2/4), 11q (2/4), Xp (2/4), and loss of 18q (2/4). Fewer changes were observed in the immature teratomas, with an average of 1.4 per case. 4 of the 9 immature teratomas had no copy number change. Gain of all or parts of 1p, 16p, 19 and 22 were identified in 2 of the cases with anomalies.

    Thus both studies frequently found 12p gains in several subtypes of OGCT, except for immature teratomas, and suggest that immature teratomas follow a different pathway to that taken by other malignant OGCT (and TGCT).

    Several interphase cytogenetic studies have been performed on paraffin sections using centromeric probes to determine the copy number of chromosomes, and probes specifically designed to identify the i(12p). A study showed over-representation of chromosomes 7 and 12, and under-representation of chromosome 18, all of which are characteristic features in the male counterpart testicular seminoma.

    Title Familial ovarian dermoid cysts.
    Authors Gustavson KH, Rune C.
    Citations Ups J Med Sci 1988; 93(1): 53-56.
    PubMedID 2767876
    Title Familial ovarian germ cell cancer: report and review.
    Authors Stettner AR, Hartenbach EM, Schink JC, Huddart R, Becker J, Pauli R, Long R, Laxova R.
    Citations Am J Med Genet 1999; 84(1): 43-46.
    PubMedID 11109172
    Title Familial predisposition to both male and female germ cell tumours?
    Authors Huddart RA, Thompson C, Houlston R, Nicholls EJ, Horwich A.
    Citations J Med Genet 1996; 33(1): 86.
    PubMedID 9202807
    Title Familial predisposition to both male and female germ cell tumours?
    Authors Huddart RA, Thompson C, Houlston R, Nicholls EJ, Horwich A.
    Citations J Med Genet 1996; 33(1): 86.
    PubMedID 9219001
    Title Familial benign cystic teratomata.
    Authors Brenner SH, Wallach RC.
    Citations Int J Gynaecol Obstet 1983; 21(2): 167-169.
    PubMedID 6498772
    Title Familial clustering of malignant germ cell tumors and Langerhans' histiocytosis.
    Authors Mandel M, Toren A, Kende G, Neuman Y, Kenet G, Rechavi G.
    Citations Cancer 1994; 73(7): 1980-1983.
    PubMedID 7697645
    Title Familial incidence of ovarian dermoid cysts.
    Authors Plattner G, Oxorn H.
    Citations Can Med Assoc J 1973; 108(7): 892-893.
    PubMedID 4707237
    Title Familial occurrence of mature ovarian teratomas.
    Authors Simon A, Ohel G, Neri A, Schenker JG.
    Citations Obstet Gynecol 1985; 66(2): 278-279.
    PubMedID 3471312
    Title Discrepancies of DNA content of various solid tumours before and after culture measured by image analysis. Comparison of cytogenetical data.
    Authors Lorenzato M, Doco M, Visseaux-Coletto B, Ferre D, Bellaoui H, Evrard G, Adnet JJ.
    Citations Pathol Res Pract 1993; 189(10): 1161-1168.
    PubMedID 7640186
    Title Dysgerminoma in mother and daughter: use of lactate dehydrogenase as a tumor marker in the child.
    Authors Chisholm JC, Darmady JM, Kohler JA.
    Citations Pediatr Hematol Oncol 1995; 12(3): 305-308.
    PubMedID 8825060
    Title Dysgerminoma. Clinocopathologic study of 22 cases.
    Authors Talerman A, Huyzinga WT, Kuipers T.
    Citations Obstet Gynecol 1973; 41(1): 137-147.
    PubMedID 4734177
    Title Expression profile of genes from 12p in testicular germ cell tumors of adolescents and adults associated with i(12p) and amplification at 12p11.2-p12.1.
    Authors Rodriguez S, Jafer O, Goker H, Summersgill BM, Zafarana G, Gillis AJ, van Gurp RJ, Oosterhuis JW, Lu YJ, Huddart R, Cooper CS, Clark J, Looijenga LH, Shipley JM.
    PubMedID 4734177
    Title Cytogenetic analysis of ependymoma and teratoma of the ovary.
    Authors Yang-Feng TL, Katz SN, Cacangiu ML, Schwartz PE.
    Citations Cancer Genet Cytogenet 1988; 35(1): 83-89.
    PubMedID 1970513
    Title Cytogenetics of a malignant ovarian germ-cell tumor.
    Authors van Echten J, van Doorn LC, van der Linden HC, van der Veen AY, Burger CW, de Jong B.
    Citations Int J Cancer 1998; 77(2): 217-218.
    PubMedID 10850452
    Title DNA copy number changes in malignant ovarian germ cell tumors.
    Authors Kraggerud SM, Szymanska J, Abeler VM, Kaern J, Eknaes M, Heim S, Teixeira MR, Trope CG, Peltomaki P, Lothe RA.
    Citations Nat Genet 2000; 24(2): 197-200.
    PubMedID 11850083
    Title Detection of chromosomal DNA gains and losses in testicular germ cell tumors by comparative genomic hybridization.
    Authors Korn WM, Oide Weghuis DE, Suijkerbuijk RF, Schmidt U, Otto T, du Manoir S, Geurts van Kessel A, Harstrick A, Seeber S, Becher R.
    Citations Genes Chromosomes Cancer 1996; 17(2): 78-87.
    PubMedID 9635841
    Title Comparative genomic hybridization of germ cell tumors of the adult testis: confirmation of karyotypic findings and identification of a 12p-amplicon.
    Authors Mostert MM, van de Pol M, Olde Weghuis D, Suijkerbuijk RF, Geurts van Kessel A, van Echten J, Oosterhuis JW, Looijenga LH.
    Citations Cancer Genet Cytogenet 1996; 89(2): 146-152.
    PubMedID 9524566
    Title Chromosome analysis and comparison of the benign cystic and malignant squamous component of an ovarian teratoma.
    Authors Noumoff JS, LiVolsi VA, Deger RB, Montone KT, Faruqi SA.
    Citations Klin Padiatr 2001; 213(4): 204-211.
    PubMedID 8697422
    Title Cytogenetic analysis of an immature teratoma of the ovary and its metastasis after chemotherapy-induced maturation.
    Authors Gibas Z, Talerman A, Faruqi S, Carlson J, Noumoff J.
    Citations Int J Gynecol Pathol 1993; 12(3): 276-280.
    PubMedID 8204448
    Title Comprehensive cytogenetic evaluation of a mature ovarian teratoma case.
    Authors Schmid-Braz AT, Cavalli LR, Cornelio DA, Wuicik L, Ribeiro EM, Bleggi-Torres LF, Lima RS, de Andrade Urban C, Haddad BR, Cavalli IJ.
    Citations 2002.
    PubMedID 9524566
    Title Benign ovarian teratomas. An analysis of their cellular origin.
    Authors Dahl N, Gustavson KH, Rune C, Gustavsson I, Pettersson U.
    Citations Cancer Genet Cytogenet 1990; 46(1): 115-123.
    PubMedID 2220805
    Title Are germ cell tumors part of the Li-Fraumeni cancer family syndrome?
    Authors Hartley AL, Birch JM, Kelsey AM, Marsden HB, Harris M, Teare MD
    Citations Cancer Genet Cytogenet 1989; 42: 221-226
    PubMedID 2332272
    Title Chromosome 12 abnormalities in malignant ovarian germ cell tumors.
    Authors Rodriguez E, Melamed J, Reuter V, Chaganti RS.
    Citations Cancer Genet Cytogenet 1995; 82(1): 62-66.
    PubMedID 8697422
    Title Chromosomal abnormalities in choriocarcinomas of the female.
    Authors Rodriguez E, Melamed J, Reuter V, Chaganti RS.
    Citations Cancer Genet Cytogenet 1995; 80(1): 9-12.
    PubMedID 8913724
    Title An unusual case of gonadic germinal tumor in a brother and sister.
    Authors Trentini GP, Palmieri B.
    Citations Cancer 1974; 33(1): 250-255.
    PubMedID 4810099
    Title Activating c-kit gene mutations in human germ cell tumors.
    Authors Tian Q, Frierson HF, Jr., Krystal GW, Moskaluk CA.
    Citations Am J Pathol 1999; 154(6): 1643-1647.
    PubMedID 11297769
    Title Androgenesis and parthenogenesis in humans.
    Authors Ohama K.
    Citations In Human Genetics 1987; Vogel F, Sperling K (eds): 245-249. Springer-Verlag: Berlin-Heidelberg.
    PubMedID 3180015
    Title Analysis of chromosome aneuploidy in ovarian dysgerminoma by flow cytometry and fluorescence in situ hybridization.
    Authors Gibas Z, Talerman A.
    Citations Diagn Mol Pathol 1993; 2(1): 50-56.
    PubMedID 8137225
    Title A chromosome study of three ovarian tumors.
    Authors Jenkyn DJ, McCartney AJ.
    Citations Cancer Genet Cytogenet 1987; 26(2): 327-337.
    PubMedID 3376353
    Title Squamous cell carcinoma in situ arising in an ovarian mature cystic teratoma. Report of one case with histopathologic, cytogenetic, and flow cytometric DNA content analysis.
    Authors Tobon H, Surti U, Naus GJ, Hoffner L, Hemphill RW.
    Citations Arch Pathol Lab Med 1991; 115(2): 172-174.
    PubMedID 1521236
    Title The Ovary.
    Authors Rice LW.
    Citations In Kistner's Gynecology & Women's Health 1999, Ryan KJ (ed): 166-189. Mosby.
    PubMedID 10655070
    Title Primary ovarian dysgerminoma in a patient with a germline BRCA1 mutation.
    Authors Werness BA, Ramus SJ, Whittemore AS, Garlinghouse-Jones K, Oakley-Girvan I, DiCioccio RA, Tsukada Y, Ponder BA, Piver MS.
    Nobel J (Eds).
    PubMedID 9650555
    Title Role of gain of 12p in germ cell tumour development.
    Authors Looijenga LH, Zafarana G, Grygalewicz B, Summersgill B, Debiec-Rychter M, Veltman J, Schoenmakers EF, Rodriguez S, Jafer O, Clark J, van Kessel AG, Shipley J, van Gurp RJ, Gillis AJ, Oosterhuis JW.
    Citations 2003.
    PubMedID 9650555
    Title Ovary-Non-Epithelial Carcinoma.
    Authors BC Cancer. 2, 2000.
    Citations Gynecol Oncol 2000; 77(2): 283-288.
    PubMedID 11528555
    Title P53 tumour suppressor gene and germ cell neoplasia.
    Authors Lutzker SG.
    Citations Apmis 1998; 106(1): 85-89.
    PubMedID 9650555
    Title Ovarian dysgerminoma in three generations?
    Authors Jackson SM.
    Citations J Med Genet 1967; 4(2): 112-113.
    PubMedID 5619989
    Title Ovarian mature cystic teratoma with malignant transformation. An interphase cytogenetic study.
    Authors Shen DH, Khoo US, Xue WC, Cheung AN.
    Citations Int J Gynecol Pathol 1998; 17(4): 351-357.
    PubMedID 10785479
    Title Ovarian Dysgerminomas
    Authors Wu AY, Michener CM, Dellinger C, Barnes A.
    Citations National Cancer Institute SEER Pediatric Monograph 2003: 125-137.
    PubMedID 7627937
    Title Ovarian Germ Cell Tumours.
    Authors National Cancer Institute 2003.
    PubMedID 7627937
    Title N-myc gene amplification and neuron specific enolase production in immature teratomas.
    Authors Ishiwata I, Ishiwata C, Soma M, Ono I, Nakaguchi T, Joh K, Furusato M, Ishikawa H.
    Citations Virchows Arch A Pathol Anat Histopathol 1991; 418(4): 333-338.
    PubMedID 1521236
    Title Occurrence of seminoma and dysgerminoma in father and daughter.
    Authors Yule SM, Dawes PJ, Malcolm AJ, Pearson AD.
    Citations Pediatr Hematol Oncol 1994; 11(2): 211-213.
    PubMedID 7627937
    Title Monosomy 22 in a mixed germ cell-sex cord-stromal tumor of the ovary.
    Authors Speleman F, Dermaut B, De Potter CR, Van Gele M, Van Roy N, De Paepe A, Laureys G.
    Citations Genes Chromosomes Cancer 1997; 19(3): 192-194.
    PubMedID 9679978
    Title Mutation analysis of the c-mos proto-oncogene in human ovarian teratomas.
    Authors de Foy KA, Gayther SA, Colledge WH, Crockett S, Scott IV, Evans MJ, Ponder BA.
    Citations Br J Cancer 1998; 77(10): 1642-1644.
    PubMedID 9785136
    Title Malignant germ cell tumours in two siblings.
    Authors Blake KI, Gerrard MP.
    Citations Med Pediatr Oncol 1993; 21(4): 299-300.
    PubMedID 8183736
    Title Molecular genetic analysis of malignant ovarian germ cell tumors.
    Authors Faulkner SW, Friedlander ML.
    Citations Cancer Res 2000; 60(11): 3025-3030.
    PubMedID 12414650
    Title Malignant Lesions of the Ovaries.
    Authors Helm CW, Edwards RP.
    Citations Cancer Genet Cytogenet 2002; 132(2): 165-168.
    PubMedID 12752258
    Title Localization to Xq27 of a susceptibility gene for testicular germ-cell tumours.
    Authors Rapley EA, Crockford GP, Teare D, Biggs P, Seal S, Barfoot R, Edwards S, Hamoudi R, Heimdal K, Fossa SD, Tucker K, Donald J, Collins F, Friedlander M, Hogg D, Goss P, Heidenreich A, Ormiston W, Daly PA, Forman D, Oliver TD, Leahy M, Huddart R, Cooper CS, Bodmer JG, Easton DF, Stratton MR, Bishop DT.
    Citations In Nelson Textbook of Pediatrics 2000, Behrman (ed) W.B. Saunders Company.
    PubMedID 12752258
    Title Incidence of the histological subtypes of ovarian cancer: the U.S.
    Authors Weiss NS, Homonchuk T, Young JLJr.
    Citations Third National Cancer Survey 1977: 1969-1971. Gynecologoy Oncology 5: 161-167
    PubMedID 6136438
    Title Immature teratoma of the ovary grade 3, with karyotype analysis.
    Authors King ME, DiGiovanni LM, Yung JF, Clarke-Pearson DL.
    Citations Int J Gynecol Pathol 1990; 9(2): 178-184.
    PubMedID 2024455
    Title Histologic grade and karyotype of immature teratoma of the ovary.
    Authors Ihara T, Ohama K, Satoh H, Fujii T, Nomura K, Fujiwara A.
    Citations Cancer 1984; 54(12): 2988-2994.
    PubMedID 4022488
    Title Granulosa-Theca Cell Tumors.
    Authors Michener, C. M., Wu, A. Y., and Barnes, A.
    Citations Oncogene 2003; 22(12): 1880-1891.
    PubMedID 12660824
    Title Gonadal and Germ Cell Neoplasms.
    Authors Smithson WA
    Citations Int J Gynecol Pathol 2000; 19(4): 390-394.
    PubMedID 12660824
    Title Germ cell, trophoblastic and other gonadal neoplasms ICCC X.
    Authors Bernstein L, Smith MA, Liu L, Deapen D, Friedman DL.
    Citations Apmis 2003; 111(1): 161-171; discussion 172-163.
    PubMedID 9530347
    Title Germ cell tumours in a brother and sister.
    Authors Akyuz C, Koseoglu V, Gogus S, Balci S, Buyukpamukcu M.
    Citations Acta Paediatr 1997; 86(6): 668-669.
    PubMedID 9530347
    Title Germ Cell Tumors.
    Authors John Hopkins Pathology 2001.
    Citations Cancer Genet Cytogenet 2001; 125(1): 59-62.
    PubMedID 7682284
    Title Genomic and expression analysis of the 12p11-p12 amplicon using EST arrays identifies two novel amplified and overexpressed genes.
    Authors Bourdon V, Naef F, Rao PH, Reuter V, Mok SC, Bosl GJ, Koul S, Murty VV, Kucherlapati RS, Chaganti RS.
    Citations 2002.
    PubMedID 7682284
    Title Genetics and biology of human ovarian teratomas. III. Cytogenetics and origins of malignant ovarian germ cell tumors.
    Authors Hoffner L, Shen-Schwarz S, Deka R, Chakravarti A, Surti U.
    Citations Cancer Genet Cytogenet 1992; 62(1): 58-65.
    PubMedID 7682284
    Title Genetics and biology of human ovarian teratomas. III. Cytogenetics and origins of malignant ovarian germ cell tumors.
    Authors Hoffner L, Shen-Schwarz S, Deka R, Chakravarti A, Surti U.
    Citations Cancer Genet Cytogenet 1992; 62(1): 58-65.
    PubMedID 1330288
    Title Genetics and biology of human ovarian teratomas. I. Cytogenetic analysis and mechanism of origin.
    Authors Surti U, Hoffner L, Chakravarti A, Ferrell RE.
    Citations Am J Hum Genet 1990; 47(4): 635-643.
    PubMedID 1655213
    Title Genetic analysis of ovarian germ cell tumors by comparative genomic hybridization.
    Authors Riopel MA, Spellerberg A, Griffin CA, Perlman EJ.
    Citations Cancer Res 1998; 58(14): 3105-3110.
    PubMedID 10362788
    Title Genetic analysis of childhood germ cell tumors with comparative genomic hybridization.
    Authors Schneider DT, Schuster AE, Fritsch MK, Calaminus G, Harms D, Gobel U, Perlman EJ.
    Citations Cancer Res 2002; 62(21): 6218-6223.
    PubMedID 9219001
    Title Trisomy 12 and translocation (7;9) in an ovarian immature teratoma.
    Authors Lopez Gines C, Gil R, Pellin A, Martorell M, Vilar F, Llombart-Bosch A.
    Citations Int J Gynecol Pathol 1989; 8(3): 277-285.
    PubMedID 2302685
    Title Trisomy 3 as the sole karyotypic change in a pediatric immature teratoma.
    Authors Mertens F, Kullendorff CM, Hjorth L, Alumets J, Mandahl N.
    Citations Cancer Genet Cytogenet 1998; 102(1): 83-85.
    PubMedID 10213045
    Title Tumors of the female Genital Organs.
    Authors Heim S, Mitelman F (eds).
    Citations In Cancer Cytogenetics 1995: 389-407.Wiley-Liss: New York.
    PubMedID 8825060
    Title Verification of isochromosome 12p and identification of other chromosome 12 aberrations in gonadal and extragonadal human germ cell tumors by bicolor double fluorescence in situ hybridization.
    Authors Suijkerbuijk RF, Looijenga L, de Jong B, Oosterhuis JW, Cassiman JJ, Geurts van Kessel A.
    Citations Cancer Genet Cytogenet 1992; 63(1): 8-16.
    PubMedID 8344765
    Title an unusual family cancer syndrome manifested in young siblings.
    Authors Weinblatt M, Kochen J.
    Citations Cancer 1991; 68(5): 1068-1070.
    PubMedID 1606571
    Title i(12p) in a malignant ovarian tumor.
    Authors Speleman F, De Potter C, Dal Cin P, Mangelschots K, Ingelaere H, Laureys G, Benoit Y, Leroy J, Van Den Berghe H.
    Citations Cancer Genet Cytogenet 1990; 45(1): 49-53.
    PubMedID 1992986
    Title i(12p) in a near-diploid mature ovarian teratoma.
    Authors Speleman F, Laureys G, Benoit Y, Cuvelier C, Suijkerbuijk R, De Jong B.
    Citations Cancer Genet Cytogenet 1992; 60(2): 216-218.
    PubMedID 8287226
    Source and Citation
    Source Atlas of Genetics and Cytogenetics in Oncology and Haematology
    Citation Lee-Jones L . Ovary: Germ cell tumors. Atlas Genet Cytogenet Oncol Haematol. August 2003 .
    URL :