Clinicopathological Study of Ovarian Germ Cell Tumours in Tertiary Care Hospital, Tamil Nadu, India: A cross-sectional Study

Introduction: Ovarian germ cell tumours are a heterogeneous group of neoplasms derived from primitive germ cells of the embryonic gonad, either directly or indirectly. They can be classified as benign and malignant, with slow and rapid growth and spread, respectively. Benign ovarian germ cell tumours are common, while malignant tumours are rare and account for about 2.6% of all ovarian malignancies. They are more common in the second and third decades of life and typically present with abdominal mass, pain, and elevated serum tumour markers, which aid in primary diagnosis and follow-up. Aim: To analyse the distribution of germ cell tumours in the ovary in relation to age, parity, mode of presentation, biochemical markers, histomorphological patterns, and immunohistochemical markers. Materials and Methods: This cross-sectional study was conducted at Department of Pathology, Sree Balaji Medical College, Hospital and Research Institute, Chromepet, Chennai, Tamil Nadu, India. The study involved 86 ovarian specimens, of which 25 were germ cell tumours. Complete clinical history, radiological findings, and pre-operative laboratory test values were recorded. The ovarian specimens were carefully examined for gross appearances, fixed in 10% neutral buffered formalin for 24-48 hours, and subjected to histopathological processing, routine and special staining, and immunohistochemical study after observing the different morphological patterns of the ovarian specimens received. Results: The age range of presentation was between 14 years and 58 years. Seventeen patients were parous (14 benign and 3 malignant), and eight (5 benign and 3 malignant) were nulliparous. Abdominal mass and abdominal pain were the most common modes of presentation. Out of 25 germ cell tumours, 19 were benign cystic mature teratomas, 2 were immature teratomas, 1 was a yolk sac tumour, 2 were dysgerminomas, and 1 was a carcinoid tumour, with 6 being malignant and 19 being benign tumours. Among the 6 malignant ovarian tumours, 5 cases had raised serum tumour markers {cancer antigen-125 (CA-125), Alpha-Fetoprotein (AFP)} pre-operatively, and the levels reduced and became normal after surgery. Among the 2 cases of immature teratoma, one was Grade-II and the other was Grade-III. For one case with mixed tumour components, CD-30 and a-fetoprotein immunohistochemical markers were performed, showing negative and positive results, respectively. Conclusion: Among the histopathological subtypes, benign cystic teratomas were the most common ovarian germ cell tumours in this study. Both benign and malignant tumours presented with abdominal pain and abdominal mass. Most of the tumours were diagnosed between the ages of 21 and 40 years. In this study, a-fetoprotein immunohistochemical marker showed strong positivity, confirming a single tumour component.