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Difficulty: HardGynecologic Oncology

Match each clinical presentation of a gynecologic neoplasm with its most likely diagnosis.

  • A 19-year-old woman with a large unilateral adnexal mass, elevated lactate dehydrogenase (LDH), and normal alpha-fetoprotein (AFP)Dysgerminoma
  • A 58-year-old woman with a unilateral adnexal mass, postmenopausal bleeding, and endometrial complex atypical hyperplasiaGranulosa cell tumor
  • A 24-year-old woman with a rapidly growing adnexal mass, markedly elevated alpha-fetoprotein (AFP), and Schiller-Duval bodies on histologyEndodermal sinus (yolk sac) tumor
  • A 64-year-old woman with diffuse abdominal bloating, early satiety, ascites, bilateral complex adnexal masses, and elevated CA-125Epithelial ovarian carcinoma

Answer

The correct pairings match the specific tumor markers, clinical demographics, and histologic findings to their respective ovarian neoplasms.
Each clinical scenario features hallmark characteristics of specific ovarian tumors. Dysgerminoma correlates with LDH; Granulosa cell tumor with estrogenic effects (endometrial hyperplasia); Endodermal sinus tumor with AFP and Schiller-Duval bodies; Epithelial ovarian carcinoma with CA-125 and advanced presentation with ascites.

Step-by-Step Solution

1
Analyze the presentation of the 19-year-old with elevated LDH and normal AFP.
This marker profile points to a dysgerminoma.
Dysgerminomas are the most common malignant germ cell tumors in young women and classically secrete LDH, while AFP remains normal.
2
Analyze the presentation of the 58-year-old with postmenopausal bleeding and endometrial hyperplasia.
This presentation aligns with a granulosa cell tumor.
Granulosa cell tumors are estrogen-secreting tumors that cause peripheral endometrial proliferation, necessitating an endometrial biopsy to rule out concurrent endometrial malignancy.
3
Analyze the presentation of the 24-year-old with elevated AFP and Schiller-Duval bodies.
This is diagnostic of an endodermal sinus (yolk sac) tumor.
Schiller-Duval bodies (resembling glomeruli) and elevated AFP are pathognomonic for yolk sac tumors.
4
Analyze the presentation of the 64-year-old with advanced age, ascites, and elevated CA-125.
This clinical picture represents epithelial ovarian carcinoma.
Epithelial ovarian cancers typically present in postmenopausal women with non-specific gastrointestinal symptoms, ascites, and elevated CA-125.

Key Concept

Differentiation of ovarian neoplasms by their characteristic tumor markers, patient demographics, and histologic features.
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Topics

Gynecologic Oncology

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