Surgical and Staging considerations

Patients diagnosed with dysgerminoma on pathologic frozen evaluation present a unique situation. A minority of these tumors have an associated gonadoblastoma and arise in a dysgenetic gonad in a phenotypically normal female with abnormal karyotype. The contralateral dysgenetic or "streak" gonad also carries a high potential for a future malignant GCT. Therefore, in cases of intra-operative diagnosis of dysgerminoma, the pathologist should be asked to carefully evaluate for any residual normal ovary and look for any elements of gonadoblastoma. As the pathologist is evaluating the specimen further, the surgeon should inspect the contralateral adnexa to determine whether a normal ovary or streak gonad is present. Normal ovarian tissue excludes the possibility of dysgenetic gonads, thereby allowing the surgeon to conserve the contralateral ovary and preserve reproductive potential [46]. However, in the event of a "streak" gonad or diagnosis of gonadoblastoma, a bilateral salpingo-oophorectomy should be performed to remove any gonadal tissue, regardless of age [9, 44, 46].

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