Study of germ cell tumors of ovary and associated immunohistochemistry

Background: Females have a 6–7% lifetime risk of developing ovarian tumors. Ovarian cancer is often termed a “silent killer” due to its frequent diagnosis at advanced stages. The present study aimed to examine the histomorphological spectrum and histological grading of ovarian germ cell tumors using the modified Bloom-Richardson Grading System. Additionally, the current study sought to molecularly classify germ cell tumors of the ovary using immunohistochemical markers, including alpha-fetoprotein (AFP), cancer antigen 125 (CA-125), and human chorionic gonadotropin (HCG). Methods: This study was carried out on 50 patients diagnosed with ovarian germ cell tumors within August 2019 and July 2023. Formalin-fixed, paraffin-embedded (FFPE) tissue sections were stained with hematoxylin and eosin (H&E). Immunohistochemistry (IHC) was performed using markers AFP, CA-125, and HCG. Results: The majority of patients were within the age range of 31–40 years. The most common presenting symptom was an abdominal mass in 28 cases (56%), followed by abdominal pain in 10 cases (20%) and postmenopausal bleeding in 8 cases (16%). Histologically, 68% and 32% of the tumors were benign and malignant, respectively. Benign tumors were predominantly cystic, whereas malignant tumors were solid or partly cystic and partly solid. Overall, 64%, 8%, and 28% of the tumors were cystic, solid, and semisolid or mixed, respectively. The diagnosis of germ cell tumors as benign or malignant was based on the predominant cell type, growth pattern, degree of fibrous stroma, cellular atypia, and invasiveness. Conclusion: The higher prevalence of malignancy was observed in patients over 50 years, postmenopausal women, tumors with solid or complex morphology, and bilateral tumors. Among ovarian neoplasms, germ cell tumors are relatively uncommon. Benign tumors were primarily mature cystic teratomas; however, malignant tumors included dysgerminomas. Choriocarcinomas showed strong HCG positivity, and endodermal sinus tumors and embryonal carcinomas demonstrated strong AFP expression.