Dysgerminoma with Estrogen-Producing Functioning Stroma Presenting Precocious Puberty

Dysgerminoma is a malignant ovarian germ cell tumor, and unlike sex-cord stromal tumors, endocrine manifestation is considered rare. Here, we report the first case of dysgerminoma presenting precocious puberty. The patient is a 7-year-old girl who presented with a breast development in Tanner stage...

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Main Authors: Shunsuke Nagase, Kanako Ogura, Karin Ashizawa, Nana Nakazawa-Tanaka, Masahiko Urao, Masaharu Fukunaga, Yuto Yamazaki, Hironobu Sasano, Toshiharu Matsumoto
Format: Article
Language:English
Published: Wiley 2021-01-01
Series:Case Reports in Pathology
Online Access:http://dx.doi.org/10.1155/2021/5545645
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Summary:Dysgerminoma is a malignant ovarian germ cell tumor, and unlike sex-cord stromal tumors, endocrine manifestation is considered rare. Here, we report the first case of dysgerminoma presenting precocious puberty. The patient is a 7-year-old girl who presented with a breast development in Tanner stage 3. Serum estradiol (E2) was markedly elevated while luteinizing hormone (LH) and follicle-stimulating hormone (FSH) were suppressed below the detection limit. Microscopically, the right ovarian mass displayed nests of large polygonal cells and fibrous septa which were focally concentrated by theca-like plump spindle cells. Immunohistochemistry revealed that the spindle cells expressed various steroidogenic enzymes involved in estrogen biosynthesis including P450 aromatase. The tumor was diagnosed with pure dysgerminoma with estrogen-producing functioning stroma. After the operation, serum E2 declined below the detection limit; LH and FSH returned within the normal range. This case demonstrates that even a conventional dysgerminoma can present endocrine manifestation through functioning stroma.
ISSN:2090-6781
2090-679X