A 22-year-old with a right ovarian mass undergoes surgery. Histology reveals a dysgerminoma with syncytiotrophoblastic giant cells. Serum markers include elevated LDH and mildly elevated β-hCG (200 mIU/mL) with normal AFP. The presence of syncytiotrophoblastic cells in dysgerminoma has which specific implication?

• A It denotes malignant transformation and requires adjuvant chemotherapy regardless of stage
• B It classifies the tumour as a mixed germ cell tumour requiring different chemotherapy regimen
• C It indicates choriocarcinoma component, which is the dominant histology for treatment purposes
• D It is a histological variant that explains modest β-hCG elevation but does not alter the prognosis of pure dysgerminoma ✓

Explanation

Dysgerminoma can contain scattered syncytiotrophoblastic giant cells that secrete β-hCG, causing modest elevation (typically <1000 mIU/mL). This does not represent a mixed germ cell tumour nor does it alter the staging or treatment of pure dysgerminoma. A true mixed tumour would require a separate malignant GCT component histologically (e.g., yolk sac tumour) making up a recognisable proportion. LDH and β-hCG are useful in monitoring recurrence in dysgerminoma containing these cells, but treatment remains BEP chemotherapy as for dysgerminoma.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

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Written and medically reviewed by the StethoPrep medical team.