Figure 22-11. Photomicrographs of subtle examples of malignant germ cell neoplasms. A, Endodermal sinus tumor amidst teratomatous elements, some in contiguity with enteric-type structures (mucin-producing lining). B, Subtle component of germinoma amidst skeletal muscle in extragonadal teratoma. (Original magnifications: A, x100; B, x200; C, x400.)
Malignant mixed germ cell tumors constitute a significant number of ovarian malignancies representing 50% of ovarian germ cell tumors and 30% of malignant germ cell tumors in children and adolescents.13 They are usually composed of teratoid elements with dysgerminoma, EST, embryonal carcinoma, and choriocarcinoma in different proportions (Figure 22-14). Documentation of all tumor types determines the types of chemothera-peutic agents to be used.
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