The diagnostic workup of ovarian germ cell tumors begins with a comprehensive history and physical examination. Particular attention should be paid to the presence or absence of menstruation and secondary sex characteristics, since malignant germ cell tumors can arise in the setting of dysgenetic gonads. Thus, a preoperative karyo-type is especially important and indicated for premenarchal girls.92 Additional baseline evaluation for all patients should include: blood studies, liver function testing, serum tumor markers (see Table 11-6), and appropriate imaging such as a pelvic ultrasound. Dysgerminomas are classically solid tumors with areas of hemorrhage, and they thus appear as solid masses on ultrasound. Teratomas and endodermal sinus tumors are more complex in appearance with cystic and solid components. For these tumors, a chest x-ray is needed during the diagnostic evaluation, since they often metastasize to the lungs and/or mediastinum. Computed tomography or magnetic resonance imaging constitutes an acceptable alternative.
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