Clinical and Computed Tomography Features of Female Pelvic Malignant Germ Cell Tumors in Children and Adolescents: A Series of 30 Cases

Study Objective To investigate the clinical features and computed tomography (CT) findings of malignant pelvic germ cell tumors in female patients and improve the diagnostic level of this disease. Design, Setting, and Participants The clinical and CT data of 30 female patients with malignant pelvic germ cell tumors confirmed using histopathology were retrospectively analyzed, before surgery, at a tertiary hospital. Patient's age, tumor location, clinical symptoms, tumor marker levels, and CT findings were recorded. Interventions None. Main Outcome Measures Identification of the clinical features and CT findings of malignant pelvic germ cell tumors. Results The patients ranged in age from 11 months to 22 years old, with a mean age of 12.3 years. The 30 cases (30 tumors) included 10 cases of yolk sac tumor, 8 cases of dysgerminoma, and 5 cases of immature teratoma. The alpha-fetoprotein levels were elevated in 8 cases of yolk sac tumor. Eight cases of dysgerminoma showed lobulation sign. Four cases of immature teratoma contained fat and calcification. The fibrovascular septa were observed on contrast-enhanced CT images in 4 cases of dysgerminoma. The “bright dot sign” was noted on contrast enhanced CT images in 9 cases of yolk sac tumor. Remarkable enhancement of the solid component or septa was detected in 10 cases of yolk sac tumor. Obvious enhancement surrounding vascular bundles in the tumor was observed in 5 cases of dysgerminoma. Conclusion Malignant pelvic germ cell tumors in female patients frequently affect children and adolescents. The CT findings of dysgerminoma, immature teratoma, and yolk sac tumor have certain characteristic features. The combination of CT manifestations, tumor markers, and patient age helps improve the diagnostic level of this disease.