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Dantkale KS, Agrawal M. A Comprehensive Review of Current Trends in the Diagnosis and Treatment of Ovarian Germ Cell Tumors. Cureus 2024; 16:e52650. [PMID: 38380211 PMCID: PMC10877227 DOI: 10.7759/cureus.52650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 01/20/2024] [Indexed: 02/22/2024] Open
Abstract
Ovarian germ cell tumors constitute a rare and intricate spectrum of neoplasms characterized by diverse histological subtypes. This comprehensive review elucidates the classification, diagnosis, treatment, prognosis, and unique challenges associated with these tumors. The classification is rooted in histological attributes, with principal subtypes encompassing dysgerminoma, immature teratoma, yolk sac tumor (endodermal sinus tumor), choriocarcinoma, and mixed germ cell tumors. Each subtype bears distinct characteristics and clinical implications, necessitating precise diagnosis and tailored therapeutic strategies. Diagnosis hinges upon recognizing the broad clinical presentation, employing imaging techniques (such as ultrasound and MRI), evaluating tumor markers (alpha-fetoprotein and beta-human chorionic gonadotropin), and conducting histopathological examinations where necessary. Staging, primarily utilizing the International Federation of Gynecology and Obstetrics (FIGO) system, is pivotal in determining the extent of disease, guiding treatment choices, and facilitating prognostic assessment. Treatment modalities encompass surgery, chemotherapy (including standard regimens and emerging therapies), radiation therapy, targeted therapies, and immunotherapy. Prognosis is influenced by histological subtype, tumor stage, patient age, surgical success, response to chemotherapy, and tumor markers, while predictive biomarkers are continually emerging. Despite advances in treatment, ovarian germ cell tumors pose distinct challenges, including late diagnosis, treatment-related side effects, and the enigma of chemoresistance. An integral aspect of comprehensive care is supportive strategies to manage symptoms and offer psychological and emotional support. This review accentuates the vital role of early diagnosis and multidisciplinary care in optimizing outcomes. Future research directions and evolving clinical practices are explored in these intricate and distinctive malignancies, highlighting the dynamic landscape of ovarian germ cell tumors.
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Affiliation(s)
- Ketki S Dantkale
- Department of Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research (DMIHER), Wardha, IND
| | - Manjusha Agrawal
- Department of Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research (DMIHER), Wardha, IND
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Kremenevski N, Buchfelder M, Hore N. Intracranial Germinomas: Diagnosis, Pathogenesis, Clinical Presentation, and Management. Curr Oncol Rep 2023; 25:765-775. [PMID: 37036624 PMCID: PMC10256636 DOI: 10.1007/s11912-023-01416-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2023] [Indexed: 04/11/2023]
Abstract
PURPOSE OF REVIEW Intracranial germinomas constitute a rare brain tumor entity of unknown etiology, characterized by unique histopathology and molecular biology. In this manuscript, we review the literature focusing on the epidemiology, histopathology with molecular biology, clinical presentation with emphasis on tumor location, diagnostic workup, and current treatment strategies with related clinical outcomes of intracranial germinomas. RECENT FINDINGS Although the optimal treatment strategy remains a matter of debate, intracranial germinomas respond well to radiotherapy, chemotherapy, or a combination of both and are characterized by very high cure and survival rates. It is well-known that early discrimination of germinomas from other intracranial neoplasms facilitates the timely initiation of appropriate treatment, thereby contributing to the reduction of morbidity as well as mortality. Ongoing research will need to be directed towards discovering and refining reliable parameters for early diagnosis and evaluation of prognosis in patients with intracranial germinomas.
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Affiliation(s)
- Natalia Kremenevski
- Department of Neurosurgery, University of Erlangen-Nürnberg, Erlangen, Germany.
| | - Michael Buchfelder
- Department of Neurosurgery, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Nirjhar Hore
- Department of Neurosurgery, University of Erlangen-Nürnberg, Erlangen, Germany
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Shahnam A, Sayer R, Herbst U, Sharma R, Yoon WH, Dinihan T, Gao B. Growing Teratoma Syndrome in the Setting of Sarcoidosis: A Case Report and Literature Review. Curr Oncol 2022; 29:4148-4154. [PMID: 35735440 PMCID: PMC9221652 DOI: 10.3390/curroncol29060331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/30/2022] [Accepted: 06/06/2022] [Indexed: 11/16/2022] Open
Abstract
Growing teratoma syndrome (GTS) is rare and can mimic disease recurrence in patients with a history of immature teratoma. Benign hypermetabolic lymphadenopathy found on staging and surveillance computed tomography (CT) and positron emission tomography (PET) may lead to the presumption of metastatic malignancy. We report a case of a 38 year old with mixed mature and immature teratomas who developed new peritoneal masses after adjuvant chemotherapy despite a normalization of tumor markers. In addition to low FDG uptake observed in these peritoneal masses, a PET scan showed hypermetabolic lymphadenopathy and pulmonary and spleen lesions suggesting widespread metastases. Subsequent surgical resection confirmed a mixed pathology with GTS and sarcoidosis. We reviewed the current literature evidence of GTS and sarcoidosis as a benign cause of lymphadenopathy in cancer patients. We emphasize the importance of a tissue diagnosis before instituting therapy for presumed cancer recurrence to avoid potentially fatal diagnostic traps and management errors. A multiple disciplinary team approach is imperative in managing patients with suspected recurrent immature teratomas.
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Affiliation(s)
- Adel Shahnam
- Medical Oncology Department, Blacktown and Westmead Hospitals, Sydney, NSW 2145, Australia;
- Correspondence: (A.S.); (B.G.); Tel.: +61-288-905-200 (B.G.)
| | - Robyn Sayer
- Gynecological Oncology Department, Chris O’Brien Lifehouse, Sydney, NSW 2050, Australia;
| | - Unine Herbst
- Gynaecological Oncology Department, Westmead Hospital, Sydney, NSW 2145, Australia;
| | - Raghwa Sharma
- Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, NSW 2145, Australia;
| | - Won-hee Yoon
- Medical Oncology Department, Blacktown and Westmead Hospitals, Sydney, NSW 2145, Australia;
| | - Tim Dinihan
- Respiratory and Thoracic Medicine, Blacktown Hospital, Sydney, NSW 2148, Australia;
| | - Bo Gao
- Medical Oncology Department, Blacktown and Westmead Hospitals, Sydney, NSW 2145, Australia;
- Correspondence: (A.S.); (B.G.); Tel.: +61-288-905-200 (B.G.)
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Wang M, Hu T, Xie KY. Dihydrofolate reductase as a predictor for poor response to platinum-based chemotherapy in epithelial ovarian cancer. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2019; 12:1723-1730. [PMID: 31933990 PMCID: PMC6947109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 02/22/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Platinum-based chemotherapy is the first line chemotherapy regimen for ovarian cancer patients. However, chemotherapy resistance is observed in a large proportion of patients. It is urgently needed to investigate prognostic biomarkers for chemo-sensitivity in ovarian cancer. METHODS Dihydrofolate reductase (DHFR) expression was measured by immunohistochemical staining in 108 specimens, as well as DHFR mRNA variants with qRT-PCR assays. The correlation between DHFR expression and platinum-based chemotherapy response was analyzed. The prognostic significance of DHFR expression was evaluated in ovarian cancer. RESULTS Positive DHFR expression was observed in 48 specimens, which was correlated to chemotherapy resistance in ovarian cancer patients. Elevated DHFR2 mRNA expression, rather than DHFR1, was observed in chemotherapy resistant tumors. Positive DHFR expression was correlated with higher histologic grade in ovarian cancer (P = 0.014). Kaplan-Meier analysis indicated that DHFR positive expression predicted poor disease-free survival (DFS) (P = 0.040), but not overall survival (OS) of ovarian cancer patients (P = 0.706). The prognostic value was further supported by TCGA data analysis. Cox regression analysis indicated that positive DHFR expression was an independent detrimental factor for disease progression for ovarian cancer patients (P = 0.016). CONCLUSION DHFR level measurement was a valuable prognostic biomarker for chemo-sensitivity of ovarian cancer. Molecular analysis for DHFR variants will provide important evidence for chemotherapy regimen options.
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Affiliation(s)
- Min Wang
- Department of Obstetrics and Gynecology, Second People’s Hospital of ChengduChengdu 610047, Sichuan, China
| | - Ting Hu
- Department of Obstetrics and Gynecology, Second People’s Hospital of ChengduChengdu 610047, Sichuan, China
| | - Ke-Yu Xie
- Department of Anesthesia, Second People’s Hospital of ChengduChengdu 610047, Sichuan, China
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Calzas Rodríguez J, Carmen Juarez Morales MD, Casero MAR. Death by bleomycin pulmonary toxicity in ovarian dysgerminoma with pathologic complete response to chemotherapy. A case report. Respir Med Case Rep 2016; 18:48-50. [PMID: 27330950 PMCID: PMC4913162 DOI: 10.1016/j.rmcr.2016.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 04/14/2016] [Accepted: 04/15/2016] [Indexed: 11/29/2022] Open
Abstract
With cisplatin-based chemotherapy, most patients with ovarian dysgerminoma will survive long-term. Bleomycin is an important part of ovarian germ cell tumors (OGCT) treatment, and its dose-limiting toxicity is the development of pulmonary toxicity and it is increased in patients older than 40 years. We report the case of an elderly patient with an unresectable ovarian dysgerminoma who received neoadjuvant chemotherapy and who developed fatal bleomycin pulmonary toxicity (BPT) after surgery. A monitoring of pulmonary function is not routinely recommended for detecting BPT, although together with carefully assessment for symptoms or signs suggestive of pulmonary toxicity is the best way to reduce the risk of BPT. The frequency of pulmonary events in older patients makes us to think about the possibility of either reduce the dose of bleomycin or removing it from the BEP in ovarian GCT.
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Meisel JL, Woo KM, Sudarsan N, Eng J, Patil S, Jacobsen EP, Murali R, Gardner GJ, Bosl GJ, Aghajanian C, Feldman DR. Development of a risk stratification system to guide treatment for female germ cell tumors. Gynecol Oncol 2015; 138:566-72. [PMID: 26115974 DOI: 10.1016/j.ygyno.2015.06.029] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 06/18/2015] [Accepted: 06/22/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Due to their rarity, little is known about prognostic factors in female germ cell tumors (GCTs) or outcomes following systemic therapy. Management is largely based on studies of male GCT and epithelial ovarian cancer. METHODS Chart review was performed for all females with GCT seen at Memorial Sloan Kettering Cancer Center (MSKCC) from 1990 to 2012. Patients receiving chemotherapy were stratified using a modification of the male IGCCCG risk system, and the classifier was correlated with outcome. RESULTS Of 93 patients, 92 (99%) underwent primary surgery and 85 (92%) received chemotherapy. Modified IGCCCG classification was significantly associated with progression-free survival (PFS) and overall survival (OS), both when applied preoperatively and pre-chemotherapy (p<0.001 for all four analyses). Progression after initial chemotherapy (n=29) was detected by imaging in 14 (48%) patients, by serum tumor markers in 6 (21%) patients, and by multiple methods in the rest. Seven (29%) of 24 patients treated with salvage chemotherapy achieved long-term PFS, including 4/6 who received high-dose chemotherapy (HDCT) as initial salvage versus 3/16 treated with other initial salvage regimens. The estimated 3-year OS rate was 84% (95% CI, 76-92%), with a trend favoring dysgerminoma over non-dysgerminoma histologies (p=0.12). CONCLUSIONS Modified IGCCCG classification was prognostic for female GCT patients in this cohort and identified a poor-risk group who may benefit from more intensive first-line chemotherapy. Both imaging and tumor marker evaluation were important in identifying relapses after first-line chemotherapy. The majority of long-term remissions with salvage therapy were achieved with initial salvage HDCT.
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Affiliation(s)
- Jane L Meisel
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Kaitlin M Woo
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Nora Sudarsan
- Department of Medicine, St. Luke's Roosevelt Hospital Center, Continuum Cancer Centers, New York, NY, United States
| | - Jana Eng
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Sujata Patil
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Erin P Jacobsen
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Rajmohan Murali
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, United States; Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Ginger J Gardner
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - George J Bosl
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Carol Aghajanian
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Darren R Feldman
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
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