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Ju UC, Kang WD, Kim SM. Enhancing the accuracy of preoperative and intraoperative evaluation of malignant ovarian germ cell tumors with a focus on fertility preservation in young women. Int J Gynaecol Obstet 2024. [PMID: 39277819 DOI: 10.1002/ijgo.15916] [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: 07/07/2024] [Revised: 08/21/2024] [Accepted: 09/03/2024] [Indexed: 09/17/2024]
Abstract
OBJECTIVE To analyze and improve the accuracy of preoperative assessment and intraoperative frozen-section analysis (FSA) for malignant ovarian germ cell tumors (MOGCTs), especially in the context of fertility preservation. METHODS A retrospective review of 48 women aged under 40 years, diagnosed with MOGCTs, and treated at Chonnam National University Hospital between July and December 2022 was conducted. The results of preoperative magnetic resonance imaging (MRI), measurement of serum tumor markers (α-fetoprotein [AFP], β-human chorionic gonadotropin, lactate dehydrogenase [LDH], cancer antigen [CA] 125, CA 19-9, CA 72-4, carcinoembryonic antigen), and intraoperative FSA were compared with the final pathology diagnosis. RESULTS MRI demonstrated a sensitivity of 95.5%, whereas FSA showed a sensitivity of 72.9% for all MOGCTs. Sensitivities varied according to the subtype, but were consistently higher in MRI (100% for dysgerminoma, 88.9% for immature teratoma, 100% for endodermal sinus tumor, 100% for others). However, there were differences in FSA according to subtype (100% for dysgerminoma, 50.0% for immature teratoma, 100% for endodermal sinus tumor, 25.0% for others). Serum tumor markers also provided diagnostic insights, particularly LDH for dysgerminoma (82.4%) and AFP for immature teratoma (75.0%) and endodermal sinus tumor (100%). CONCLUSION Preoperative MRI and serum tumor marker measurement may be effective in guiding fertility-sparing surgical decisions. MRI could outperform FSA in terms of accuracy, especially for immature teratoma.
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Affiliation(s)
- U Chul Ju
- Department of Obstetrics and Gynecology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Woo Dae Kang
- Department of Obstetrics and Gynecology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Seok Mo Kim
- Department of Obstetrics and Gynecology, Chonnam National University Medical School, Gwangju, Republic of Korea
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Kulkarni K, Agarwala S, Jain V, Dhua A, Yadav DK, Goel P, Srinivas M, Bakhshi S. Management and Outcomes of Children with Malignant Germ Cell Tumor. Indian J Pediatr 2024:10.1007/s12098-024-05223-w. [PMID: 39102016 DOI: 10.1007/s12098-024-05223-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Accepted: 07/16/2024] [Indexed: 08/06/2024]
Abstract
OBJECTIVES To assess the clinico-pathological features, management and outcomes, amongst extracranial malignant germ cell tumors (MGCTs) in children treated primarily at a tertiary care center in a resource-challenged nation. METHODS The prospectively maintained data for children below 14 y of age treated for extracranial MGCT from May 1994 to January 2023 was analyzed for patient characteristics, management, event-free survival (EFS) and overall survival (OS) and factors effecting survival. Events was defined as death, recurrence and progression. Multivariate logistic regression analysis was performed to identify the factors independently predicting unfavorable outcomes. RESULTS One hundred and seventy-seven children (37% males) with a median (IQR) age at presentation of 30 mo (range 2-168 mo) were included. The cohort consisted of 87 (49%) extra-gonadal and 90 (51%) gonadal cases. Disease was metastatic at presentation in 48 (27%) with lungs being the most common site. Neoadjuvant chemotherapy (NACT) was given to 119 (67%) and finally 162/177 (92%) had undergone resection of the primary tumor. Endodermal sinus tumor (EST) was the commonest histological subtype in 141 children (73%). Twenty-two (12%) patients had died giving a 5-y OS of 84.7% (95% CI 78.3- 91.1). Recurrence occurred in 25 patients, and an additional 5 patients had progression giving a 5-y EFS of 69.9% (95% CI 62.5- 77.3). Stage III (p = 0.05), Stage IV (p = 0.006) and extra-gonadal site (p = 0.05) were significantly associated with poorer EFS. CONCLUSIONS Children with MGCT have a favorable outcome with 5-y OS of 84.7% and EFS of 69.9%. Stage III and IV disease and extra-gonadal sites were independent predictors of a poor outcome.
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Affiliation(s)
- Kaushal Kulkarni
- Department of Pediatric Surgery, AIIMS, New Delhi, 110029, India
| | - Sandeep Agarwala
- Department of Pediatric Surgery, AIIMS, New Delhi, 110029, India.
| | - Vishesh Jain
- Department of Pediatric Surgery, AIIMS, New Delhi, 110029, India
| | - Anjan Dhua
- Department of Pediatric Surgery, AIIMS, New Delhi, 110029, India
| | | | - Prabudh Goel
- Department of Pediatric Surgery, AIIMS, New Delhi, 110029, India
| | - M Srinivas
- Department of Pediatric Surgery, AIIMS, New Delhi, 110029, India
| | - Sameer Bakhshi
- Department of Medical Oncology, BRAIRCH, AIIMS, New Delhi, India
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Sekar MD, Pradeep I, Srinivas BH, Kayal S. Extragonadal Germ Cell Tumors: A Single Institution Experience with Clinicopathological Correlation. Int J Surg Pathol 2024; 32:865-874. [PMID: 37853749 DOI: 10.1177/10668969231201413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
Background. Extragonadal germ cell tumors (EGCTs) are a rare heterogeneous group of tumors without evidence of primary gonadal germ cell tumors. They account for 2%-5% of overall malignancies. EGCTs are often not clinically suspected, making them challenging for pathologists. In this retrospective observational study, we describe our institutional experience among EGCTs with clinicopathological correlation. Materials and methods. All patients diagnosed as EGCTs from January 2014 to April 2023 were collected. All relevant clinical data and serum markers were retrieved from hospital medical records. Histopathology and immunohistochemistry slides were reviewed. Results. The present study included a total of 56 patients; 34 (60%) men and 22 (40%) women with a men-to-women ratio of 1.5:1. Of them, 1 patient had congenital/neonatal EGCTs, 21 patients had prepubertal EGCTs, and 34 had post-pubertal EGCTs. The common sites included are mediastinum (45%), sacrococcyx (18%), retroperitoneum (14%), and central nervous system (12%). The other rare sites were the vagina, liver, colon, and duodenum. The common germ cell tumor included mature teratoma (34%), mixed germ cell tumor (27%), seminoma/germinoma (12%), pure yolk sac tumor (11%), immature teratoma (9%), mature teratoma with somatic tumor (5%), and embryonal carcinoma (2%). All histological diagnoses of germ cell tumors were confirmed with IHC markers like PLAP, CD117 (KIT), AFP, LIN28, CD30, and β-hCG. Pre and posttreatment serum tumor marker levels were available in 37 patients. All our treated patients had a decrease or normal tumor marker levels post-therapy. Conclusion. In our study, a heterogeneous group of germ cell tumors was seen. Most of them were seen in post-pubertal adolescents and young adults. Early intervention by platinum-based combination chemotherapy in seminoma and nonseminomatous germ cell tumors has significantly improved the prognosis of malignant EGCTs similar to their germ cell counterparts.
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Affiliation(s)
- Mithraa Devi Sekar
- Department of Pathology, Jawarharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Immanuel Pradeep
- Department of Pathology and Laboratory medicine, A.I.I.M.S Bibinagar, Hyderabad, India
| | - Bheemanathi Hanuman Srinivas
- Department of Pathology, Jawarharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Smita Kayal
- Department of Medical Oncology, Jawarharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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Gashawbeza B, Dereje B, Abubeker FA. Primary Dysgerminoma of the Uterine Cervix: A Rare Case Report. Case Rep Obstet Gynecol 2024; 2024:6465387. [PMID: 38938322 PMCID: PMC11208782 DOI: 10.1155/2024/6465387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 05/13/2024] [Accepted: 05/21/2024] [Indexed: 06/29/2024] Open
Abstract
Introduction Primary extragonadal germ cell tumors (EGCTs) are a very rare clinical encounter most commonly reported in males. Among females, the placenta, pelvis, uterus, brain, and mediastinum are the most common extragonadal sites and predominantly display nondysgerminoma histology. In this report, we present a case of a primary cervical dysgerminoma in a young female patient. Case Report. An 18-year-old nulligravid woman presented with a 12-month history of vaginal bleeding and discharge. Routine blood tests and serum levels of tumor markers were within normal limits. The chest X-ray was normal. A high-resolution pelvic MRI showed a well-defined lobulated cervicovaginal mass measuring 8 × 6 × 5 cm expanding into the vaginal canal with mild homogenous contrast enhancement. An incisional biopsy was performed vaginally under anesthesia, and histologic findings were consistent with dysgerminoma. A repeat follow-up pelvic MRI was done and showed a reduction in the size of the mass by more than 70%. The patient was treated with 4 cycles of bleomycin, etoposide, and cisplatin chemotherapy. Additional external pelvic beam radiation treatment was administered for a partial response. After 3 months of radiotherapy, a contrast abdominopelvic CT scan showed a recurrent cervicovaginal mass with extension to the pelvic sidewalls. The patient was initiated with ifosfamide, paclitaxel, and cisplatin (ITP) as second-line chemotherapy for a recurrent germ cell tumor but later died from hydronephrosis, chronic anemia, and sepsis. Conclusion The uterine cervix is a very unusual site for primary dysgerminoma and can have a very aggressive clinical course. A high index of suspicion and an exhaustive workup are necessary to reach a diagnosis, particularly in a young patient presenting with a cervical lesion.
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Affiliation(s)
- Biruck Gashawbeza
- Department of Obstetrics and GynecologySaint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Bethel Dereje
- Department of Obstetrics and GynecologySaint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Ferid A. Abubeker
- Department of Obstetrics and GynecologySaint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
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Burnham EL, Tomita T. Histogenesis of intracranial germ cell tumors: primordial germ cell vs. embryonic stem cell. Childs Nerv Syst 2023; 39:359-368. [PMID: 36595083 DOI: 10.1007/s00381-022-05808-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/14/2022] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Intracranial germ cell tumor (iGCT) is a rare disorder and often occurs during childhood and adolescence. iGCTs are frequently localized in pineal region and hypothalamic-neurohypophyseal axis (HNA). In spite of well-established clinical and pathological entity, histogenesis of iGCTs remains unsettled. Current theories of histogenesis of iGCTs include germ cell theory (from primordial germ cells (PGCs) of aberrant migration) and stem cell theory (transformed embryonic stem (ES) cells). In order to comprehend the histogenesis, we revisit the origin, migration, and fate of the human PGCs, and their transformation processes to iGCT. DISCUSSION In "germ cell theory," transformation of ectopic PGCs to iGCT is complex and involves multiple transcription factors. Germinoma is derived from ectopic PGCs and is considered a prototype of all GCTs. Non-germinomatous germ cell tumors (NGGCTs) develop from more differentiated counterparts of embryonic and extra-embryonic tissues. However, there is a distinct genomic/epigenomic landscape between germinoma and NGGCT. ES cells transformed from ectopic PGCs through molecular dysregulation or de-differentiation may become the source of iGCT. "Stem cell theory" is transformation of endogenous ES cells or primitive neural stem cell to iGCTs. It supports histological diversity of NGGCTs because of ES cell's pluripotency. However, neural stem cells are abundantly present along the subependymal zone; therefore, it does not explain why iGCTs almost exclusively occur in pineal and HNA locations. Also, the vast difference of methylation status between germinoma and NGGCT makes it difficult to theorize all iGCTs derive from the common cellular linage. CONCLUSION Transformation of PGCs to ES cells is the most logical mechanism for histogenesis of iGCT. However, its detail remains an enigma and needs further investigations.
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Affiliation(s)
- Emma L Burnham
- Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Tadanori Tomita
- Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Liu P, Li Z, Cheng X, Gao Q, Che Y, Zhang Z, Chu R, Chen Z, Zhang Y, Wang Q, Dou Z, Wei Y, Cui Z, Wang J, Xie X, Ma D, Yang X, Kong B, Song K. Assessment of prognostic and reproductive outcomes of omentectomy for patients with clinically apparent early-stage (I, II) malignant ovarian germ cell tumours: A multicentre retrospective study. BJOG 2022; 129 Suppl 2:23-31. [PMID: 36485067 DOI: 10.1111/1471-0528.17325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE This study assessed the effect of omentectomy on the prognosis and fertility in patients with clinically early-stage (I, II) malignant ovarian germ cell tumours (MOGCT). DESIGN A retrospective multicentre study. SETTING Four university teaching hospitals in China. POPULATION A total of 268 patients with clinically apparent early-stage (I, II) MOGCT. METHODS Data were obtained from the medical records. Additionally, the propensity score matching (PSM) algorithm was adopted. MAIN OUTCOME MEASURES Prognostic outcomes were disease-free survival (DFS) and overall survival (OS). Fertility outcomes were pregnancy and live birth rates. RESULTS A total of 187 (69.8%) patients underwent omentectomy. Kaplan-Meier analysis showed no significant differences in DFS and OS between the omentectomy and non-omentectomy groups before and after PSM (p > 0.05). Additionally, subgroup analysis stratified by age (<18 and ≥18 years) showed similar results. International Federation of Gynecology and Obstetrics (FIGO) stage was the only risk factor associated with DFS (hazard ratio [HR] 14.71, 95% confidence interval [CI] 4.47-48.38, p < 0.001) and OS (HR 37.36, 95% CI 3.87-361.16, p = 0.002). Pregnancy and live birth rates in the total population were 80.3% and 66.7%, respectively. There were no significant differences between the two groups before and after PSM. CONCLUSIONS Omentectomy did not improve survival or affect fertility in patients with clinically apparent early-stage (I, II) MOGCT, regardless of the age. The clinical FIGO stage was an independent risk factor for recurrence and death.
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Affiliation(s)
- Penglin Liu
- Department of Obstetrics and Gynaecology, Qilu Hospital of Shandong University, Jinan, China
| | - Zhuang Li
- Department of Obstetrics and Gynaecology, Qilu Hospital of Shandong University, Jinan, China
| | - Xiaodong Cheng
- Department of Gynaecological Oncology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qinglei Gao
- Department of Obstetrics and Gynaecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yanci Che
- Department of Obstetrics and Gynaecology, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zhaoyang Zhang
- Department of Obstetrics and Gynaecology, Qilu Hospital of Shandong University, Jinan, China
| | - Ran Chu
- Department of Obstetrics and Gynaecology, Qilu Hospital of Shandong University, Jinan, China
| | - Zhongshao Chen
- Department of Obstetrics and Gynaecology, Qilu Hospital of Shandong University, Jinan, China
| | - Yue Zhang
- Department of Obstetrics and Gynaecology, Qilu Hospital of Shandong University, Jinan, China
| | - Qiannan Wang
- Department of Obstetrics and Gynaecology, Qilu Hospital of Shandong University, Jinan, China
| | - Zhiyuan Dou
- Department of Obstetrics and Gynaecology, Qilu Hospital of Shandong University, Jinan, China
| | - Yuan Wei
- Department of Obstetrics and Gynaecology, Qilu Hospital of Shandong University, Jinan, China
| | - Zhumei Cui
- Department of Obstetrics and Gynaecology, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jianliu Wang
- Department of Obstetrics and Gynaecology, Peking University People's Hospital, Beijing, China
| | - Xing Xie
- Department of Gynaecological Oncology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ding Ma
- Department of Obstetrics and Gynaecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xingsheng Yang
- Department of Obstetrics and Gynaecology, Qilu Hospital of Shandong University, Jinan, China
| | - Beihua Kong
- Department of Obstetrics and Gynaecology, Qilu Hospital of Shandong University, Jinan, China.,Key Laboratory of Gynaecological Oncology, Qilu Hospital of Shandong University, Jinan, China
| | - Kun Song
- Department of Obstetrics and Gynaecology, Qilu Hospital of Shandong University, Jinan, China.,Key Laboratory of Gynaecological Oncology, Qilu Hospital of Shandong University, Jinan, China
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Pallavi VR, Kansal Y, Rathod PS, Shobha K, Kundargi R, Bafna UD, Devi U, Vijay CR. Impact of Optimal Therapy and Prognostic Factors in Malignant Germ Cell Tumors of Ovary: 20 Years' Institutional Experience. Indian J Surg Oncol 2022; 13:633-640. [PMID: 36187515 PMCID: PMC9515283 DOI: 10.1007/s13193-022-01537-3] [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: 09/20/2021] [Accepted: 04/19/2022] [Indexed: 11/25/2022] Open
Abstract
The objective of this study is to analyze the impact of clinicopathological and treatment-related factors on survival in patients with malignant ovarian germ cell tumor. A total of 253 patients of ovarian germ cell malignancy were retrospectively reviewed during 2000-2019. Out of these, 111 had primary treatment at our institute, which is a dedicated regional cancer center. The remaining 142 were operated elsewhere and were referred to us for adjuvant chemotherapy or with recurrent disease. The clinicopathological and treatment-related characteristics were analyzed for association with tumor persistence/recurrence or death. Among them, 107 were dysgerminomas; 60 had endodermal sinus tumor, 53 mixed germ cell tumors, and 31 immature teratoma; and one each had embryoma and primitive germ cell tumor. The median follow-up period was 19 months (range 0-214). Median time to recurrence or progression was 5 months. Forty-nine patients (19.4%) had a recurrence and there were 16 (6.3%) deaths. Five-year disease-free-survival was 71.3% and 5-year overall survival rate was 88.1%, for the entire cohort. Disease-free-survival was 90.4% and overall survival was 92.1% for patients entirely treated at the reporting institute. Sub-group analysis based on treatment adequacy showed that survival rate was 91.0% in patients who had timely and complete initial treatment versus 78.3% in patients where treatment was incomplete or delayed (p = 0.032). Factors affecting relapse were tumor histology, absence of surgical staging, presence of residual disease, inadequate response to chemotherapy, treatment outside reporting institute, and incomplete/delayed chemotherapy. Significant factors adversely affecting survival were presence of post-operative residual disease, tumor histology, incomplete response to chemotherapy, and inadequate/delayed treatment at primary setting. There was no statistically significant difference based on disease stage and whether fertility-sparing surgery or non-fertility-sparing surgery was performed. Prognosis of ovarian germ cell malignancies is excellent with timely, optimal treatment. The outcome improves significantly if managed adequately in the primary setting, involving dedicated gynecologic oncologists.
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Affiliation(s)
- V. R. Pallavi
- Department of Gynecologic Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka 560029 India
| | - Yamini Kansal
- Department of Gynecologic Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka 560029 India
| | - Praveen S. Rathod
- Department of Gynecologic Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka 560029 India
| | - K. Shobha
- Department of Gynecologic Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka 560029 India
| | - Rajshekar Kundargi
- Department of Gynecologic Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka 560029 India
| | - U. D. Bafna
- Department of Gynecologic Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka 560029 India
| | - Uma Devi
- Department of Gynecologic Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka 560029 India
| | - C. R. Vijay
- Department of Biostatistics, Kidwai Memorial Institute of Oncology, Bengaluru, India
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Gică N, Peltecu G, Chirculescu R, Gică C, Stoicea MC, Serbanica AN, Panaitescu AM. Ovarian Germ Cell Tumors: Pictorial Essay. Diagnostics (Basel) 2022; 12:diagnostics12092050. [PMID: 36140449 PMCID: PMC9498179 DOI: 10.3390/diagnostics12092050] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/11/2022] [Accepted: 08/19/2022] [Indexed: 11/16/2022] Open
Abstract
Ovarian germ cell tumors of the ovary represent a histologically heterogenous group of tumors with a high incidence at reproductive age. Patients with this pathology are very often young women with amenorrhea. The aim of this article is to present a pictorial essay of this rare pathology and to promote a national tumor registry and protocol. The treatment is individualized according to age, and fertility-sparing surgery is the actual standard of surgical treatment for young patients in early stage of the disease.
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Affiliation(s)
- Nicolae Gică
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Filantropia Clinical Hospital, 011132 Bucharest, Romania
| | - Gheorghe Peltecu
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Filantropia Clinical Hospital, 011132 Bucharest, Romania
- Correspondence:
| | - Raluca Chirculescu
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Filantropia Clinical Hospital, 011132 Bucharest, Romania
| | - Corina Gică
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Filantropia Clinical Hospital, 011132 Bucharest, Romania
| | | | - Andreea Nicoleta Serbanica
- Department of Pediatrics, Fundeni Clinical Institute, Department of Pediatrics Hematology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Anca Maria Panaitescu
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Filantropia Clinical Hospital, 011132 Bucharest, Romania
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Qin L, Wang B, Wang Z, He D. Clinicopathological features, prognosis, and fertility outcomes in Chinese Han women treated for ovarian yolk sac tumor: A retrospective case series study from two tertiary-care academic medical centers. Medicine (Baltimore) 2022; 101:e29868. [PMID: 35866762 PMCID: PMC9302259 DOI: 10.1097/md.0000000000029868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE Ovarian yolk sac tumor (YST) is a very rare malignant tumor in young women. This study aimed to explore the clinicopathological prognostic characteristics and reproductive outcomes of Chinese Han patients. METHODS To describe a case series study, we reviewed the clinicopathological data of 50 YST patients treated from 2 tertiary medical academic medical centers from January 2009 to December 2019. The Akaike information criterion was used to select variables. The influence of relevant characteristics on prognosis factors was analyzed by the Cox proportional hazard model. RESULTS The median follow-up time was 64.5 months (range from 3 to 124 months). The median age was 22.7 years (3 to 34 years). Abdominal pain (54.0%) or mass (42.0%) were the most common clinical symptoms in the early stage of diagnosis. The tumors were located bilaterally in 4 cases. 27 patients, 7 patients, 13 patients, and 3 patients were in stage I, II, III, and IV, respectively. Twenty-one stage I patients and 12 stage II to IV patients underwent fertility-preserving surgery. Of the 50 patients who received postoperative chemotherapy, 49 received the BEP regimen. At the last follow-up, 92% of the patients were still alive. The overall survival rate and disease-free survival rate were 91.6% and 90.6%, respectively. Recurrence occurred in 7 (14%) patients with a median survival time of 16.7 months (range from 3 to 50 months). Six patients had recurrence in the abdominal space. The percentage of Ki67 (P = .01) and tumor size (P = .03) were 2 important prognostic factors in multivariate analysis. In terms of survival outcomes, fertility-preserving surgery can be equivalent to radical surgery. Sixteen patients tried to conceive, and 6 patients with advanced-stage succeeded in 10 pregnancies. Of these, 6 patients successfully gave birth to 6 healthy babies. CONCLUSIONS The diagnosis of YST of childbearing age is very rare. Because the failure of primary treatment is related to the residual disease after salvage surgery, the fertility and survival results of patients undergoing fertility-preserving surgery are promising.
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Affiliation(s)
- Li Qin
- Department of Obstetrics and Gynecology, The Central Hospital of Enshi Tujia and Miao Autonomous prefecture, Enshi, Hubei, China
| | - Bo Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zaiping Wang
- Department of Obstetrics and Gynecology, The Central Hospital of Enshi Tujia and Miao Autonomous prefecture, Enshi, Hubei, China
| | - Du He
- Department of Obstetrics and Gynecology, The Central Hospital of Enshi Tujia and Miao Autonomous prefecture, Enshi, Hubei, China
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Ramanathan S, Prasad M, Vora T, Parambil BC, Kembhavi S, Ramadwar M, Khanna N, Laskar S, Kurkure P, Qureshi S, Banavali S, Chinnaswamy G. Outcomes and prognostic variables of extracranial germ cell tumors in children and adolescents treated over a decade: A developing world perspective. Pediatr Blood Cancer 2022; 69:e29765. [PMID: 35561025 DOI: 10.1002/pbc.29765] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 04/11/2022] [Accepted: 04/18/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND The purpose of this single-center study was to analyze the outcomes of extracranial germ cell tumors (GCTs) in children treated on a multimodality regimen. METHODS Retrospective study of children (<18 years) with a histopathologically confirmed diagnosis of extracranial GCT over a period of 10 years (January 2009 to December 2018) treated on a uniform institution-based protocol consisting of both cisplatin- and carboplatin-based regimens. All completely excised teratomas and stage I gonadal tumors received no further therapy (low risk [LR]); stage IV ovarian, stage III-IV extragonadal GCTs received six cycles of chemotherapy (high risk [HR]), and the remaining received four cycles of chemotherapy (intermediate risk [IR]). RESULTS A total of 297 children were treated with a female:male ratio of 1.72:1 and median age of 4 years. Forty-three children had pure teratomas. Gonadal GCTs (N = 180) were more common than extragonadal GCTs (N = 117) with ovary as primary site in 128 children (43%) and sacrococcygeal site being the commonest extragonadal location (N = 41; 14%). LR, IR, and HR disease were noted in 60 (20.2%), 125 (42%), and 112 (37.8%) patients, respectively. Three-fourths of ovarian tumors and half of testicular tumors operated prior to presentation needed upstaging. Forty-one patients relapsed and 43 children expired (disease-related: 33; toxic deaths: 9; unknown: 1). The 5-year event-free survival (EFS)/overall survival (OS) of malignant GCT (n = 254) was 72.50%/82.70%, respectively, with gonadal site (p = .001), LR and IR (p = .001) and nonmetastatic disease (p = .001) being favorable prognostic variables. CONCLUSIONS The LR and IR GCTs in our cohort had an excellent outcome. A significant proportion of IR gonadal GCTs can be spared of systemic chemotherapy by adhering to strict surgical guidelines. In HR GCTs however, intensifying therapies to improve outcomes must be balanced against the risk of cumulative toxicity, more so in a resource-limited setting.
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Affiliation(s)
| | - Maya Prasad
- Department of Pediatric Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Tushar Vora
- Department of Pediatric Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Badira C Parambil
- Department of Pediatric Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Seema Kembhavi
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Mukta Ramadwar
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Nehal Khanna
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Siddhartha Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Purna Kurkure
- Department of Pediatric Hematology/Oncology, SRCC Children's Hospital, Mumbai, Maharashtra, India
| | - Sajid Qureshi
- Department of Pediatric Surgery, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Shripad Banavali
- Department of Pediatric Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Girish Chinnaswamy
- Department of Pediatric Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
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11
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Storey B, Raman A, Grant A. Metachronous testicular tumour recurrence in extra-gonadal germ cell tumour: A case report and review of the literature. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/2051415819892763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 24-year-old male presented in 2014 with left sided abdominal pain and a palpable abdominal mass. After appropriate investigation a diagnosis of an extra-gonadal germ cell tumour was made and he was treated with platinum based chemotherapy. He then underwent retroperitoneal lymph node dissection due to residual disease identified on imaging with no specific tissue type identified on the histological sample. In early 2019 he presented to his General Practitioner with a left sided testicular lump and was diagnosed with non-seminomatous germ cell tumour of the testis, an uncommon condition; metachronous testicular tumour. Level of Evidence: 5
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Affiliation(s)
- Benjamin Storey
- Department of Urology, Royal Newcastle Centre, New Lambton Heights, Australia
| | - Avi Raman
- Department of Urology, Royal Newcastle Centre, New Lambton Heights, Australia
| | - Alexander Grant
- Department of Urology, Royal Newcastle Centre, New Lambton Heights, Australia
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12
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To Be or Not to Be a Germ Cell: The Extragonadal Germ Cell Tumor Paradigm. Int J Mol Sci 2021; 22:ijms22115982. [PMID: 34205983 PMCID: PMC8199495 DOI: 10.3390/ijms22115982] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 02/06/2023] Open
Abstract
In the human embryo, the genetic program that orchestrates germ cell specification involves the activation of epigenetic and transcriptional mechanisms that make the germline a unique cell population continuously poised between germness and pluripotency. Germ cell tumors, neoplasias originating from fetal or neonatal germ cells, maintain such dichotomy and can adopt either pluripotent features (embryonal carcinomas) or germness features (seminomas) with a wide range of phenotypes in between these histotypes. Here, we review the basic concepts of cell specification, migration and gonadal colonization of human primordial germ cells (hPGCs) highlighting the analogies of transcriptional/epigenetic programs between these two cell types.
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13
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Complex Vascular Reconstruction following Resection of a Large Retroperitoneal Teratoma. SURGERIES 2021. [DOI: 10.3390/surgeries2020013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Germ cell tumors (GCTs) are a common malignancy in males, with variations in differentiation making different therapeutic strategies necessary. Generally, GCTs show good curation rates due to their good response to radiotherapy or chemotherapy. However, certain subtypes are resistant to these therapies and require surgery. We present a case of a 25-year-old patient with a large retroperitoneal GCT with somatic malignant transformation, where resection of large abdominal blood vessels with complex reconstruction was necessary to completely remove the tumor. The tumor was completely resected, and the patient has since been recurrence-free in the follow-up period. GCTs with somatic transformation show high resistance rates to chemo- and radiotherapy, and the patient in the presented case study did indeed show only a limited response to carboplatin-based chemotherapy. Patients suffering from these conditions should be resected whenever possible, as curation can be achieved by complete tumor resection. Infiltration of neighboring structures is no contraindication to surgery. The case presented here shows that interdisciplinary surgical planning including vascular and general surgeons as well as radiologists is vital to ensure successful tumor resection.
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Chen J, Li Y, Wu J, Liu Y, Kang S. Whole-exome sequencing reveals potential germline and somatic mutations in 60 malignant ovarian germ cell tumors†. Biol Reprod 2021; 105:164-178. [PMID: 33739378 DOI: 10.1093/biolre/ioab052] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/05/2021] [Accepted: 03/16/2021] [Indexed: 11/13/2022] Open
Abstract
Malignant ovarian germ cell tumors (MOGCTs) are rare and heterogeneous ovary tumors. We aimed to identify potential germline mutations and somatic mutations in MOGCTs by whole-exome sequencing. The peripheral blood and tumor samples from these patients were used to identify germline mutations and somatic mutations, respectively. For those genes with copy number alterations (deletion and duplication region), functional annotation was performed. Immunohistochemistry was performed to evaluate the expression of mutated genes corresponding to CNA deletion region and duplication region. In peripheral blood, copy number loss and gain were mostly found in yolk sac tumors (YSTs). Moreover, POU5F1 was the most significant mutated gene with mutation frequency >10% in both CNA deletion and duplication region. In addition, strong cytoplasm staining of POU5F1 (corresponding to CNA deletion region and duplication region) was found in two YST and nuclear staining in two dysgerminomas tumor samples. Genes corresponding to CNA deletion region were significantly enriched in the signaling pathway of regulating pluripotency of stem cells. In addition, genes corresponding to CNA duplication region were significantly enriched in the signaling pathways of RIG-I (DExD/H-box helicase 58)-like receptor, Toll-like receptor and nuclear factor (NF)-kappa. Keratin 4 (KRT4), ribosomal protein L14 (RPL14), proprotein convertase subtilisin/kexin type 6 (PCSK6), poly(A)-binding protein cytoplasmic 3 (PABPC3), and sterile alpha and TIR motif containing 1 (SARM1) mutations were detected in both peripheral blood and tumor samples. Identification of potential germline mutations and somatic mutations in MOGCTs may provide a new field in understanding the genetic feature of the rare biological tumor type in the ovary.
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Affiliation(s)
- Juan Chen
- Department of Obstetrics and Gynaecology, Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumor Hospital, Hebei, China
| | - Yan Li
- Department of Molecular Biology, Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumor Hospital, Hebei, China
| | - Jianlei Wu
- Department of Obstetrics and Gynaecology, Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumor Hospital, Hebei, China
| | - Yakun Liu
- Department of Obstetrics and Gynaecology, Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumor Hospital, Hebei, China
| | - Shan Kang
- Department of Obstetrics and Gynaecology, Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumor Hospital, Hebei, China
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15
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Kumar N, Madan R, Dracham CB, Khosla D, Das N, Dey T, Elangovan A, Tripathi M, Gupta K, Ahuja CK, Kapoor R. Multimodality treatment for Central Nervous System Germ Cell Tumors: Disease spectrum and management strategies - A tertiary care center experience from India. Clin Neurol Neurosurg 2021; 202:106481. [PMID: 33508649 DOI: 10.1016/j.clineuro.2021.106481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/06/2021] [Accepted: 01/07/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Intracranial germ cell tumors (GCTs) are relatively rare neoplasms, representing 2-3 % of paediatric brain tumors in Western countries and 8-15 % in East Asia. Here, we discuss the clinical features and treatment outcomes in patients with central nervous system (CNS) GCTs treated at our institute. METHODS Medical records of all primary CNS GCT patients were retrieved retrospectively from 2007 to 2019. Demographic, clinical, treatment and follow up details were entered in a predesigned proforma. Overall survival (OS) and progression-free survival was computed using Kaplan-Meier method and Log-Rank test. Effect of various prognostic factors on survival outcomes was assessed by univariate and multivariate analysis. RESULTS A total of 28 CNS GCT patients were included in this analysis. Median age at presentation was 17 years (range, 7-45 years) with a male to female ratio of 1.8:1. Pineal region was the commonest location, encountered in 15 patients (53.6 %). Pure germinoma was the most frequent histology observed, seen in 19 patients (67.9 %). Male gender and germinoma histology were highly associated with pineal location (p = 0.043 and p = 0.052, respectively). Fourteen patients underwent surgical intervention and nine patients underwent biopsy for diagnostic purpose or to relieve the obstructive symptoms. Only 23 patients (82.1 %) received chemotherapy. However, all patients received radiotherapy (Craniospinal irradiation/whole brain radiotherapy/whole ventricular radiotherapy/ or local radiotherapy). After a median follow-up of 53 months (range, 7-150), 23 patients (82.1 %) were alive. OS was significantly affected by histology (89 % in germinoma vs. 60 % in non-germinomatous, p = 0.054) and location (93 % in pineal region vs. 64.2 % in other location, p = 0.042). Age, gender and surgery did not have any impact on the survival outcomes. CONCLUSION CNS GCTs are relatively rare and heterogeneous neoplasms commonly seen in pineal and suprasellar locations. A combination of chemotherapy and radiotherapy had shown excellent outcomes.
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Affiliation(s)
- Narendra Kumar
- Department of Radiotherapy & Oncology, PGIMER, Chandigarh, India.
| | - Renu Madan
- Department of Radiotherapy & Oncology, PGIMER, Chandigarh, India.
| | - Chinna Babu Dracham
- Department of Radiation Oncology, Queen's NRI Hospital, Visakhapatnam, India.
| | - Divya Khosla
- Department of Radiotherapy & Oncology, PGIMER, Chandigarh, India.
| | - Namrata Das
- Department of Radiotherapy & Oncology, PGIMER, Chandigarh, India.
| | - Treshita Dey
- Department of Radiotherapy & Oncology, PGIMER, Chandigarh, India.
| | - Arun Elangovan
- Department of Radiation Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Canada.
| | | | - Kirti Gupta
- Department of Pathology, PGIMER, Chandigarh, India.
| | | | - Rakesh Kapoor
- Department of Radiotherapy & Oncology, PGIMER, Chandigarh, India.
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Miller KD, Fidler-Benaoudia M, Keegan TH, Hipp HS, Jemal A, Siegel RL. Cancer statistics for adolescents and young adults, 2020. CA Cancer J Clin 2020; 70:443-459. [PMID: 32940362 DOI: 10.3322/caac.21637] [Citation(s) in RCA: 600] [Impact Index Per Article: 150.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 02/06/2023] Open
Abstract
Cancer statistics for adolescents and young adults (AYAs) (aged 15-39 years) are often presented in aggregate, masking important heterogeneity. The authors analyzed population-based cancer incidence and mortality for AYAs in the United States by age group (ages 15-19, 20-29, and 30-39 years), sex, and race/ethnicity. In 2020, there will be approximately 89,500 new cancer cases and 9270 cancer deaths in AYAs. Overall cancer incidence increased in all AYA age groups during the most recent decade (2007-2016), largely driven by thyroid cancer, which rose by approximately 3% annually among those aged 20 to 39 years and 4% among those aged 15 to 19 years. Incidence also increased in most age groups for several cancers linked to obesity, including kidney (3% annually across all age groups), uterine corpus (3% in the group aged 20-39 years), and colorectum (0.9%-1.5% in the group aged 20-39 years). Rates declined dramatically for melanoma in the group aged 15 to 29 years (4%-6% annually) but remained stable among those aged 30 to 39 years. Overall cancer mortality declined during 2008 through 2017 by 1% annually across age and sex groups, except for women aged 30 to 39 years, among whom rates were stable because of a flattening of declines in female breast cancer. Rates increased for cancers of the colorectum and uterine corpus in the group aged 30 to 39 years, mirroring incidence trends. Five-year relative survival in AYAs is similar across age groups for all cancers combined (range, 83%-86%) but varies widely for some cancers, such as acute lymphocytic leukemia (74% in the group aged 15-19 years vs 51% in the group aged 30-39 years) and brain tumors (77% vs 66%), reflecting differences in histologic subtype distribution and treatment. Progress in reducing cancer morbidity and mortality among AYAs could be addressed through more equitable access to health care, increasing clinical trial enrollment, expanding research, and greater alertness among clinicians and patients for early symptoms and signs of cancer. Further progress could be accelerated with increased disaggregation by age in research on surveillance, etiology, basic biology, and survivorship.
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Affiliation(s)
| | | | - Theresa H Keegan
- Hematology and Oncology, University of California at Davis Health, Sacramento, California
| | - Heather S Hipp
- Reproductive Endocrinology and Infertility, Emory University School of Medicine, Atlanta, Georgia
| | - Ahmedin Jemal
- Surveillance Research, American Cancer Society, Atlanta, Georgia
| | - Rebecca L Siegel
- Surveillance Research, American Cancer Society, Atlanta, Georgia
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17
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Dellino M, Silvestris E, Loizzi V, Paradiso A, Loiacono R, Minoia C, Daniele A, Cormio G. Germinal ovarian tumors in reproductive age women: Fertility-sparing and outcome. Medicine (Baltimore) 2020; 99:e22146. [PMID: 32991408 PMCID: PMC7523774 DOI: 10.1097/md.0000000000022146] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
MOGCTs (malignant ovarian germ cell tumors) are rare tumors that mainly affect patients of reproductive age. The aim of this study was to evaluate the fertility and survival outcomes in young women with MOCGTs treated with fertility-sparing surgery (FSS).From 2000 to 2018, data from 28 patients of reproductive age with a diagnosis of MOGCT at the University of Bari were collected. Most received FSS, and in patients treated conservatively, the reproductive outcome and survival were investigated. Data of patient demographics, clinical presentation, oncology marker dosage, staging, type of surgery, histological examination, survival, and reproductive outcome were collected from hospital and office charts. All informed consent was obtained from all patients. The median age was 24 (range: 9-45 years). The majority of the patients had stage IIIC. Twenty-four woman received FSS consisting of unilateral ovariectomy and omentectomy, whereas only 4 women, based on their stage (IIIC), received a radical surgery (hysterectomy with bilateral adnexectomy, lymphadenectomy, and omentectomy). Our study shows that FSS in MOGCTs can produce good results both on reproductive outcomes and on survival. Indeed, in our group, there was only 1 case of exitus as result of recurrence. Furthermore, patients after FSS maintained normal ovarian function and 5 of 5 women who tried to get pregnant succeeded spontaneously. The median follow-up was 90 months (range 3-159).Conservative surgery for MOGCTs should be considered for women of reproductive age who wish to preserve fertility.
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Affiliation(s)
- Miriam Dellino
- Gynecologic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | - Erica Silvestris
- Gynecologic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | - Vera Loizzi
- Department of Biomedical Sciences and Human Oncology, Unit of Obstetrics and Gynaecology
| | | | - Rosalia Loiacono
- Gynecologic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | - Carla Minoia
- Haematology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | - Antonella Daniele
- Biology Research, Department of Experimental Oncology, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | - Gennaro Cormio
- Department of Biomedical Sciences and Human Oncology, Unit of Obstetrics and Gynaecology
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18
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The individualized significance of lymphadenectomy across all age groups and histologies in malignant ovarian germ cell tumors. Arch Gynecol Obstet 2020; 302:1441-1450. [PMID: 32888090 DOI: 10.1007/s00404-020-05772-3] [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: 12/28/2019] [Accepted: 08/26/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the therapeutic role of lymphadenectomy on patients with malignant ovarian germ cell tumor (MOGCT) and to investigate the risk factors of lymph node metastasis. METHODS Patients of MOGCT between 1988 and 2013 with definite lymph node information were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Survival curves were estimated using the Kaplan-Meier method, and Cox regression analyses were performed to evaluate the effects of clinical and pathologic variables on survival. RESULTS 2424 MOGCT patients with information on lymph nodes were included. Of the entire cohort, 46.2% patients received lymphadenectomy. The most common (42.2%) histologic type was teratoma, and 70.6% patients had FIGO stage I disease. Cox proportional model verified that age, grade, and log odds of positive lymph nodes (LODDS) were independent prognostic factors. Subgroup analysis showed that the association between the lymph node resection and better survival in the different age cohort. CONCLUSIONS Lymphadenectomy is not recommended for children (0-14 years). For patients 40 years of age and older, and for those who have the dysgerminoma type or endodermal sinus type, lymphadenectomy had an outstanding therapeutic role. As a parameter to assess lymph node status, LODDS could be used to classify MOGCTs.
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19
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Bennetsen AKK, Baandrup L, Aalborg GL, Kjaer SK. Non-epithelial ovarian cancer in Denmark - Incidence and survival over nearly 40 years. Gynecol Oncol 2020; 157:693-699. [PMID: 32223987 DOI: 10.1016/j.ygyno.2020.03.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 03/16/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To examine trends in incidence and survival of non-epithelial ovarian cancer in Denmark over nearly 40 years, using nationwide, population-based cancer registry data. METHODS From 1978 to 2016, we identified the non-epithelial ovarian cancer cases among all ovarian malignancies in the Danish Cancer Registry. Age-specific incidence rates, age-standardized incidence rates, and average annual percentage change (AAPC) were estimated with 95% confidence intervals (CIs). Overall and 5-year relative survival analyses were conducted and supplemented with Cox regression to explore the effect of different characteristics on overall mortality. RESULTS A total of 720 non-epithelial ovarian cancers were identified, corresponding to 3.4% of all ovarian malignancies. The majority of non-epithelial ovarian cancers were germ cell tumors (49.9%) and sex cord-stromal tumors (38.6%). The age-standardized incidence rate of germ cell tumors was stable over the study period, ranging between 0.33 and 0.39 per 100,000 woman-years. In contrast, the age-standardized incidence rate of sex cord-stromal tumors declined from 0.30 (1978-1987) to 0.09 (2008-2016) per 100,000 woman-years (AAPC = -5.15%; 95% CI: -7.29, -2.96). The 5-year relative survival of germ cell tumors and sex cord-stromal tumors was 94% and 79%, respectively, in the most recent period (2008-2011). Cox regression showed that overall mortality was associated with calendar year, age, and stage. CONCLUSIONS The incidence of germ cell tumors was stable over calendar time, whereas the incidence of sex cord-stromal tumors decreased significantly. Non-epithelial ovarian cancer overall mortality has decreased during the study period and this could not be explained by taking stage and age at diagnosis into account.
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Affiliation(s)
- A K K Bennetsen
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, 2100 Copenhagen, Denmark.
| | - L Baandrup
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, 2100 Copenhagen, Denmark.
| | - G L Aalborg
- Statistics and Pharmacoepidemiology, Danish Cancer Society Research Center, 2100 Copenhagen, Denmark.
| | - S K Kjaer
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, 2100 Copenhagen, Denmark; Department of Gynecology, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark.
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20
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Calaminus G, Schneider DT, von Schweinitz D, Jürgens H, Infed N, Schönberger S, Olson TA, Albers P, Vokuhl C, Stein R, Looijenga L, Sehouli J, Metzelder M, Claviez A, Dworzak M, Eggert A, Fröhlich B, Gerber NU, Kratz CP, Faber J, Klingebiel T, Harms D, Göbel U. Age-Dependent Presentation and Clinical Course of 1465 Patients Aged 0 to Less than 18 Years with Ovarian or Testicular Germ Cell Tumors; Data of the MAKEI 96 Protocol Revisited in the Light of Prenatal Germ Cell Biology. Cancers (Basel) 2020; 12:E611. [PMID: 32155835 PMCID: PMC7139559 DOI: 10.3390/cancers12030611] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 02/14/2020] [Accepted: 03/02/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To evaluate prognostic factors in pediatric patients with gonadal germ cell tumors (GCT). METHODS Patients <18 years with ovarian and testicular GCT (respectively OGCT and TGCT) were prospectively registered according to the guidelines of MAKEI 96. After resection of the primary tumor, patients staged ≥II received risk-stratified cisplatin-based combination chemotherapy. Patients were analyzed in respect to age (six age groups divided into 3-year intervals), histology, stage, and therapy. The primary end point was overall survival. RESULTS Between January 1996 and March 2016, the following patients were registered: 1047 OGCT, of those, 630 had ovarian teratoma (OTER) and 417 had malignant OGCT (MOGCT); and 418 TGCT, of those, 106 had testicular teratoma (TTER) and 312 had malignant TGCT (MTGCT). Only in MTGCT, older age correlated with a higher proportion of advanced tumors. All 736 teratomas and 240/415 stage I malignant gonadal GCT underwent surgery and close observation alone. In case of watchful waiting, the progression rate of OGCT was higher than that of TGCT. However, death from disease was reported in 8/417 (1.9%) MOGCT and 8/312 (2.6%) MTGCT irrespective of adjuvant chemotherapy and repeated surgery. CONCLUSIONS The different pathogenesis and histogenesis of gonadal GCT reflects sex- and age-specific patterns that define clinically relevant risk groups. Therefore, gender and age should be considered in further research on the biology and clinical practice of pediatric gonadal GCT.
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Affiliation(s)
- Gabriele Calaminus
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, 53113 Bonn, Germany;
| | | | | | - Heribert Jürgens
- Pediatric Hematology and Oncology, University Children’s Hospital Muenster, 48149 Münster, Germany; (H.J.); (B.F.)
| | - Nacera Infed
- Coordination Center for Clinical Studies, University Düsseldorf, 40225 Düsseldorf, Germany;
| | - Stefan Schönberger
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, 53113 Bonn, Germany;
| | - Thomas A. Olson
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA 30322, USA;
| | - Peter Albers
- Department of Urology, University Hospital Düsseldorf, Medical Faculty Heinrich-Heine University, 40225 Düsseldorf, Germany;
| | - Christian Vokuhl
- Section of Pediatric Pathology, Department of Pathology, Universitiy Hospital Bonn, 53127 Bonn, Germany;
| | - Raimund Stein
- Department of Pediatric, University Medical Centre Mannheim, Adolescent and Reconstructive Urology, 68167 Mannheim, Germany;
| | - Leendert Looijenga
- Princess Máxima Center for Pediatric Oncology, 3584 Utrecht, The Netherlands;
| | - Jalid Sehouli
- Department Gynecology and Center of Gynecological Oncology, Charité University Medicine Berlin, 13353 Berlin, Germany;
| | - Martin Metzelder
- Department of Pediatric Surgery, Medical University Vienna, 1090 Vienna, Austria;
| | - Alexander Claviez
- Campus Kiel, Department of Pediatric Oncology, Medical University of Schleswig-Holstein, 24105 Kiel, Germany;
| | - Michael Dworzak
- St. Anna Children’s Hospital and Children’s Cancer Research Institute, Medical University Vienna, Pediatric Clinic, 1090 Vienna, Austria;
| | - Angelika Eggert
- Department of Pediatric Oncology and Hematology, Charité University Medicine Berlin, 13353 Berlin, Germany;
| | - Birgit Fröhlich
- Pediatric Hematology and Oncology, University Children’s Hospital Muenster, 48149 Münster, Germany; (H.J.); (B.F.)
| | - Nicolas U. Gerber
- Department of Oncology, University Children’s Hospital, 8032 Zürich, Switzerland;
| | - Christian P. Kratz
- Hannover Medical School, Pediatric Hematology and Oncology, 30625 Hannover, Germany;
| | - Jörg Faber
- Department of Pediatric Hematology/Oncology/Hemostaseology, University Medical Center of the Johannes Gutenberg University Mainz, Center for Pediatric and Adolescent Medicine, 55131 Mainz, Germany;
| | - Thomas Klingebiel
- Department of Pediatric Hematology/Oncology/Hemostaseology, Goethe-University Frankfurt, University Hospital for Children and Adolescents, 60590 Frankfurt am Main, Germany;
| | - Dieter Harms
- Department of Pathology, University of Kiel, 24105 Kiel, Germany;
| | - Ulrich Göbel
- ESPED Surveillance Unit, University Düsseldorf, Coordination Center for Clinical Studies, 40225 Düsseldorf, Germany;
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Ronchi A, Cozzolino I, Montella M, Panarese I, Zito Marino F, Rossetti S, Chieffi P, Accardo M, Facchini G, Franco R. Extragonadal germ cell tumors: Not just a matter of location. A review about clinical, molecular and pathological features. Cancer Med 2019; 8:6832-6840. [PMID: 31568647 PMCID: PMC6853824 DOI: 10.1002/cam4.2195] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 03/25/2019] [Accepted: 04/10/2019] [Indexed: 12/25/2022] Open
Abstract
Extragonadal germ cell tumors (EGGCTs) are uncommon neoplasms, which arise in anatomical locations other than gonads. The pathogenesis of these neoplasms is still poorly understood and it is a matter of debate if they really represent extragondal primary neoplasms or rather extragondal metastasis from occult gonadal neoplasms. The actual observations suggest that EGGCTs represent a unique entity, so their biology and behavior are substantially different from gonadal counterparts. The diagnosis of EGGCTs is often challenging, and differential diagnosis is particularly wide. Nevertheless, a correct diagnosis is essential for the correct management of the patient. We summarize the state of art about EGGCTs, with particular emphasis on diagnosis and prognosis.
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Affiliation(s)
- Andrea Ronchi
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Immacolata Cozzolino
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Marco Montella
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Iacopo Panarese
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Federica Zito Marino
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Sabrina Rossetti
- Uro-Andrologic Oncology Unit, Department of Uro-Gynaecological Oncology, Istituto Nazionale Tumori "Fondazione G. Pascale"-IRCCS, Naples, Italy
| | - Paolo Chieffi
- Department of Psychology, University of Campania "L. Vanvitelli", Caserta, Italy
| | - Marina Accardo
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Gaetano Facchini
- Uro-Andrologic Oncology Unit, Department of Uro-Gynaecological Oncology, Istituto Nazionale Tumori "Fondazione G. Pascale"-IRCCS, Naples, Italy
| | - Renato Franco
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "L. Vanvitelli", Naples, Italy
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22
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Mäkelä JA, Koskenniemi JJ, Virtanen HE, Toppari J. Testis Development. Endocr Rev 2019; 40:857-905. [PMID: 30590466 DOI: 10.1210/er.2018-00140] [Citation(s) in RCA: 148] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 07/17/2018] [Indexed: 12/28/2022]
Abstract
Production of sperm and androgens is the main function of the testis. This depends on normal development of both testicular somatic cells and germ cells. A genetic program initiated from the Y chromosome gene sex-determining region Y (SRY) directs somatic cell specification to Sertoli cells that orchestrate further development. They first guide fetal germ cell differentiation toward spermatogenic destiny and then take care of the full service to spermatogenic cells during spermatogenesis. The number of Sertoli cells sets the limits of sperm production. Leydig cells secrete androgens that determine masculine development. Testis development does not depend on germ cells; that is, testicular somatic cells also develop in the absence of germ cells, and the testis can produce testosterone normally to induce full masculinization in these men. In contrast, spermatogenic cell development is totally dependent on somatic cells. We herein review germ cell differentiation from primordial germ cells to spermatogonia and development of the supporting somatic cells. Testicular descent to scrota is necessary for normal spermatogenesis, and cryptorchidism is the most common male birth defect. This is a mild form of a disorder of sex differentiation. Multiple genetic reasons for more severe forms of disorders of sex differentiation have been revealed during the last decades, and these are described along with the description of molecular regulation of testis development.
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Affiliation(s)
- Juho-Antti Mäkelä
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
| | - Jaakko J Koskenniemi
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland.,Department of Pediatrics, Turku University Hospital, Turku, Finland
| | - Helena E Virtanen
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
| | - Jorma Toppari
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland.,Department of Pediatrics, Turku University Hospital, Turku, Finland
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23
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Global incidence comparisons and trends in ovarian germ cell tumors by geographic region in girls, adolescents and young women: 1988-2012. Gynecol Oncol 2019; 154:608-615. [PMID: 31303255 DOI: 10.1016/j.ygyno.2019.06.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/21/2019] [Accepted: 06/30/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Ovarian germ cell tumors (OGCT) are the primary ovarian malignancy affecting girls and young women. Globally, incidence rates and trends for OGCTs have not been compared in the literature and their etiology is not well described. Comparisons of incidence globally could inform etiologic hypotheses. The aim of this analysis was to evaluate geographic variation in OGCT incidence and to identify trends in incidence rates. METHODS Data were extracted from Cancer Incidence in 5 Continents (CI5) from 1988 to 2012. Rates of OGCT in women and girls were calculated for ages 0-9, 10-19, and 20-39 years and standardized to the 2000-2025 average world population. Data were aggregated within subregions corresponding to the United Nations Statistics Division (UNSD) geoscheme. Incidence rates were compared in subregions and average annual percent change (AAPC) was estimated using Poisson regression. RESULTS Overall, the highest incidence rates were observed in 10-19-year-olds. Incidence was generally the highest in Eastern Asia, Central America and North America. While incidence was variable by geographic region, less variation was observed in 0-9-year-olds as compared to adolescents and young adults. Significant increases in incidence were seen in some regions (Eastern Asia, Oceania, Western Europe, Southern Europe, and North America) and in countries with a high or very high human development index for one or more age groups. CONCLUSIONS Evaluating 25 years of OGCT incidence data, the highest incidence rates and largest increases in incidence were seen in Eastern Asia. Future studies should focus on etiologic features that may account for geographic variation and increases in incidence of OGCT.
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Magudia K, Menias CO, Bhalla S, Katabathina VS, Craig JW, Hammer MM. Unusual Imaging Findings Associated with Germ Cell Tumors. Radiographics 2019; 39:1019-1035. [PMID: 31125295 DOI: 10.1148/rg.2019180050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Germ cell tumors, because they contain immature and mature elements, can differentiate into different tissue types. They can exhibit unusual imaging features or manifest in a syndromic fashion. The authors describe these features and assign them to one of the following categories: (a) unusual manifestations of metastatic disease (growing teratoma syndrome, choriocarcinoma syndrome, ossified metastases, and gliomatosis peritonei); (b) autoimmune manifestations (sarcoidlike reaction and paraneoplastic syndromes); (c) endocrine syndromes (sex hormone production, struma ovarii, and struma carcinoid); or (d) miscellaneous conditions (ruptured dermoid cyst, squamous cell carcinoma arising from a mature teratoma, Currarino triad, fetus in fetu, pseudo-Meigs syndrome, and pancreatitis). Rare conditions associated with germ cell tumors demonstrate characteristic imaging findings that can help lead to the appropriate diagnosis and management recommendations. When evaluating for potential metastatic disease, alternative benign diagnoses should be considered (eg, growing teratoma syndrome, ossified metastases, ruptured dermoid cyst, gliomatosis peritonei, and sarcoidlike reaction), which may impact management. Germ cell tumors may also lead to life-threatening complications such as extensive hemorrhage from choriocarcinoma metastases or the rupture of mature teratomas, cases in which timely diagnosis is crucial. Autoimmune and endocrine manifestations such as paraneoplastic encephalitis, autoimmune hemolytic anemia, and hyperthyroidism may occur owing to the presence of germ cell tumors and can create a diagnostic dilemma for clinicians. Knowledge of the syndromic and unusual imaging findings associated with germ cell tumors helps guide appropriate management. ©RSNA, 2019.
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Affiliation(s)
- Kirti Magudia
- From the Departments of Radiology (K.M., M.M.H.) and Pathology (J.W.C.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, Ariz (C.O.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B.); and Department of Radiology, University of Texas Health Science Center, San Antonio, Tex (V.S.K.)
| | - Christine O Menias
- From the Departments of Radiology (K.M., M.M.H.) and Pathology (J.W.C.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, Ariz (C.O.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B.); and Department of Radiology, University of Texas Health Science Center, San Antonio, Tex (V.S.K.)
| | - Sanjeev Bhalla
- From the Departments of Radiology (K.M., M.M.H.) and Pathology (J.W.C.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, Ariz (C.O.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B.); and Department of Radiology, University of Texas Health Science Center, San Antonio, Tex (V.S.K.)
| | - Venkata S Katabathina
- From the Departments of Radiology (K.M., M.M.H.) and Pathology (J.W.C.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, Ariz (C.O.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B.); and Department of Radiology, University of Texas Health Science Center, San Antonio, Tex (V.S.K.)
| | - Jeffrey W Craig
- From the Departments of Radiology (K.M., M.M.H.) and Pathology (J.W.C.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, Ariz (C.O.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B.); and Department of Radiology, University of Texas Health Science Center, San Antonio, Tex (V.S.K.)
| | - Mark M Hammer
- From the Departments of Radiology (K.M., M.M.H.) and Pathology (J.W.C.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, Ariz (C.O.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B.); and Department of Radiology, University of Texas Health Science Center, San Antonio, Tex (V.S.K.)
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25
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A Rare Localized Pituitary Stalk Germinoma Presenting in the Third Decade. Case Rep Endocrinol 2018; 2018:1746917. [PMID: 30647977 PMCID: PMC6311725 DOI: 10.1155/2018/1746917] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 08/16/2018] [Indexed: 12/28/2022] Open
Abstract
We report the case of a 34-year-old male Hispanic patient who presented with an 8-month history of polyuria and decreased libido. An evaluation revealed hypopituitarism, central diabetes insipidus, and a pituitary stalk lesion. No evidence of a neoplasm or an inflammatory/infiltrative disease was found. We treated the patient conservatively with steroid therapy. However, as a result of disease progression, transsphenoidal surgery was performed to obtain tissue for a pathological analysis. Histopathology revealed an intrasellar germinoma, confirmed by immunochemistry. Due to localized disease, radiotherapy was initiated and clinical improvement was noted. This case emphasizes the importance of histopathological analysis; for many physicians, the presentation of a pituitary stalk lesion in a young male adult creates a clinical conundrum. Although the most common etiologies are an inflammatory or secondary neoplasm, the possible presence of an intrasellar neoplasm should not be ruled out. In many cases, imaging characteristics and tumor markers may aid in the diagnosis without the need of an aggressive diagnostic approach. However, in this case, histopathological analysis was the only way to make a correct diagnosis and provide adequate treatment for the patient.
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26
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De Giorgi U, Richard S, Badoglio M, Kanfer E, Bourrhis JH, Nicolas-Virelizier E, Vettenranta K, Lioure B, Martin S, Dreger P, Schuler MK, Thomson K, Scarpi E, Rosti G, Selle F, Mangili G, Lanza F, Bregni M. Salvage high-dose chemotherapy in female patients with relapsed/refractory germ-cell tumors: a retrospective analysis of the European Group for Blood and Marrow Transplantation (EBMT). Ann Oncol 2018; 28:1910-1916. [PMID: 28510616 DOI: 10.1093/annonc/mdx259] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background High-dose chemotherapy (HDC) with hematopoietic progenitor cell transplantation is a standard option for relapsed/refractory testicular germ-cell tumor (GCT), but only few data have been reported in female patients with GCT. We conducted a retrospective analysis of female patients with GCT treated with HDC and registered with the European Society for Blood and Marrow Transplantation. Patients and methods Between 1985 and 2013, 60 registered female patients with GCT, median age 27 years (range 15-48), were treated with salvage HDC. Forty patients (67%) had primary ovarian GCT, 8 (13%) mediastinal, 7 (12%) retroperitoneal and 5 (8%) other primary sites/unknown. Twenty-two patients (37%) received HDC as second-line therapy, 29 (48%) as third-line, and 9 (15%) as fourth- to sixth-line. Nine of 60 patients (15%) received HDC as late-intensification with no evidence of metastasis before HDC. The conditioning HDC regimens comprised carboplatin in 51 of 60 cases (85%), and consisted of a single HDC cycle in 31 cases (52%), a multi-cycle HDC regimen in 29 (48%). Results Nine cases who underwent late intensification HDC were not evaluable for response. Of the other 51 assessable patients, 17 (33%) achieved a complete response (CR), 8 (16%) a marker-negative partial remission (PRm-), 5 (10%) a marker-positive partial remission, 5 (10%) stable disease, and 13 (25%) progressive disease. There were 3 toxic deaths (6%). With an overall median follow-up of 14 months (range 1-219), 7 of 9 (78%) patients with late intensification and 18 of the 25 patients (72%) achieving a CR/PRm- following HDC were free of relapse/progression. In total, 25 of 60 patients (42%) were progression-free following HDC at a median follow-up of 87 months (range 3-219 months). Conclusions Salvage HDC based on carboplatin represents a therapeutic option for female patients with relapsed/refractory GCT.
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Affiliation(s)
- U De Giorgi
- Department of Medical Oncology and Hematology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - S Richard
- Department of Medical Oncology, Hopital Tenon, Paris
| | | | - E Kanfer
- Department of Hematology, Imperial College, Hammersmith Hospital, London, UK
| | - J H Bourrhis
- Hematology-Marrow Transplant Service, Institute Gustave-Roussy, Villejuif
| | | | - K Vettenranta
- Department of Pediatrics, University of Helsinki, Helsinki, Finland
| | - B Lioure
- Department of Hematology/Oncology, Strasbourg University Hospital, Strasbourg, France
| | - S Martin
- Department of Internal Medicine II, Robert-Bosch-Hospital, Stuttgart
| | - P Dreger
- Department of Medicine V, University of Heidelberg, Heidelberg
| | - M K Schuler
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - K Thomson
- Department of Haematology, University College London Hospital, London, UK
| | - E Scarpi
- Biostatistics and Clinical Trials Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola
| | - G Rosti
- Department of Oncology, Policlinico San Matteo IRCCS, Pavia
| | - F Selle
- Department of Medical Oncology, Hopital Tenon, Paris
| | - G Mangili
- Department of Obstetrics and Gynaecology, San Raffaele Scientific Institute, Milan
| | - F Lanza
- Department of Onco-Hematology, Santa Maria delle Croci Hospital, Ravenna
| | - M Bregni
- Department of Medical Oncology, Busto Arsizio Hospital, Busto Arsizio, Italy
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27
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The role of preoperative serum cancer antigen 125 in malignant ovarian germ cell tumors. Taiwan J Obstet Gynecol 2018; 57:236-240. [DOI: 10.1016/j.tjog.2018.02.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2017] [Indexed: 12/22/2022] Open
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28
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Nogales FF, Prat J, Schuldt M, Cruz-Viruel N, Kaur B, D'Angelo E, Matias-Guiu X, Vidal A, McCluggage WG, Oosterhuis JW. Germ cell tumour growth patterns originating from clear cell carcinomas of the ovary and endometrium: a comparative immunohistochemical study favouring their origin from somatic stem cells. Histopathology 2017; 72:634-647. [PMID: 29106744 DOI: 10.1111/his.13426] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 10/19/2017] [Accepted: 10/27/2017] [Indexed: 01/08/2023]
Abstract
AIMS To report a series of 11 ovarian and one endometrial neoplasm in elderly patients with mixed clear cell tumour and germ cell tumour (GCT) components, to compare their immunohistochemical profiles and demonstrate a putative stem cell population. METHODS AND RESULTS The clear cell tumours included 11 clear cell carcinomas (CCC) and one borderline clear cell tumour, while the GCT always included glandular yolk sac tumour (YST). In four cases, there were also foci of teratoma with immature neuroepithelial and endodermal tissues and undifferentiated areas showing true embryoids. To distinguish between the clear cell and YST components, the following antibodies were used: HNF1-β, napsin-A, cytokeratin 7 (CK7), PAX8, EMA, AFP, SALL4, villin, glypican-3 (GPC-3), GATA3, HepPar-1, OCT4, CDX2, CD30 and SOX2. HNF1-β, CK7, EMA and GPC-3 were often expressed in both components. Other markers had higher specificity for each cellular lineage; napsin-A and PAX8 were expressed only in CCC, while SALL4, villin, AFP and HepPar-1 were positive in the glandular YST component but negative in the clear cell component. OCT4 expression occurred in six of 10 cases and consistently in teratoma (four of four). CONCLUSIONS There is considerable immunophenotypical overlap between the two components in these mixed neoplasms, and a panel of markers should be used to facilitate the distinction. We propose that OCT4-expressing somatic cancer cells differentiate into GCT and represent spontaneously induced pluripotent stem cells, possibly conditioned by age-related epigenetic factors. These neoplasms have features of prepubertal type GCT showing lack of 12p gain, preponderance of YST and coexistence with immature neuroectoderm. However, there may also be undifferentiated stem cell areas with embryoid bodies, of the type seen in postpubertal testicular GCT, but lacking a complete embryonal carcinoma immunophenotype.
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Affiliation(s)
| | - Jaime Prat
- Autonomous University of Barcelona, Barcelona, Spain
| | - Maolly Schuldt
- Department of Pathology, University of Granada, Granada, Spain
| | | | - Baljeet Kaur
- Imperial College Healthcare NHS Trust, London, UK
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29
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Di Tucci C, Casorelli A, Morrocchi E, Palaia I, Muzii L, Panici PB. Fertility management for malignant ovarian germ cell tumors patients. Crit Rev Oncol Hematol 2017; 120:34-42. [DOI: 10.1016/j.critrevonc.2017.10.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 08/23/2017] [Accepted: 10/11/2017] [Indexed: 01/02/2023] Open
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30
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Solheim O, Førsund M, Tropé CG, Kraggerud SM, Nesland JM, Davidson B. Epithelial-mesenchymal transition markers in malignant ovarian germ cell tumors. APMIS 2017; 125:781-786. [PMID: 28585395 DOI: 10.1111/apm.12715] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 04/03/2017] [Indexed: 12/15/2022]
Abstract
The purpose of this study was to determine the expression and potential clinical role of epithelial-to-mesenchymal transition (EMT)-related factors in malignant ovarian germ cell tumors (MOGCT). Protein expression of E-cadherin, N-cadherin, P-cadherin, Zeb1, HMGA2, and vimentin by immunohistochemistry was analyzed in 42 MOGCT from patients treated in Norway during the period 1981-2001. Expression was analyzed for association with clinicopathologic parameters. E-cadherin (p = 0.016) and HMGA2 (p = 0.002) expression was significantly higher in immature teratomas and yolk sac tumors compared with dysgerminomas. Vimentin (p < 0.001) and Zeb1 (p = 0.029) staining was significantly higher in immature teratomas compared with yolk sac tumors and dysgerminomas, whereas no significant differences were observed for N-cadherin and P-cadherin. EMT-associated markers were not significantly related to clinicopathologic parameters including age, tumor diameter, and FIGO stage. In conclusion, based on this limited series, EMT-associated markers are not associated with clinical parameters in MOGCT, in contrast to ovarian carcinoma. EMT-related proteins are differentially expressed among various MOGCT subtypes, suggesting differences in biological characteristics associated with invasion and metastasis.
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Affiliation(s)
- Olesya Solheim
- Department of Gynecologic Oncology, Oslo University Hospital, Norwegian Radium Hospital, Oslo, Norway
| | - Mette Førsund
- Department of Pathology, Oslo University Hospital, Norwegian Radium Hospital, Oslo, Norway
| | - Claes G Tropé
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Sigrid Marie Kraggerud
- Department of Molecular Oncology, Institute for Cancer Research, Division of Cancer Medicine Surgery and Transplantation, Oslo University Hospital, Oslo, Norway.,Center for Cancer Biomedicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jahn M Nesland
- Department of Pathology, Oslo University Hospital, Norwegian Radium Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ben Davidson
- Department of Pathology, Oslo University Hospital, Norwegian Radium Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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31
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Evers M, Rechnitzer C, Graem N, Skov Wehner P, Schroeder H, Rosthoej S, Mosbech CH, Hoei-Hansen CE, Sehested A, Treger TD, Brok J. Epidemiological study of paediatric germ cell tumours revealed the incidence and distribution that was expected, but a low mortality rate. Acta Paediatr 2017; 106:779-785. [PMID: 28135773 DOI: 10.1111/apa.13767] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 11/03/2016] [Accepted: 01/25/2017] [Indexed: 12/31/2022]
Abstract
AIM Germ cell tumours (GCTs) are a rare heterogeneous tumour group derived from primordial germ cells, which can be benign or malignant and occur in the gonads or extragonadally. This study mapped the paediatric GCTs in Denmark from 1984 to 2013 to study the incidence and outcome. METHODS We identified paediatric GCTs from the Danish Childhood Cancer and National Pathology Registries and reviewed the case records for patient characteristics, tumour characteristics and clinical outcome. RESULTS We identified 403 (71% female) paediatric GCTs and the crude incidence was 1.43 per 100 000. Of these, 79 (20%) were malignant, 39 (10%) were potentially malignant and 285 (70%) were benign. Extragonadal GCTs (39%) were mainly observed in early childhood and were predominately sacrococcygeal teratomas. Gonadal GCTs (61%) in late childhood were most frequently mature teratomas in the ovaries. Nearly all patients underwent surgery. Of the malignant tumours, 62% were treated with chemotherapy. Radiotherapy was only administered to intracranial GCTs. In the cohort, 12 patients died (3%). CONCLUSION Paediatric GCTs in Denmark were mainly benign and mortality was low, even for malignant tumours. We identified a peak of extragonadal GCTs in early childhood and a peak of gonadal GCTs in late childhood, which was comparable to previous reports.
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Affiliation(s)
- Madeline Evers
- Department of Paediatric and Adolescent Haematology and Oncology; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - Catherine Rechnitzer
- Department of Paediatric and Adolescent Haematology and Oncology; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - Niels Graem
- Department of Pathology; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - Peder Skov Wehner
- Department of Paediatric Haematology and Oncology; H. C. Andersen Children's Hospital; Odense University Hospital; Odense Denmark
| | - Henrik Schroeder
- Department of Paediatric Oncology; Aarhus University Hospital; Aarhus Denmark
| | - Steen Rosthoej
- Paediatric Oncology Section; Paediatric Department; Aalborg University Hospital; Aalborg Denmark
| | | | | | - Astrid Sehested
- Department of Paediatric and Adolescent Haematology and Oncology; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - Taryn D. Treger
- Cancer Section; Institute of Child Health; University College London; London UK
| | - Jesper Brok
- Department of Paediatric and Adolescent Haematology and Oncology; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
- Cancer Section; Institute of Child Health; University College London; London UK
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32
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Park JY, Kim DY, Suh DS, Kim JH, Kim YM, Kim YT, Nam JH. Analysis of outcomes and prognostic factors after fertility-sparing surgery in malignant ovarian germ cell tumors. Gynecol Oncol 2017; 145:513-518. [PMID: 28372870 DOI: 10.1016/j.ygyno.2017.03.023] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 03/27/2017] [Accepted: 03/28/2017] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To evaluate the oncologic and reproductive outcomes and to analyze prognostic factors after fertility-sparing surgery in patients with early and advanced malignant ovarian germ cell tumors (MOGCTs). METHODS This study included 171 patients who underwent fertility-sparing surgery. Data were gathered from patients' medical records. Survival analysis was performed using the log-rank test and Cox's proportional hazards model. Reproductive outcomes were analyzed. RESULTS Twenty-five patients (14.6%) had recurrent disease, and five patients (2.9%) died of disease during the median follow-up time of 86months (range, 9-294months). The 5-year disease-free survival (DFS) was 86%, and the 5-year overall survival (OS) was 97%. The 5-year DFS was 84% for stage I and 89% for stage II-IV. The 5-year OS was 99% for stage I and 91% for stage II-IV. In multivariate analysis, yolk sac tumor, incomplete staging surgery, and residual tumor were independent risk factors for reduced DFS, and yolk sac tumor and residual tumor were independent risk factors for reduced OS. Reproductive and obstetric outcomes were evaluable in 124 patients, and 106 patients (85.5%) had regular menstruation, 12 patients (9.7%) had irregular menstruation, and six patients (4.8%) had premature menopause. Twenty patients tried to conceive, 15 patients (75%) succeeded in achieving 21 pregnancies, and 13 of the patients (65%) gave birth to 20 healthy babies. CONCLUSION Fertility-sparing surgery has excellent survival outcomes in young women with MOGCTs, even in advanced stages. Reproductive and obstetric outcomes were promising. Yolk sac tumor, incomplete surgical staging, and residual tumor were independent prognostic factors.
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Affiliation(s)
- Jeong-Yeol Park
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
| | - Dae-Yeon Kim
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Dae-Shik Suh
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jong-Hyeok Kim
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Yong-Man Kim
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Young-Tak Kim
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Joo-Hyun Nam
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Zhao Q, Cao D, Yu M, Yang J, Liu Y, Xiang Y, Wu M, Pan L, Lang J, Xu K, Han J, Shen K. Safety and efficacy of bleomycin/pingyangmycin-containing chemotherapy regimens for malignant germ cell tumor patients in the female genital system. Oncotarget 2017; 8:15952-15960. [PMID: 28160575 PMCID: PMC5362537 DOI: 10.18632/oncotarget.15021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 01/09/2017] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To comprehensively evaluate the safety and effectiveness of bleomycin/pingyangmycin-containing chemotherapy for female patients with malignant germ cell tumors in their genital system; to assess the diagnostic value of pulmonary function tests for bleomycin-induced pulmonary toxicity. METHODS Data from a cohort of 120 patients, collected across 25 years, was reviewed. Chemotherapy-related adverse events were routinely monitored. Pulmonary toxicity was diagnosed and graded according to serial pulmonary function testing results, and potential impact factors were explored. Short-term remission probability and long-term prognosis were evaluated. RESULTS Overall, 49.2% of the patients had pulmonary dysfunction, and the majority manifested as diffusion function impairment. A moderate reduction of carbon monoxide diffusion capacity was detected in 45.0% of all patients, and was severe in 3 patients. Thrombocytopenia, renal dysfunction, and accumulating dose of bleomycin/pingyangmycin significantly increased the risk of lung injury (P<0.05). Thorough surgical removal of tumors enhanced both remission and survival rate. Full-dose delivery of bleomycin/pingyangmycin and patients' sensitivity to chemotherapy also improved long-term survival (P<0.05). CONCLUSIONS BPT could be sensitively detected and elaborately graded by PFTs, but the appropriate cut-off value for diagnosis needs further investigations. Timely recognition and control of renal dysfunction and thrombocytopenia could avail the patients of the opportunity to complete curative antineopalstic treatment. Prescriptive bleomycin/pingyangmycin-containing chemotherapy after optimal surgical resection could benefit MGCT patients maximally by improving both remission and survival rate.
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Affiliation(s)
- Qianying Zhao
- Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Dongyan Cao
- Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Mei Yu
- Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jiaxin Yang
- Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yongjian Liu
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yang Xiang
- Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ming Wu
- Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Lingya Pan
- Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jinghe Lang
- Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Kaifeng Xu
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jiangna Han
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Keng Shen
- Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Zhao Q, Yang J, Cao D, Han J, Xu K, Liu Y, Shen K. Tailored therapy and long-term surveillance of malignant germ cell tumors in the female genital system: 10-year experience. J Gynecol Oncol 2016; 27:e26. [PMID: 27029747 PMCID: PMC4823357 DOI: 10.3802/jgo.2016.27.e26] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 12/21/2015] [Accepted: 12/23/2015] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To explore the appropriate treatment of malignant germ cell tumor (MGCT) in the female genital system, and to analyze the factors influencing both therapeutic response and survival outcome. METHODS A cohort of 230-Chinese women diagnosed with MGCT of the genital system was retrospectively reviewed and prospectively followed. The demographic and pathological features, extent of disease and surgery, treatment efficiency, recurrence and survival were analyzed. RESULTS MGCTs from different genital origins shared a similar therapeutic strategy and response, except that all eight vaginal cases were infantile yolk sac tumors. The patients' cure rate following the initial treatment, 5-year overall survival and disease-free survival (DFS) were 85.02%, 95.00%, and 86.00%, respectively. Although more extensive excision could enhance the remission rate; it did not improve the patients' survival. Instead, the level of the medical institution, extent of surgery and disease were independent prognostic factors for relapse (p<0.05). Approximately 20% of patients had recurrent or refractory disease, more than half of whom were in remission following secondary cytoreductive surgery with salvage chemotherapy. CONCLUSION Fertility-sparing surgery with or without standardized PEB/PVB (cisplatin, etoposide/vincristine, and bleomycin) chemotherapy is applicable for female MGCTs of different origins. Comprehensive staging is not required; nor is excessive debulking suggested. Appropriate cytoreduction by surgery and antineoplastic medicine at an experienced medical institution can bring about an excellent prognosis for these patients.
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Affiliation(s)
- Qianying Zhao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jiaxin Yang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Dongyan Cao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jiangna Han
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Kaifeng Xu
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yongjian Liu
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Keng Shen
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
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Chevreau C, Gladieff L, Faure-Conter C. [Germ cell tumor in adolescents and young adults]. Bull Cancer 2016; 103:1057-1063. [PMID: 27823808 DOI: 10.1016/j.bulcan.2016.10.005] [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: 09/06/2016] [Revised: 10/05/2016] [Accepted: 10/06/2016] [Indexed: 11/28/2022]
Abstract
Management of extracranial germ cell tumors (TG) is emblematic of the adolescents and young adults' problematic. Beyond persisting differences in care between adult and pediatric oncologists, it emphasizes the need for effective collaboration between both teams. If the therapy is primarily guided today by adult standards, pediatricians bring expertise in long-term follow-up, justified by the increasing description of late side effects in this young population, with highly curable disease since cisplatin's emergence.
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Affiliation(s)
- Christine Chevreau
- Institut Claudius-Regaud, IUCT-Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse, France
| | - Laurence Gladieff
- Institut Claudius-Regaud, IUCT-Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse, France
| | - Cécile Faure-Conter
- Institut d'hémato-oncologie pédiatrique, 1, place J.-Renaud, 69008 Lyon, France.
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Kakkar A, Biswas A, Kalyani N, Chatterjee U, Suri V, Sharma MC, Goyal N, Sharma BS, Mallick S, Julka PK, Chinnaswamy G, Arora B, Sridhar E, Chatterjee S, Jalali R, Sarkar C. Intracranial germ cell tumors: a multi-institutional experience from three tertiary care centers in India. Childs Nerv Syst 2016; 32:2173-2180. [PMID: 27476038 DOI: 10.1007/s00381-016-3167-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 07/04/2016] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Central nervous system germ cell tumors (CNS GCTs) are relatively rare neoplasms. Incidence of CNS GCTs in Western literature is low (0.3-0.6 %) as compared to East Asia (3-4 %). No large study is available on CNS GCTs from India. METHODS Intracranial GCT cases were retrieved from databases of three tertiary care institutes in India; clinicopathological data was reviewed. RESULTS Ninety-five intracranial GCT cases were identified, accounting for 0.43 % of CNS tumors. Median age was 12 years (range, birth to 48 years); male preponderance was noted (66 %). Most patients (86.3 %) were aged <18 years. Pineal location was most common (45 %) and was associated with male gender and age >14 years. Germinoma was the commonest histopathological type (63.2 %), followed by teratoma (20 %). Suprasellar location was associated with germinoma histology. Follow-up was available for 71 patients (median, 15 months). Of these, 48 received adjuvant chemotherapy and/or radiotherapy. At the last follow-up, 44 patients showed no evidence of disease. Age >10 years, male gender, pineal location, and germinoma histology were associated with favorable outcome. CONCLUSION This is the first multicentric study from India establishing that incidence of CNS GCT in India is similar to that in the West and differs from that in East Asian countries. However, similar to both, germinoma is the commonest histological type, and pineal location is most frequent. Studies on molecular alterations based on ethnicity and geographical location are necessary to provide clarity on differences in incidence. Attention needs to be focused on decreasing treatment heterogeneity and minimizing treatment-related morbidity and mortality, improving the cure rate of these highly treatable tumors.
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Affiliation(s)
- Aanchal Kakkar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Ahitgani Biswas
- Department Radiation Oncology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Nikhil Kalyani
- Neuro Oncology Group, Tata Memorial Hospital, Mumbai, 400012, India
| | | | - Vaishali Suri
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Mehar C Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Nishant Goyal
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Bhawani S Sharma
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Supriya Mallick
- Department Radiation Oncology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Pramod K Julka
- Department Radiation Oncology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | | | - Brijesh Arora
- Neuro Oncology Group, Tata Memorial Hospital, Mumbai, 400012, India
| | - Epari Sridhar
- Neuro Oncology Group, Tata Memorial Hospital, Mumbai, 400012, India
| | | | - Rakesh Jalali
- Neuro Oncology Group, Tata Memorial Hospital, Mumbai, 400012, India
| | - Chitra Sarkar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India.
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Banas T, Juszczyk G, Pitynski K, Nieweglowska D, Ludwin A, Czerw A. Incidence and mortality rates in breast, corpus uteri, and ovarian cancers in Poland (1980-2013): an analysis of population-based data in relation to socioeconomic changes. Onco Targets Ther 2016; 9:5521-30. [PMID: 27660470 PMCID: PMC5021054 DOI: 10.2147/ott.s112187] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES This study aimed to analyze incidence and mortality trends in breast cancer (BC), corpus uteri cancer (CUC), and ovarian cancer (OC) in Poland in the context of sociodemographic changes. MATERIALS AND METHODS Incidence and mortality data (1980-2013) were retrieved from the Polish National Cancer Registry, while socioeconomic data (1960-2013) were obtained from the World Bank. Age-standardized incidence and mortality rates were calculated by direct standardization, and join-point regression was performed to describe trends using the average annual percentage change (AAPC). RESULTS A significant decrease in birth and fertility rates and a large increase in gross domestic product were observed together with a decrease in the total mortality rate among women, as well as an increase in life expectancy for women. A large, significant increase in BC incidence was observed (AAPC1980-1990 2.14, AAPC1990-1996 4.71, AAPC1996-2013 2.21), with a small but significant decrease in mortality after a slight increase (AAPC1980-1994 0.52, AAPC1994-2013 -0.66). During the period 1980-2013, a significant increase in CUC incidence (AAPC1980-1994 3.7, AAPC1994-2013 1.93) was observed, with an initial mortality-rate reduction followed by a significant increase (AAPC1980-2006 -1.12, AAPC2006-2013 3.74). After the initial increase of both OC incidence and mortality from 1994, the incidence rate decreased significantly (AAPC1980-1994 2.98, AAPC1994-2013 -0.49), as did the mortality rate (AAPC1980-1994 0.52, AAPC1994-2013 -0.66). CONCLUSION After 1994, a decrease in OC incidence was found, while the incidence of BC and CUC continued to increase. A reduction in mortality rate was observed for BC and OC predominantly at the end of the study period, while for CUC, after a long decreasing mortality trend, a significant increase was observed.
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Affiliation(s)
- Tomasz Banas
- Department of Gynecology and Oncology, Jagiellonian University Medical College, Krakow
| | - Grzegorz Juszczyk
- Faculty of Health Science, Medical University of Warsaw, Warsaw, Poland
| | - Kazimierz Pitynski
- Department of Gynecology and Oncology, Jagiellonian University Medical College, Krakow
| | - Dorota Nieweglowska
- Department of Gynecology and Oncology, Jagiellonian University Medical College, Krakow
| | - Artur Ludwin
- Department of Gynecology and Oncology, Jagiellonian University Medical College, Krakow
| | - Aleksandra Czerw
- Faculty of Health Science, Medical University of Warsaw, Warsaw, Poland
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van Leeuwen MT, Gurney H, Turner JJ, Turner SL, Pearson SA, Laaksonen MA, Harnett P, Balakrishnar B, Sabanathan D, Vajdic CM. Patterns and trends in the incidence of paediatric and adult germ cell tumours in Australia, 1982–2011. Cancer Epidemiol 2016; 43:15-21. [DOI: 10.1016/j.canep.2016.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 05/03/2016] [Accepted: 05/08/2016] [Indexed: 02/02/2023]
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Liao ZW, Rodrigues MC, Poynter JN, Amatruda JF, Rodriguez-Galindo C, Frazier AL. Risk of second gonadal cancers in women and children with germ cell tumors. Cancer 2016; 122:2076-82. [PMID: 27152727 DOI: 10.1002/cncr.30014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 02/16/2016] [Accepted: 02/22/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND Men with testicular cancer have an increased risk of developing cancer in the contralateral testis, but the risks of second gonadal cancers (SGCs) in women and children treated for germ cell tumors (GCTs) have not previously been quantified. METHODS The incidence of SGCs was ascertained in patients who had survived for at least 1 year after GCT diagnosis using data from the Surveillance, Epidemiology, and End Results SEER 9 registries (1980-2012). Relative risks of SGCs were estimated separately for boys, women, and girls compared with men based on Poisson regression analysis. RESULTS The cohort included 21,546 individuals (1116 boys, 827 women, 622 girls, and 18,981 men). A total of 25 SGCs were identified in boys, 1 in women, and 2 in girls compared with 254 in men. The risk of SGC in postpubertal boys (aged ≥10 years) was comparable to that of adult men (boys: standardized incidence ratio, 15.90; 95% confidence interval, 10.29-23.47; men: standardized incidence ratio, 10.88; 95% confidence interval, 9.58-12.30). However, no SGCs were observed in boys who were diagnosed with a testicular GCT before age 10 years (N = 179). An elevated risk of SGC was also not observed for women or girls. CONCLUSIONS The apparent lack of an SGC in prepubertal boys suggests that susceptibility is either age-dependent and/or histology-dependent. The sex differences in the risk of SGC suggest differences in the etiology of ovarian versus testicular GCT. The finding that the risk of SGCs in postpubertal boys is similar to that observed in men indicates that long-term follow-up for SGC is warranted in postpubertal boys. Cancer 2016;122:2076-82. © 2016 American Cancer Society.
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Affiliation(s)
- Zi Wei Liao
- Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, Massachusetts.,Interdepartmental Program in Biochemistry, Wellesley College, Wellesley, Massachusetts
| | | | - Jenny N Poynter
- Department of Pediatrics, Division of Epidemiology and Clinical Research, University of Minnesota, Minneapolis, Minnesota.,Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - James F Amatruda
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Molecular Biology, University of Texas Southwestern Medical Center, Dallas, Texas.,Center for Cancer and Blood Disorders, Children's Medical Center, Dallas, Texas
| | | | - A Lindsay Frazier
- Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, Massachusetts
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Mustafa OM, Mohammed SF, Aljubran A, Saleh WN. Immature mediastinal teratoma with unusual histopathology: A case report of multi-lineage, somatic-type malignant transformation and a review of the literature. Medicine (Baltimore) 2016; 95:e3378. [PMID: 27367976 PMCID: PMC4937890 DOI: 10.1097/md.0000000000003378] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Germ cell tumors (GCTs) represent a well-recognized group of heterogeneous neoplasms with diverse clinical, histopathological, diagnostic, and prognostic characteristics. We present a rare case of a locally aggressive, chemotherapy-resistant immature mediastinal teratoma with a peculiar histological finding of a multilineage somatic-type malignant degeneration. A 21-year-old male patient presented with a 3-week history of persistent, blood-tinged productive cough and shortness of breath. A contrast-enhanced computed tomography (CT) scan of the chest showed a heterogeneous mass occupying the right hemithorax and abutting on adjacent structures. CT-guided biopsy was consistent with immature teratoma. Combination chemotherapy with bleomycin, etoposide, and cisplatin was initiated, albeit without success; the mass showed interval progression in size, and surgical resection through clamshell incision was performed. Histological assessment of the resected mass confirmed the diagnosis of immature teratoma and revealed an extensive multilineage malignant differentiation into sarcomatous, carcinomatous, and melanomatous components. The patient underwent an uneventful recovery but presented 2 months later with extensive liver and bone melanomatous metastases. In this report, relevant findings from the literature are also highlighted. Despite being exceptionally rare, such tumors carry poor prognosis. Understanding the clinicopathological characteristics and biological behavior of such tumors may provide an insight into interventions tailored to improve the otherwise dismal disease outlook.
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Affiliation(s)
- Osama M. Mustafa
- College of Medicine, Alfaisal University
- Correspondence: Waleed N. Saleh, Division of Thoracic Surgery, Department of Surgery, King Faisal Specialist Hospital & Research Center, P.O. Box 3354, Riyadh 11211, Saudi Arabia (e-mail: )
| | | | | | - Waleed N. Saleh
- Division of Thoracic Surgery, Department of Surgery, King Faisal Specialist Hospital and Research Center (KFSH&RC), Riyadh, Saudi Arabia
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Primary Yolk Sac Tumor of the Prostate in a Child: Case Report. Clin Genitourin Cancer 2016; 14:e535-e537. [PMID: 27212043 DOI: 10.1016/j.clgc.2016.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 04/16/2016] [Indexed: 12/21/2022]
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Ko JJ, Asif T, Li H, Alimohamed N, Nguyen PT, Heng DY. Disease characteristics and survival outcomes of extragonadal primary germ cell tumour in two Canadian tertiary cancer centres. Can Urol Assoc J 2016; 10:E165-E170. [PMID: 27790297 PMCID: PMC5065405 DOI: 10.5489/cuaj.3357] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Extragonadal germ cell tumours (EGCTs) are a heterogeneous group with distinct natural history and responses to treatment modalities. We sought to evaluate characteristics and survival outcomes in men with EGCTs. METHODS We performed a retrospective analysis on a consecutive list of men diagnosed with EGCT in two Albertan cancer centres between 1990 and 2013. Demographic characteristics and outcomes, stratified by primary site, were evaluated. RESULTS Sixty-nine cases were identified. The median age was 29 (range 15-76) and 48 cases (70%) were non-seminomatous. Twenty-four (35%) belonged to International Germ Cell Cancer Collaborative Group (IGCCCG) favourable risk group, 14 (20%) to intermediate, and 31 (45%) to poor. Thirty (43%) had mediastinal primary (MPs); 29 were treated with first-line bleomycin, etopo-side, and cisplatin (BEP). Seventeen (57%) relapses occurred, of which three patients achieved long-term survival. Seventeen (25%) had a central nervous system (CNS) primary, with eight (47%) classic germinoma. Seven (41%) received primary chemotherapy alone; 5 (29%) received primary radiotherapy alone, and 5 (29%) received both. Nineteen (28%) had a retroperitoneal primary (RPs) and received first-line chemotherapy; all but two received BEP and eight (42%) had surgical resection. Three (5%) had other or unknown primary. Five-year overall survival (OS) and disease-free survival for all patients were 56% and 44%, respectively; for MPs, 44% and 34%; for CNS primary, 76% and 53%; for RPs, 58% and 53%. Factors that correlated with decreased OS were elevated alpha fetoprotein (AFP) (p<0.001) or human chorionic gonadotropin (HCG) (p=0.001), lactate dehydrogenase (LDH) levels (p=0.028), bone metastasis (p<0.001), lung metastasis (p<0.001), and IGCCCG poor risk (p=0.001). CONCLUSIONS EGCT is a rare, but important subset of GCT. Patients with EGCTs, despite aggressive treatments, still have poorer outcomes than gonadal primary.
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Affiliation(s)
- Jenny J. Ko
- Department of Medical Oncology, Abbotsford Cancer Centre, Abbotsford, BC, Canada
| | - Tehmina Asif
- Department of Medical Oncology, Saskatchewan Cancer Agency, Saskatoon, SK, Canada
| | - Haocheng Li
- Departments of Oncology and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Nimira Alimohamed
- Department of Medical Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Phuong Thao Nguyen
- Department of Medical Oncology, Royal Inland Cancer Centre, Kamloops, BC, Canada
| | - Daniel Y.C. Heng
- Department of Medical Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada
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Mortazavi N, Mahzooni P, Taheri D, Jalilian M, Novin K. Germ Cell Tumor's Survival Rate in Young Patients. IRANIAN JOURNAL OF CANCER PREVENTION 2015; 8:e3440. [PMID: 26478797 PMCID: PMC4606379 DOI: 10.17795/ijcp.3440] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 07/11/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND Germ cell tumors are neoplasms that originate from multi potential germ cells and can be intra or extra gonadal. According to pathologic classification, they have different subtypes. They account for 3% of pediatric malignancies and most commonly happen in children before the age of 15 years old. Epidemiologic evidence about pediatric germ cell tumors is scant in our region. OBJECTIVES The aim of current study was to determine demographic characteristics, recurrence and survival rate of germ cell tumor patients under the age of 21 years. PATIENTS AND METHODS During a 10-year period (1996 - 2006), 106 patients under the age of 21 years suffering from germ cell tumor were admitted to our centers. We extracted the data needed for our study from patients' medical records in the hospitals. RESULTS Thirty seven boys and 69 girls with a mean age of 8.4 ± 7.8 years were included. Most tumors were diagnosed before the age of one year (37%). The most common pathologic subtype was mature teratoma (44%). Ovary (35%) was the most common primary site. Surgery plus chemotherapy were used to treat 54 patients and BEP was the most common chemotherapy regimen. Metastasis and recurrent tumor were seen in 22% and 8% of cases, respectively. Four-year overall survival was 89%. CONCLUSIONS Our study showed that demographic characteristics of GCT patients in our population are similar to patients of other geographic regions in the world. Primary tumor site, histologic subtype and metastasis were significant prognostic factors for survival.
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Affiliation(s)
- Nafiseh Mortazavi
- Department of Pathology, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Parvin Mahzooni
- Department of Pathology, Isfahan University of Medical Sciences, Isfahan, IR Iran
| | - Diana Taheri
- Department of Pathology, Isfahan University of Medical Sciences, Isfahan, IR Iran
| | - Mahshid Jalilian
- Department of Radiation Oncology, Isfahan University of Medical Sciences, Isfahan, IR Iran
| | - Kambiz Novin
- Department of Radiation Oncology, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
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Hung GY, Horng JL, Yen HJ, Lee CY. Pre-pubertal and adolescent germ cell neoplasms in Taiwan: time trends and geographic variation. Andrology 2015; 3:895-901. [DOI: 10.1111/andr.12083] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 05/25/2015] [Accepted: 06/24/2015] [Indexed: 11/27/2022]
Affiliation(s)
- G.-Y. Hung
- Division of Pediatric Hematology and Oncology; Department of Pediatrics; Taipei Veterans General Hospital; Taipei Taiwan
- Department of Pediatrics; National Yang-Ming University School of Medicine; Taipei Taiwan
| | - J.-L. Horng
- Department of Anatomy and Cell Biology; School of Medicine; College of Medicine; Taipei Medical University; Taipei Taiwan
| | - H.-J. Yen
- Division of Pediatric Hematology and Oncology; Department of Pediatrics; Taipei Veterans General Hospital; Taipei Taiwan
- Department of Pediatrics; National Yang-Ming University School of Medicine; Taipei Taiwan
| | - C.-Y. Lee
- Division of Pediatric Hematology and Oncology; Department of Pediatrics; Taipei Veterans General Hospital; Taipei Taiwan
- Department of Pediatrics; National Yang-Ming University School of Medicine; Taipei Taiwan
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Solheim O, Tropé C, Rokkones E, Kærn J, Paulsen T, Salvesen H, Hagen B, Vereide A, Fosså S. Fertility and gonadal function after adjuvant therapy in women diagnosed with a malignant ovarian germ cell tumor (MOGCT) during the “cisplatin era”. Gynecol Oncol 2015; 136:224-9. [DOI: 10.1016/j.ygyno.2014.12.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 11/27/2014] [Accepted: 12/08/2014] [Indexed: 11/26/2022]
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Tan C, Scotting P. Expression of Kit and Etv1 in restricted brain regions supports a brain-cell progenitor as an origin for cranial germinomas. Cancer Genet 2015; 208:55-61. [PMID: 25736805 DOI: 10.1016/j.cancergen.2014.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 12/24/2014] [Accepted: 12/27/2014] [Indexed: 02/07/2023]
Abstract
Mismigrating germ-cell progenitors have historically been accepted as the cell of origin for central nervous system (CNS) germinomas. However, an alternative hypothesis suggests that CNS germinomas arise from a brain-cell progenitor. Germinomas often acquire Kit signaling pathway mutations, and there is evidence for an oncogenic relationship between KIT and the ETV1 transcription factor. KIT appears to be necessary to stabilize ETV1, and ETV1 then activates oncogenesis-associated genes. ETV1 expression is not increased by KIT, so ETV1 already needs to be expressed in order for KIT to have an oncogenic function. Therefore, if brain-cell progenitors are the cell of origin for germinomas, those cells would already need to coexpress ETV1 and KIT. We examined Kit and Etv1 in situ hybridization data from the Allen Brain Atlas, for mouse brain tissue at various stages of development. Both Kit and Etv1 were expressed in the regions where germinomas most commonly arise, and in the medulla oblongata. All human cases of germinomas correlated to the regions where ETV1 and KIT are coexpressed. We therefore postulate that germinomas in the brain share a similar mechanism with other KIT-driven cancers, which supports the hypothesis that germinomas arise from a brain-cell progenitor.
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Affiliation(s)
- Chris Tan
- Queen's Medical Centre Medical School, Nottingham, United Kingdom.
| | - Paul Scotting
- Queen's Medical Centre Medical School, Nottingham, United Kingdom
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Tomasetti C, Vogelstein B. Cancer etiology. Variation in cancer risk among tissues can be explained by the number of stem cell divisions. Science 2015; 347:78-81. [PMID: 25554788 PMCID: PMC4446723 DOI: 10.1126/science.1260825] [Citation(s) in RCA: 1209] [Impact Index Per Article: 134.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Some tissue types give rise to human cancers millions of times more often than other tissue types. Although this has been recognized for more than a century, it has never been explained. Here, we show that the lifetime risk of cancers of many different types is strongly correlated (0.81) with the total number of divisions of the normal self-renewing cells maintaining that tissue's homeostasis. These results suggest that only a third of the variation in cancer risk among tissues is attributable to environmental factors or inherited predispositions. The majority is due to "bad luck," that is, random mutations arising during DNA replication in normal, noncancerous stem cells. This is important not only for understanding the disease but also for designing strategies to limit the mortality it causes.
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Affiliation(s)
- Cristian Tomasetti
- Division of Biostatistics and Bioinformatics, Department of Oncology, Sidney Kimmel Cancer Center, Johns Hopkins University School of Medicine and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, 550 North Broadway, Baltimore, MD 21205, USA.
| | - Bert Vogelstein
- Ludwig Center for Cancer Genetics and Therapeutics and Howard Hughes Medical Institute, Johns Hopkins Kimmel Cancer Center, 1650 Orleans Street, Baltimore, MD 21205, USA.
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Kaatsch P, Häfner C, Calaminus G, Blettner M, Tulla M. Pediatric germ cell tumors from 1987 to 2011: incidence rates, time trends, and survival. Pediatrics 2015; 135:e136-43. [PMID: 25489016 DOI: 10.1542/peds.2014-1989] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Malignant germ cell tumors (GCTs) are a rare and a heterogeneous group of pediatric cancers. The incidence rate has increased in some populations or subgroups. However, only a few recent publications on epidemiologic data showing the trends in incidence of pediatric GCTs are available. METHODS We analyzed the incidence rates, time trends, and survival for 1366 GCTs in children 0 to 14 years old registered in the nationwide, population-based German Childhood Cancer Registry in 1987-2011. RESULTS The incidence rate of GCTs was slightly higher in girls (age-standardized rate: girls, 5.3; boys, 4.4 per million). A bimodal age distribution was seen. In children aged <1 year, the highest age-specific incidence rates were seen for girls with GCTs in the pelvis (12.7 per million) and for boys with GCTs in the testis (9.5 per million). For 10- to 14-year-old boys, the tumors occurred most often in the central nervous system (3.1 per million); for girls, the most common site was in the ovaries (4.5 per million). Only the incidence rate for ovarian GCTs increased statistically significantly. The 5- and 20-year survival probabilities for the patients diagnosed between 1987 and 2010 were 92% and 90%, respectively. Survival rates improved notably for intracranial and extragonadal GCTs from 1987 to 2006. CONCLUSIONS The localization and histology of the GCTs varied between the genders and age groups. During 1987 to 2011, the incidence rate increased only for ovarian GCTs. The increase, however, may be due to changes in reporting. The survival rates were excellent.
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Affiliation(s)
- Peter Kaatsch
- German Childhood Cancer Registry, Institute for Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre Mainz, Mainz, Germany
| | - Carla Häfner
- Faculty of Health and Medical Sciences, Departments of Biochemistry and Physiology, University of Surrey, Guildford, Surrey, United Kingdom
| | - Gabriele Calaminus
- Pediatric Hematology and Oncology, University Children's Hospital Muenster, Muenster, Germany; and
| | - Maria Blettner
- Institute for Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre Mainz, Mainz, Germany
| | - Mira Tulla
- German Childhood Cancer Registry, Institute for Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre Mainz, Mainz, Germany;
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Poynter JN, Fonstad R, Tolar J, Spector LG, Ross JA. Incidence of intracranial germ cell tumors by race in the United States, 1992-2010. J Neurooncol 2014; 120:381-8. [PMID: 25086758 DOI: 10.1007/s11060-014-1562-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 07/21/2014] [Indexed: 11/28/2022]
Abstract
Little is known about the etiology of intracranial germ cell tumors (iGCTs), although international incidence data suggest that the highest incidence rates occur in Asian countries. In this analysis, we used 1992-2010 data from the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) Program to determine whether rates of iGCT were also high in Asian/Pacific Islanders living in the United States. Frequencies, incidence rates and survival rates were evaluated for the entire cohort and for demographic subgroups based on sex, age category (0-9 and 10-29 years), race (white, black, and Asian/Pacific Islander), and tumor location (pineal gland vs. other) as sample size permitted. Analyses were conducted using SEER*Stat 8.1.2. We observed a significantly higher incidence rate of iGCT in Asian/Pacific Islanders compared with whites (RR = 2.05, 95 % CI 1.57-2.64, RR = 3.04, 95 % CI 1.75-5.12 for males and females, respectively) in the 10-29 year age group. This difference was observed for tumors located both in the pineal gland and for tumors in other locations. Five-year relative survival differed by demographic and tumor characteristics, although these differences were not observed in comparisons limited to cases treated with radiation. Increased incidence rates of iGCT in individuals of Asian descent in the SEER registry are in agreement with data from the International Agency for Research on Cancer, where Japan and Singapore were among the countries with highest incidence. The increased incidence in individuals of Asian ancestry in the United States suggests that underlying genetic susceptibility may play a role in the etiology of iGCT.
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Affiliation(s)
- Jenny N Poynter
- Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, 420 Delaware St SE MMC 715, Minneapolis, MN, 55455, USA,
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50
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Germ cell tumors in children and adolescents in Finland: trends over 1969–2008. Cancer Causes Control 2014; 25:1337-41. [DOI: 10.1007/s10552-014-0439-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 07/10/2014] [Indexed: 12/27/2022]
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