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Vasta FM, Cormio G, Cassani C, Bergamini A, Scarfone G, Ferrandina G, De Vivo R, Marinaccio M, Danese S, Raspagliesi F, Pignata S, Mangili G. Reproductive outcomes after conservative treatment in early and advanced stage MOGCTs. Gynecol Oncol 2024; 181:28-32. [PMID: 38104526 DOI: 10.1016/j.ygyno.2023.11.023] [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] [Received: 08/02/2023] [Revised: 11/05/2023] [Accepted: 11/22/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Malignant ovarian germ cell tumors usually occur in young women. The standard of care is fertility sparing surgery and comprehensive surgical staging followed by adjuvant chemotherapy with BEP (bleomycin, etoposide, cisplatin) if needed. The aim of this study was to analyze the reproductive outcomes after conservative treatment in patients diagnosed, treated and followed up in MITO (Multicenter Italian Trials in Ovarian Cancer) centers. METHODS A questionnaire concerning gynecological symptoms, reproductive outcomes and fertility treatment was administered to 164 MOGCTs survivors. Data regarding patients deceased were collected from MITO-9 database. There were 114 patients diagnosed at reproductive age between 1983 and 2019 included. RESULTS 109 patients answered the questionnaire and 5 patients decesased were included (median age 24.9 years). 78.1% were stage I,4.4% stage II, 14.9% stage III and 2.6% stage IV. 57.9% received chemotherapy, the mean number of cycles was 4.1. Median time to menstrual recovery after BEP was of 5.6 months range, only 1 case of premature ovarian failure was reported. Among the 114 patients 38 (33.3%) attempted to become pregnant, 29/38 (76.3%) got pregnant with a total of 44 conceptions. 40.9% received chemotherapy and 22.9% did not (p 0.048). Pregnancy desire was the only predictive factor associated with live births among women who attempted pregnancy after treatment. CONCLUSIONS As MOGCTs affect women of child-bearing age, fertility preservation represents a major treatment issue. Our results are consistent with the available evidence, confirming that adjuvant chemotherapy for MOGCT does not impact the reproductive function and fertility.
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Affiliation(s)
- Francesca M Vasta
- Department of Obstetrics and Gynecology, IRCCS San Raffaele, Milan, Italy
| | - Gennaro Cormio
- Gynecologic Oncology Unit, IRCCS Istituto Tumori di Bari, Italy; Department of Interdisciplinary Medicine, University of Bari, Italy
| | - Chiara Cassani
- Department of Obstetrics and Gynaecology, Fondazione IRCCS Policlinico San Matteo-University of Pavia, Pavia, Italy
| | - Alice Bergamini
- Department of Obstetrics and Gynecology, IRCCS San Raffaele, Milan, Italy; Università Vita Salute San Raffaele, Milan, Italy.
| | | | - Gabriella Ferrandina
- Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore, Istituto di Ginecologia e Ostetricia, Roma, Italy
| | - Rocco De Vivo
- Department of Oncology, Ospedale san Bartolo, Vicenza, Italy
| | - Marco Marinaccio
- Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncologic Science, University of Bari, Italy
| | - Saverio Danese
- Deparment of Obstetrics and Gynecology, A.O.U. Città della Salute e della Scienza, Torino, Italy
| | | | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale Napoli, Italy
| | - Giorgia Mangili
- Department of Obstetrics and Gynecology, IRCCS San Raffaele, Milan, Italy
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Saani I, Raj N, Sood R, Ansari S, Mandviwala HA, Sanchez E, Boussios S. Clinical Challenges in the Management of Malignant Ovarian Germ Cell Tumours. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6089. [PMID: 37372675 DOI: 10.3390/ijerph20126089] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/22/2023] [Accepted: 04/25/2023] [Indexed: 06/29/2023]
Abstract
Nonepithelial ovarian cancers (NEOC) are a group of rare malignancies, including germ cell tumours (GCT) and sex cord-stromal tumours (SCST), along with small-cell carcinomas and sarcomas. GCTs represent 2-5% of ovarian cancers, with a yearly incidence of 4:100,000, and they usually affect young women and adolescents. Precursory germ cells of the ovary form the basis of GCT. They are histologically classified into primitive GCT, teratomas, and monodermal and somatic-type tumours associated with dermoid cysts. A primitive GCT can be either a yolk sac tumour (YST), dysgerminoma, or mixed germ cell neoplasm. Teratomas are either mature (benign) or immature (malignant). Given that malignant GCTs occur rarely compared to epithelial ovarian tumours (EOC), greater focus is required in their diagnosis and treatment. In this article, we review the epidemiology, clinical manifestations, diagnosis, and molecular biology, along with the management and therapeutic challenges.
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Affiliation(s)
- Iqra Saani
- Department of Medicine, Medway NHS Foundation Trust, Windmill Road, Gillingham ME7 5NY, UK
| | - Nitish Raj
- Department of Radiology, University Hospitals Plymouth NHS Trust, Plymouth PL6 8DH, UK
| | - Raja Sood
- Department of Clinical Medical Education, Epsom and St Helier University Hospitals NHS Trust, Epsom KT18 7EG, UK
| | - Shahbaz Ansari
- Department of Medicine, Glan Clwyd Hospital, NHS Wales, Denbighshire LL18 5UJ, UK
| | - Haider Abbas Mandviwala
- Department of Internal Medicine, School of Medicine, Faculty of Health Sciences, Ziauddin Medical University, Karachi 75000, Sindh, Pakistan
| | - Elisabet Sanchez
- Department of Medical Oncology, Medway NHS Foundation Trust, Windmill Road, Gillingham ME7 5NY, UK
| | - Stergios Boussios
- Department of Medical Oncology, Medway NHS Foundation Trust, Windmill Road, Gillingham ME7 5NY, UK
- Faculty of Life Sciences & Medicine, School of Cancer & Pharmaceutical Sciences, King's College London, London SE1 9RT, UK
- Kent Medway Medical School, University of Kent, Canterbury CT2 7LX, UK
- AELIA Organization, 9th Km Thessaloniki-Thermi, 57001 Thessaloniki, Greece
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Dai GL, Tang FR, Wang DQ. Primary ovarian choriocarcinoma occurring in a postmenopausal woman: A case report. World J Clin Cases 2023; 11:3592-3598. [PMID: 37383899 PMCID: PMC10294203 DOI: 10.12998/wjcc.v11.i15.3592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 04/05/2023] [Accepted: 04/21/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Nongestational ovarian choriocarcinoma (NGOC) is a rare but aggressive neoplasm with limited sensitivity to chemotherapy and a very poor prognosis. Few cases of NGOC have been reported, and there is limited information regarding its clinical features, treatment protocols, or prognosis.
CASE SUMMARY A postmenopausal woman in her 5th decade of life visited our clinic because of abnormal vaginal bleeding and an abdominal mass. Although she had been menopausal for more than eight years and her last abortion occurred nine years ago, she had an increased level of serum β-human chorionic gonadotropin (β-hCG). Thus, an ovarian neoplasm of trophoblastic origin was suspected, and exploratory laparotomy was performed. Based on the patient’s clinical history and the histopathological examination and immunohistochemistry results obtained postoperatively, we concluded that she most likely had primary NGOC. Cytoreductive surgery was performed in combination with adjuvant chemotherapy comprising bleomycin, etoposide, and cisplatin. Serum β-hCG levels decreased to normal after two cycles, and there was no evidence of recurrence after four cycles of chemotherapy.
CONCLUSION Even in postmenopausal women, ovarian choriocarcinoma should be considered in the initial differential diagnosis for an adnexal mass.
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Affiliation(s)
- Guan-Lin Dai
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, Sichuan Province, China
| | - Fu-Rong Tang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, Sichuan Province, China
| | - Dan-Qing Wang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, Sichuan Province, China
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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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Youssef R, Ahmed GS, Alhyassat S, Badr S, Sabry A, Kohla S. Ovarian Dysgerminoma in Pregnant Women with Viable Fetus: A Rare Case Report. Case Rep Oncol 2021; 14:141-146. [PMID: 33776695 PMCID: PMC7983548 DOI: 10.1159/000513622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 12/07/2020] [Indexed: 11/19/2022] Open
Abstract
Dysgerminoma is an uncommon malignant tumor arising from the germ cells of the ovary. Its association with pregnancy is extremely rare, with a reported incidence of about 0.2-1 per 100,000 pregnancies. Women in the reproductive age group are more commonly affected. It can be extremely rare to conceive naturally, without assisted reproductive interventions, in cases with ovarian dysgerminoma. If a pregnancy does occur with a concurrent dysgerminoma, it is even more unusual to carry the pregnancy to viability or childbirth without fetal or maternal compromise. We report a case of right ovarian dysgerminoma in a young female with a viable intrauterine pregnancy at 10 weeks, which is rarely diagnosed and managed at this gestational age. Numerous factors played a role in her favorable outcome, including early suspicion by ultrasound and presenting history, surgery, histopathological assessment, imaging, and involvement of the multidisciplinary oncology team. Ovarian neoplasms may rapidly increase in size within a short period with little or no symptoms. This poses a diagnostic challenge for obstetricians and oncologists. Hence, we aimed to evaluate the role of imaging in pregnancy using ultrasound as an imaging modality for both early detection of ovarian neoplasms and for follow-up. In conclusion, patients with ovarian dysgerminoma in pregnancy can have favorable outcomes. Treatment should be individualized on a case-to-case basis, depending on many factors; cancer stage, previous reproductive history, the impact of imaging in staging or follow-up of tumor on the fetus, fetal gestational age, and whether termination of the pregnancy can improve survival or morbidity for the mother.
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Affiliation(s)
- Reda Youssef
- Department of Clinical Imaging, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar.,Weill-Cornell Medical College, Doha, Qatar
| | - Gamal Sayed Ahmed
- Department of Obstetrics and Gynecology, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar.,Weill-Cornell Medical College, Doha, Qatar.,Clinical Department, College of Medicine, QU Health, Qatar University, Doha, Qatar.,University of Dundee, Dundee, United Kingdom
| | - Samir Alhyassat
- Anatomic Pathology Division, Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar
| | - Sanaa Badr
- Department of Clinical Imaging, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Sabry
- Department of Clinical Imaging, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar.,Weill-Cornell Medical College, Doha, Qatar
| | - Samah Kohla
- Hematopathology Division, Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar.,Weill-Cornell Medical College, Doha, Qatar
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Reproductive Outcomes and Fertility Preservation Strategies in Women with Malignant Ovarian Germ Cell Tumors after Fertility Sparing Surgery. Biomedicines 2020; 8:biomedicines8120554. [PMID: 33265938 PMCID: PMC7761340 DOI: 10.3390/biomedicines8120554] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/20/2020] [Accepted: 11/26/2020] [Indexed: 12/19/2022] Open
Abstract
Malignant ovarian germ cell tumors are rare tumors that mainly affect patients of reproductive age. The aim of this study was to investigate the reproductive outcomes and fertility preservation strategies in malignant ovarian germ cell tumors after fertility-sparing surgery. Data in literature support that fertility-sparing surgery is associated with an excellent oncological outcome not only in early stages malignant ovarian germ cell tumors but also in advanced stages. Moreover, the possibility of performing conservative treatment should be considered even in case of relapse or advanced disease, given the high chemosensitivity. Indeed, available data have shown that menstrual function is maintained after platinum-based regimens in over 85-95% of patients with malignant ovarian germ cell tumors and rate of premature menopause reported in literature ranges between 3% and 7.4%, while premature ovarian failure rates are between 3.4% and 5%. Moreover, reproductive outcomes are about 80% with no increase in the risk of teratogenicity compared to general population. Therefore, conservative surgery for malignant ovarian germ cell tumors currently may represent a therapeutic option in patients who wish to preserve fertility but must be available for extended follow-up and after subscribing to informed consent.
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Prognostic factors and oncological outcomes of ovarian yolk sac tumors: a retrospective multicentric analysis of 99 cases. Arch Gynecol Obstet 2019; 300:175-182. [PMID: 30982145 DOI: 10.1007/s00404-019-05160-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 04/09/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE To investigate the clinico-pathological prognostic factors and treatment outcomes in patients with ovarian yolk sac tumors (YST). METHODS A multicenter, retrospective department database review was performed to identify patients with ovarian YST who underwent surgery between 2000 and 2017 at seven Gynecologic Oncology Centers in Turkey. RESULTS The study group consisted of 99 consecutive patients with a mean age of 23.9 years. While 52 patients had early stage (stage I-II) disease, the remaining 47 patients had advanced stage (stage III-IV) disease. The uterus was preserved in 74 (74.8%) of the cases. The absence of gross residual disease following surgery was achieved in 76.8% of the cases. Of the 54 patients with lymph node dissection (LND), lymph node metastasis was detected in 10 (18.5%) patients. Of the 99 patients, only 3 patients did not receive adjuvant therapy, and most of the patients (91.9%) received BEP (bleomycin, etoposide, cisplatin) chemotherapy. Disease recurred in 21 (21.2%) patients. The 5-year disease-free survival (DFS) and overall survival (OS) in the entire cohort were 79.2% and 81.3%, respectively. In multivariate analysis, only residual disease following initial surgery was found to be significantly associated with DFS and OS in patients with ovarian YST (p = 0.026 and p = 0.001, respectively). CONCLUSIONS Our results demonstrate the significance of achieving no visible residual disease in patients with ovarian YST. Fertility-sparing approach for patients with no visible residual disease affected neither DFS nor OS. Although high lymphatic involvement rate was detected, the benefit of LND could not be demonstrated.
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Liang P, Zhang X, Zhang Z, Xu G, Yu X, Li S, Zhang Y, Bian L, Zhang B. Treatment Approach and Prognosis of Pediatric and Adolescent Nonepithelial Malignant Ovarian Tumors: A Retrospective Prognosis Analysis. J Pediatr Adolesc Gynecol 2018; 31:304-310. [PMID: 28993225 DOI: 10.1016/j.jpag.2017.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 09/17/2017] [Accepted: 09/26/2017] [Indexed: 10/18/2022]
Abstract
STUDY OBJECTIVE Nonepithelial malignant ovarian tumors are rare in the pediatric and adolescent population. The aim of this study was to observe the spectrum of pathology, presentation, outcome, and risk factors for survival of pediatric nonepithelial malignant ovarian tumors in a Chinese pediatric population. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: This was a retrospective study of 171 girls (median age at presentation of 14 years) diagnosed with primary malignant ovarian tumors between 1990 and 2014 at the Yat-Sen Memorial Hospital and Cancer Center of Sun Yat-sen University. Symptoms, pathological data, treatments, and outcomes were obtained retrospectively from the medical records. RESULTS Most (85.96%, 147/171) tumors occurred in patients aged 10-18 years and most cases were International Federation of Gynecology and Obstetrics stage I (68.42%, 117/171). The predominant pathological type was germ cell tumors (87.13%, 149/171). All patients underwent surgery, and 87 (50.88%, 87/171) underwent conservative incomplete staging surgery (unilateral salpingo-oophorectomy or tumor excision). The 5-year progression-free survival (PFS) was 59.2%. The 5-year overall survival (OS) was 88.7%. Surgical hospital (hazard ratio, 0.388; 95% confidence interval, 0.213-0.706; P = .002) was independently associated with PFS. Recurrence state (hazard ratio, 163.26; 95% confidence interval, 1.321-20,181.875; P = .038) was independently associated with OS. CONCLUSION Ovarian cancers in children and adolescents have features of good prognosis. Girls who received their first surgery in a tertiary hospital had better PFS. Patients who did not suffer recurrence had better OS.
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Affiliation(s)
- Peili Liang
- Gynaecology and Obstetrics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Gynaecology and Obstetrics, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xin Zhang
- Gynaecology and Obstetrics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhenfeng Zhang
- Invasive Technology Department, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Guocai Xu
- Gynaecology and Obstetrics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xingsu Yu
- Reproductive Center, Guangdong Women's Health Care Center, Guangzhou, China
| | - Sijin Li
- Gynaecology and Obstetrics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Yuanyuan Zhang
- Gynaecology and Obstetrics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lijuan Bian
- Pathology Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Bingzhong Zhang
- Gynaecology and Obstetrics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
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Kusamura S, Teixeira LC, dos Santos MA, de Angelo Andrade LA, Campos Torres JC, Sagarra A, Deraco M, Derchain SF. Ovarian Germ Cell Cancer: Clinicopathologic Analysis and Outcome of 31 Cases. TUMORI JOURNAL 2018; 86:450-4. [PMID: 11218184 DOI: 10.1177/030089160008600603] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims The aim of the study was to evaluate some clinicopathologic characteristics and the outcome of patients with ovarian germ cell cancer (OGCC) treated with cisplatin-based chemotherapy. Methods It was a clinical retrospective study. The clinical charts of 31 patients with OGCC assisted at the Department of Obstetrics and Gynecology of the State University of Campinas, Brazil, from January 1986 to June 1997 were reviewed. Results Ten patients had dysgerminoma and 21 patients nondysgerminomatous tumors. Women with dysgerminoma and nondysgerminomatous tumors did not present differences regarding surgical staging, age, ascites or residual tumor after the initial surgery. Frozen section, performed in 16 patients, showed some discrepancy with paraffin histology diagnosis in 8 patients. Platinum-based chemotherapy was used in 5/10 patients with dysgerminoma and in 17/21 patients with nondysgerminomatous tumors, with a 5-year survival of 100% for the dysgerminoma and 53% for the nondysgerminomatous group. Conclusions Women with dysgerminoma and nondysgerminomatous tumors did not present differences regarding clinicopathologic characteristics. The prognosis for patients with dysgerminoma was better than for those with nondysgerminomatous tumors. Frozen section had a high error rate in diagnosing OGCC intraoperatively.
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Affiliation(s)
- S Kusamura
- Department of Obstetrics and Gynaecology, State University of Campinas, Brazil.
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Abstract
OBJECTIVE The last large study of second primary tumors (SPTs) in women with ovarian cancer was published in 1996, prior to major changes in the differential diagnosis and treatment. The present study reports on the incidence of SPTs in a contemporary cohort of patients with a diagnosis of ovarian cancer. METHODS Ovarian cancer patients with a diagnosis of an ovarian malignancy between 1992 and 2012 were identified and characterized from 13 registries of the Surveillance, Epidemiology, and End Results database. RESULTS Of 41,073 women with a diagnosis of an ovarian malignancy between 1992 and 2012, 1831 (4.5%) developed a microscopically confirmed SPT. There was no significant difference in the risk of developing an SPT at all sites between women with an ovarian cancer and the general population. There was an elevated risk of site-specific SPTs of the small intestine, vagina, thyroid gland, and acute nonlymphocytic leukemia in ovarian cancer patients compared with the general Surveillance, Epidemiology, and End Results population. Conversely, the risk of lung and non-Hodgkin lymphoma was significantly decreased in women with ovarian cancer. An elevated risk of SPTs was observed in women with mucinous, endometrioid, and germ cell tumors. White women had an overall decreased risk of developing a second primary solid tumor, whereas American Indian and Asian/Pacific Islander women had an overall increased risk of an SPT at any site. CONCLUSIONS The incidence of SPTs in women with ovarian cancer was not significantly different as compared with the general population. However, divergent rates of SPTs in relation to histology, latency, age, and race were observed.
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11
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Iavazzo C, Vorgias G, Iavazzo PE, Gkegkes ID. Fertility sparing approach as the standard of care in young patients with immature teratomas. J Turk Ger Gynecol Assoc 2017; 18:43-47. [PMID: 28506950 PMCID: PMC5450210 DOI: 10.4274/jtgga.2016.0090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Immature teratomas are quite rare tumors arising in young women. They are usually diagnosed in early stage and grade and have a good prognosis. In these young patients, fertility-sparing management is suggested as the standard of care. Bilateral immature teratoma is a rare condition with an incidence of 10%, with a five-year survival rate of 80%. The majority of patients received fertility-sparing treatment followed by adjuvant chemotherapy in 78%. Older age, advanced stage, and high grade are negative prognostic factors. The surgery-only, watch-and-wait approach was evaluated; however, after a median follow-up time of 42 months, 50% of patients experienced recurrence, but they were successfully salvaged with chemotherapy. In a retrospective study, 12 out of 27 patients tried to conceive, resulting in 10 pregnancies (8 after chemotherapy). We present a narrative review of the current literature regarding the essential multidisciplinary approach of such patients in order to achieve the best oncologic and fertility-sparing outcome.
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Affiliation(s)
- Christos Iavazzo
- Department of Gynecological Oncology, Christie Hospital, Manchester, United Kingdom
| | - George Vorgias
- Department of Gynecological Oncology, Metaxa Cancer Hospital, Piraeus, Greece
| | | | - Ioannis D Gkegkes
- First Department of Surgery, General Hospital of Attica "KAT", Athens, Greece
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Adegoke AS, Oshodi Y, Onyekwere C, Adedayo O, Akinola O. A Successful Pregnancy Following Conservative Surgery and Chemotherapy in a Patient with Malignant Teratoma. J Gynecol Surg 2016. [DOI: 10.1089/gyn.2015.0133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Yusuf Oshodi
- Department of Obstetrics and Gynaecology Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Chioma Onyekwere
- Department of Obstetrics and Gynaecology Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Ogunyemi Adedayo
- Department of Obstetrics and Gynaecology Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Oluwarotimi Akinola
- Department of Obstetrics and Gynaecology Lagos State University Teaching Hospital, Lagos, Nigeria
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Yang QE, Nagaoka SI, Gwost I, Hunt PA, Oatley JM. Inactivation of Retinoblastoma Protein (Rb1) in the Oocyte: Evidence That Dysregulated Follicle Growth Drives Ovarian Teratoma Formation in Mice. PLoS Genet 2015; 11:e1005355. [PMID: 26176933 PMCID: PMC4503754 DOI: 10.1371/journal.pgen.1005355] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 06/12/2015] [Indexed: 02/02/2023] Open
Abstract
The origin of most ovarian tumors is undefined. Here, we report development of a novel mouse model in which conditional inactivation of the tumor suppressor gene Rb1 in oocytes leads to the formation of ovarian teratomas (OTs). While parthenogenetically activated ooctyes are a known source of OT in some mutant mouse models, enhanced parthenogenetic propensity in vitro was not observed for Rb1-deficient oocytes. Further analyses revealed that follicle recruitment and growth is disrupted in ovaries of mice with conditional inactivation of Rb1, leading to abnormal accumulation of secondary/preantral follicles. These findings underpin the concept that miscues between the germ cell and somatic compartments cause premature oocyte activation and the formation of OTs. Furthermore, these results suggest that defects in folliculogenesis and a permissive genetic background are sufficient to drive OT development, even in the absence of enhanced parthenogenetic activation. Thus, we have discovered a novel role of Rb1 in regulating the entry of primordial oocytes into the pool of growing follicles and signaling between the oocyte and granulosa cells during the protracted process of oocyte growth. Our findings, coupled with data from studies of other OT models, suggest that defects in the coordinated regulation between growth of the oocyte and somatic components in follicles are an underlying cause of OT formation.
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Affiliation(s)
- Qi-En Yang
- Center for Reproductive Biology, School of Molecular Biosciences, College of Veterinary Medicine, Washington State University, Pullman, Washington, United States of America
| | - So I. Nagaoka
- Center for Reproductive Biology, School of Molecular Biosciences, College of Veterinary Medicine, Washington State University, Pullman, Washington, United States of America
| | - Ivy Gwost
- Center for Reproductive Biology, School of Molecular Biosciences, College of Veterinary Medicine, Washington State University, Pullman, Washington, United States of America
| | - Patricia A. Hunt
- Center for Reproductive Biology, School of Molecular Biosciences, College of Veterinary Medicine, Washington State University, Pullman, Washington, United States of America
| | - Jon M. Oatley
- Center for Reproductive Biology, School of Molecular Biosciences, College of Veterinary Medicine, Washington State University, Pullman, Washington, United States of America
- * E-mail:
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Reddihalli PV, Subbian A, Umadevi K, Rathod PS, Krishnappa S, Nanaiah SP, Bafna UD. Immature teratoma of ovary--outcome following primary and secondary surgery: study of a single institution cohort. Eur J Obstet Gynecol Reprod Biol 2015; 192:17-21. [PMID: 26142911 DOI: 10.1016/j.ejogrb.2015.06.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Revised: 06/15/2015] [Accepted: 06/16/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To analyse the clinical presentation, treatment - primary and secondary debulking and outcomes with focus on recurrences in ovarian immature teratoma. STUDY DESIGN This is a single institution, retrospective analysis of 24 women who presented to a gynecologic oncology unit from 1999 to 2011 with ovarian immature teratoma. Patient's clinical presentation, operative and chemotherapy details were included in a database. Follow up details regarding recurrence and management and future outcomes were also noted. Overall survival was calculated from the date of registration to last follow up or date of death. Survival curve was constructed by Kaplan-Meier method. RESULTS Immature teratoma accounted for 11% of 218 malignant germ cell tumors. Of the 24 patients, pain was the predominant symptom and abdominal mass was the commonest clinical presentation. Sixteen out of 24 patients presented in Stage I and grade 3 tumors were found in 43% of patients. Six patients had only unilateral salpingo oophorectomy and no staging procedure. Twelve patients underwent staging, with omentectomy being the commonest procedure. All but one, had cisplatin based combination chemotherapy. Six patients underwent secondary debulking of recurrence. Most recurrences were recorded in Stage III, higher grade tumors. With secondary cytoreduction and platinum based chemotherapy, it was possible to salvage most recurrences as well. Overall survival after a mean follow-up of 39 months was 91.6%. CONCLUSION Majority of the patients did well with conservative surgery in terms of survival, menstrual and reproductive function. Platinum based chemotherapy was indicated in higher grade and higher stage tumors as recurrences commonly occurred in this subgroup of patients. Recurrences could be salvaged with selected secondary cytoreduction and platinum based chemotherapy.
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Affiliation(s)
- Pallavi V Reddihalli
- Department of Gynecologic Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - Anbukkani Subbian
- Department of Gynecologic Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India.
| | - K Umadevi
- Department of Gynecologic Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - Praveen S Rathod
- Department of Gynecologic Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - Shobha Krishnappa
- Department of Gynecologic Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - Shakuntala P Nanaiah
- Department of Gynecologic Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - Uttam D Bafna
- Department of Gynecologic Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
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Saber MM, Zeeneldin AA, El Gammal MM, Salem SE, Darweesh AD, Abdelaziz AA, Monir M. Treatment outcomes of female germ cell tumors: the Egyptian National Cancer Institute experience. J Egypt Natl Canc Inst 2014; 26:103-8. [PMID: 24841162 DOI: 10.1016/j.jnci.2014.03.001] [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: 01/16/2014] [Revised: 03/05/2014] [Accepted: 03/06/2014] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION Female germ cell tumors (GCTS) are rare tumors that carry a good prognosis. AIM To report the experience of the Egyptian National Cancer Institute (ENCI) in managing female GCTs. METHODS This retrospective study included 19 females with ovarian GCTs presenting to the ENCI between 2006 and 2010. RESULTS The median age was 23years. Ovaries were the primary site in all patients. Dysgerminoma and teratoma were the predominant pathologies followed by mixed GCT in females. Unilateral ovariectomy or ovarian tumorectomy were the classic surgical procedures with R0 resection being feasible in most cases. Surveillance was adopted in six patients with stage I disease. Chemotherapy was administered in 63% of ovarian GCTs with BEP being the commonest regimen with reasonable tolerability and good response rates. The median OS and EFS were not reached. The projected 5-year OS rate was 93.8%. Both OS and EFS were better in patients responding to chemotherapy than non-responders (p<0.002). Stage of disease did not significantly affect OS or EFS. CONCLUSIONS Female GCTs rarely affect Egyptian females. They have good prognosis.
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Affiliation(s)
- Magdy M Saber
- Medical Oncology Department, NCI, Cairo University, Egypt
| | | | | | - Salem E Salem
- Medical Oncology Department, NCI, Cairo University, Egypt
| | | | | | - Manar Monir
- Department of Medical Statics, NCI, Cairo University, Egypt
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Abu-Zaid A, Nazer A, Alomar O, Azzam A, Al-Eid HS, Elhassan TA, Al-Badawi IA. Incidence of malignant ovarian germ cell tumors (MOGCTs) in Saudi Arabia. Hematol Oncol Stem Cell Ther 2014; 7:41-3. [PMID: 24412326 DOI: 10.1016/j.hemonc.2013.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 12/24/2013] [Accepted: 12/26/2013] [Indexed: 02/05/2023] Open
Abstract
Incidence of malignant ovarian germ cell tumors (MOGCTs) in the Saudi Arabian population has not been studied before. Therefore, the primary objective of this study was to define the population-based incidence rates and histopathological types of MOGCTs in the Saudi Arabian population from 1999 to 2008. Our study showed that MOGCTs are a common type of ovarian tumors in the Saudi Arabian population, and the incidence rates and histopathological types are relatively comparable to the international populations with few differences.
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Affiliation(s)
- Ahmed Abu-Zaid
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia; Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
| | - Ahmed Nazer
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
| | - Osama Alomar
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
| | - Ayman Azzam
- Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia; Faculty of Medicine, Alexandria University, Alexandria, Egypt.
| | - Haya S Al-Eid
- Saudi Cancer Registry, Ministry of Health, Riyadh, Saudi Arabia.
| | - Tusneem Ahmed Elhassan
- Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
| | - Ismail A Al-Badawi
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia; Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
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Malignant ovarian germ cell tumors: presentation, survival and second cancer in a population based Norwegian cohort (1953-2009). Gynecol Oncol 2013; 131:330-5. [PMID: 24001518 DOI: 10.1016/j.ygyno.2013.08.028] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 08/23/2013] [Accepted: 08/25/2013] [Indexed: 11/20/2022]
Abstract
PURPOSE To quantify and compare survival in women with malignant ovarian germ cell tumors (MOGCTs) in Norway before and after the introduction of cisplatin-based chemotherapy (around 1980), and to explore the association between different types of treatment and the development of a second cancer. PATIENTS AND METHODS We identified 351 patients diagnosed with MOGCTs from 1953 to 2009 in the Cancer Registry of Norway. Ovarian cancer-specific survival was calculated separately for patients diagnosed before and after 1980. Patients were divided into subgroups by histological subtype (pure dysgerminoma, malignant teratoma, other MOGCTs) and extent of disease (localized and metastatic). We estimated the cumulative incidence of a second cancer in 10-year MOGCT survivors. Kaplan-Meier estimates were used, and p<0.05 was considered significant. RESULTS 20-Year ovarian cancer-specific survival increased from 59% (95% CI 51% to 66%) before 1980 to 88% (95% CI 83%-93%) thereafter. Significant improvement was observed in all subgroups. No second cancer was diagnosed in any of 31 10-year MOGCT survivors treated with surgery only; second cancer was diagnosed in 23 of 139 patients who underwent cytotoxic treatment (98 radiotherapy ± chemotherapy, 41 chemotherapy only; p=0.08). Patients aged >50 years had a significantly poorer ovarian cancer-specific survival than younger patients (HR=5.98, 95% CI 3.39-10.57) after adjustment for histological subtype and stage at presentation. Our results favor the treatment of patients with metastatic MOGCTs at large cancer centers. CONCLUSION Today women with MOGCTs have an excellent prognosis if treated according to modern therapeutic principles.
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He L, Ding H, Wang JH, Zhou Y, Li L, Yu YH, Huang L, Jia WH, Zeng M, Yun JP, Luo RZ, Zheng M. Overexpression of karyopherin 2 in human ovarian malignant germ cell tumor correlates with poor prognosis. PLoS One 2012; 7:e42992. [PMID: 22962582 PMCID: PMC3433466 DOI: 10.1371/journal.pone.0042992] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Accepted: 07/16/2012] [Indexed: 01/02/2023] Open
Abstract
Background The aim of this study was to identify a biomarker useful in the diagnosis and therapy of ovarian malignant germ cell tumor (OMGCT). Methods The karyopherin 2 (KPNA2) expression in OMGCT and normal ovarian tissue was determined by standard gene microarray assays, and further validated by a quantitative RT-PCR and immunohistochemistry. The correlation between KPNA2 expression in OMGCT and certain clinicopathological features were analyzed. Expression of SALL4, a stem cell marker, was also examined in comparison with KPNA2. Results KPNA2 was found to be over-expressed by approximately eight-fold in yolk sac tumors and immature teratomas compared to normal ovarian tissue by microarray assays. Overexpression was detected in yolk sac tumors, immature teratomas, dysgerminomas, embryonal carcinomas, mature teratomas with malignant transformation and mixed ovarian germ cell tumors at both the transcription and translation levels. A positive correlation between KPNA2 and SALL4 expression at both the transcription level (R = 0.5120, P = 0.0125), and the translation level (R = 0.6636, P<0.0001), was presented. Extensive expression of KPNA2 was positively associated with pathologic type, recurrence and uncontrolled, ascitic fluid presence, suboptimal cytoreductive surgery necessity, resistance/refraction to initial chemotherapy, HCG level and SALL4 level in OMGCT patients. KPNA2 was found to be an independent factor for 5-year disease-free survival (DFS) of OMGCT (P = 0.02). The 5-year overall survival (OS) and DFS rate for KPNA2-low expression patients (88% and 79%, n = 48) were significantly higher than the OS and DFS rate for KPNA2-high expression patients (69% and 57.1%, n = 42)(P = 0.0151, P = 0.0109, respectively). The 5-year OS and DFS rate for SALL4-low expression patients (84% and 74%, n = 62) was marginally significantly higher than the high expression patients (78.6% and 71.4%, n = 28)(P = 0.0519, P = 0.0647, respectively). Conclusions KPNA2 is a potential candidate molecular marker and important prognostic marker in OMGCT patients.
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Affiliation(s)
- Li He
- State Key Laboratory of Oncology in Southern China, Cancer Center, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
- Department of Gynecology, Cancer Center, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Hui Ding
- State Key Laboratory of Oncology in Southern China, Cancer Center, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
- Department of Gynecology, Cancer Center, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Jian-Hua Wang
- Department of Chest, Second People's Hospital of Guangdong Province, Guangzhou, Guangdong, People's Republic of China
| | - Yun Zhou
- State Key Laboratory of Oncology in Southern China, Cancer Center, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
- Department of Gynecology, Cancer Center, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Li Li
- Department of Gynecology, Huang-pu District Hospital, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Yan-Hong Yu
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Long Huang
- State Key Laboratory of Oncology in Southern China, Cancer Center, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
- Department of Gynecology, Cancer Center, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Wei-Hua Jia
- State Key Laboratory of Oncology in Southern China, Cancer Center, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Musheng Zeng
- State Key Laboratory of Oncology in Southern China, Cancer Center, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Jing-Ping Yun
- Department of Pathology, Cancer Center, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Rong-Zhen Luo
- Department of Pathology, Cancer Center, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Min Zheng
- State Key Laboratory of Oncology in Southern China, Cancer Center, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
- Department of Gynecology, Cancer Center, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
- * E-mail:
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Low JJ, Ilancheran A, Ng JS. Malignant ovarian germ-cell tumours. Best Pract Res Clin Obstet Gynaecol 2012; 26:347-55. [DOI: 10.1016/j.bpobgyn.2012.01.002] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Accepted: 01/10/2012] [Indexed: 11/26/2022]
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Outcome and risk factors for recurrence in malignant ovarian germ cell tumors: a MITO-9 retrospective study. Int J Gynecol Cancer 2012; 21:1414-21. [PMID: 21795985 DOI: 10.1097/igc.0b013e3182236582] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
AIMS This study aimed to investigate the outcome of patients with malignant ovarian germ cell tumors (MOGCTs) and to define the risk factors for recurrence. METHODS A total of 123 patients with MOGCTs were retrospectively reviewed among MITO centers. Eighty-one patients had primary treatment in a MITO center, whereas the other 42 were referred for adjuvant chemotherapy or recurrence. The clinicopathologic characteristics were evaluated for association with relapse or death. RESULTS Median age was 24 years (range, 11-76 years). Forty-nine (39.8%) had dysgerminomas, 35 (28.5%) had immature teratomas, 12 (9.8%) had mixed germ cell tumors, 26 (21.1%) had yolk sac tumors, and 1 (0.8%) had embryonal carcinoma. International Federation of Gynecology and Obstetrics stage distribution was as follows: stage I, 87 (70.7%); stage II, 3 (2.4%); stage III, 29 (23.6%); and stage IV, 4 (3.3%). Fertility-sparing surgery was performed in 92 patients, whereas the remaining 31 received radical surgery; 65.8% of patients received adjuvant chemotherapy. Recurrence rate was 17.8% and the median time to recurrence was 9 months. Univariate and multivariate analyses showed that patient age (>45 years) and treatment outside a referral (MITO) center were the most important predictors of recurrence. The 5-year overall survival rate was 88.8%, with a median follow-up of 61 months. Univariate and multivariate analyses demonstrated that stage greater than I and yolk sac tumors were independent poor prognostic indicators. CONCLUSIONS This study confirms that MOGCTs have excellent prognosis, with 5-year overall survival rates of 95.6% and 73.2% in stage I and advanced stages, respectively. Age older than 45 years and treatment not in a referral center are independent risk factors for recurrence, whereas stage greater than I and yolk sac histology are independent poor prognostic indicators.
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Akhtar K, Ahmad SS, Kumar A, Afshan N. Dysgerminoma with pregnancy and viable baby: a case report. Oman Med J 2011; 26:198-200. [PMID: 22043416 DOI: 10.5001/omj.2011.48] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2011] [Accepted: 03/11/2011] [Indexed: 11/03/2022] Open
Abstract
Dysgerminomas are the most common of primitive germ cell tumors of the ovary, accounting for 1-5% of all ovarian malignancies. The reproductive age group females are most commonly affected, thereby causing problems in conception and if pregnancy occurs, it leads to feto-maternal compromise. It is extremely rare to have a successful natural pregnancy, with viable child birth with a coexisting dysgerminoma, without any assisted reproductive interventions. We hereby report a case of successful spontaneous natural pregnancy in a primi gravida, associated with dysgerminoma, with no feto-maternal compromise.
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Lee CW, Song MJ, Park ST, Ki EY, Lee SJ, Lee KH, Ryu KS, Park JS, Hur SY. Residual tumor after the salvage surgery is the major risk factors for primary treatment failure in malignant ovarian germ cell tumors: a retrospective study of single institution. World J Surg Oncol 2011; 9:123. [PMID: 21988930 PMCID: PMC3214187 DOI: 10.1186/1477-7819-9-123] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 10/11/2011] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Malignant ovarian germ cell tumors are rare, and knowledge of their prognostic factors is limited, with little available randomized data. This study was conducted to evaluate the clinicopathologic characteristics of malignant ovarian germ cell tumors and to determine the association of their prognostic factors to primary treatment failure. METHODS The medical records of 57 patients with stages I to IV malignant ovarian germ cell tumor were retrospectively reviewed, and their clinicopathologic and treatment-related data were collected and analyzed. RESULTS The median age at the diagnosis was 23.3 years (range: 8-65 years), and the median follow-up period was 108 months (range: 48-205 months). The histological types of the tumors were immature teratoma (n = 24), dysgerminoma (n = 20), endodermal sinus tumor (n = 8), mixed germ cell tumor (n = 4), and choriocarcinoma (n = 1). 66.7% of the patients had stage I disease; 5.2%, stage II; 26.3%, stage III; and 1.8%, stage IV. After the initial surgery, 49 patients (86%) received cisplatin-based chemotherapy. The five-year survival rate was 96.5%. There were six primary treatment failures, with two of the patients dying of the disease, and the median time to the recurrence was 8 months. The histological diagnosis (P < 0.0001), tumor stage (P = 0.0052), elevation of beta-hCG (P = 0.0134), operation methods (P = 0.0006), and residual tumor after the salvage surgery (P < 0.0001) were significantly associated with the risk of primary treatment failure in the univariate analysis. In the multivariate analysis, the residual tumor after the salvage surgery was the only significant variable associated with primary treatment failure (P = 0.0011, Hazard ratio = 29.046, 95% Confidence interval 3.832-220.181). CONCLUSION Most malignant ovarian germ cell tumors have excellent prognoses with primary treatment, and good reproductive outcomes can be expected. Because primary treatment failure is associated with the residual disease after the salvage surgery, knowledge of the presence or absence of this risk factor may be helpful in risk stratification and individualization of adjuvant therapy in malignant ovarian germ cell tumors. Further large-scale prospective studies to confirm these results should be performed.
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Affiliation(s)
- Chung Won Lee
- Department of Obstetrics and Gynecology, the Catholic University, Seoul, Korea
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Yeap ST, Hsiao CC, Hsieh CS, Yu HR, Chen YC, Chuang JH, Sheen JM. Pediatric malignant ovarian tumors: 15 years of experience at a single institution. Pediatr Neonatol 2011; 52:140-4. [PMID: 21703555 DOI: 10.1016/j.pedneo.2011.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2010] [Revised: 06/11/2010] [Accepted: 07/13/2010] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Malignant ovarian tumors in children are relatively rare. We reviewed our 15-year experience to understand their clinical presentations, managements, and prognoses. METHODS There were 15 children who were diagnosed to have malignant ovarian tumors from January 1994 to June 2009 in our hospital. The presenting symptoms, treatments, and outcomes were obtained retrospectively from the medical records. RESULTS The median age at presentation was 13 years. The most common presenting symptom was abdominal pain, occurring in 10 patients (66.7%). The tumors were in the left side in 10 patients (66.7%). The pathologic diagnoses were yolk sac tumors in four patients, immature teratomas in four, dysgerminomas in three, malignant mixed germ cell tumors in three, and carcinosarcoma in one patient. According to the Federation Internationale de Gynecologie Oncologique classification, seven girls had Stage I, one had Stage II, and seven had Stage III disease. Thirteen patients received chemotherapy with platinum-based regimens. Three patients died of their disease: one of yolk sac tumor, one of malignant mixed germ cell tumor, and one of carcinosarcoma. They all had Stage III disease at diagnosis. The 10-year overall survival and disease-free survival rates were 77% and 69%, respectively. CONCLUSIONS Pediatric malignant ovarian tumors were highly curable disease if they were not in the advanced stage at presentation. Earlier consideration of malignant ovarian tumor in the differential diagnosis of young girls with abdominal pain is important.
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Affiliation(s)
- Say-Tin Yeap
- Department of Pediatrics, Chang Gung Memorial Hospital - Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Parkinson CA, Hatcher HM, Earl HM, Ajithkumar TV. Multidisciplinary management of malignant ovarian germ cell tumours. Gynecol Oncol 2011; 121:625-36. [PMID: 21353692 DOI: 10.1016/j.ygyno.2010.12.351] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Revised: 12/17/2010] [Accepted: 12/19/2010] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Malignant ovarian germ cell tumours (MOGCT) are rare cancers of young women. Limited prospective trials exist from which evidence-based management can be developed. This review summarizes the available literature concerning MOGT in order to provide the clinician with information relevant to their multidisciplinary management. METHODS MEDLINE was searched between 1966 and 2010 for all publications in English where the studied population included women diagnosed with malignant ovarian germ cell tumours. RESULTS The majority of patients can be cured with fertility-preserving surgery with or without combination chemotherapy. Long term survival approaches 100% in early stage disease and is approximately 75% in advanced stage disease. Most studies suggest that the treatment has little, if any, effect on future fertility and limited data suggest that there is no adverse effect on the future quality of life. CONCLUSION MOGCTs are rare tumours of young women the majority of which can be successfully treated with fertility-preserving surgery with or without chemotherapy with preservation of reproductive function. Minimisation of chemotherapy in good prognostic groups and improved treatment in resistant and relapsed MOGCT are important goals for the future. Further studies are needed to quantify the late adverse effects of treatment in long term survivors.
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Affiliation(s)
- C A Parkinson
- Medical Oncology, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, UK.
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Benjapibal M, Chaopotong P, Leelaphatanadit C, Jaishuen A. Ruptured ovarian endodermal sinus tumor diagnosed during pregnancy: Case report and review of the literature. J Obstet Gynaecol Res 2010; 36:1137-41. [DOI: 10.1111/j.1447-0756.2010.01254.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Colombo N, Peiretti M, Castiglione M. Non-epithelial ovarian cancer: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol 2010; 20 Suppl 4:24-6. [PMID: 19454453 DOI: 10.1093/annonc/mdp118] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- N Colombo
- Department of Gynecologic Oncology, European Institute of Oncology, Milan, Italy
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Les tumeurs rares de l’ovaire : stratégies thérapeutiques en 2010, Observatoire francophone des tumeurs rares de l’ovaire et émergence des centres de références. Bull Cancer 2010; 97:123-35. [DOI: 10.1684/bdc.2010.1017] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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30
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Sivanesaratnam V. Third S. S. Ratnam Memorial Lecture 2007. Ovarian cancer: Is there hope for women? J Obstet Gynaecol Res 2009; 35:393-404. [DOI: 10.1111/j.1447-0756.2009.01049.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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31
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Lee KH, Lee IH, Kim BG, Nam JH, Kim WK, Kang SB, Ryu SY, Cho CH, Choi HS, Kim KT. Clinicopathologic characteristics of malignant germ cell tumors in the ovaries of Korean women: a Korean Gynecologic Oncology Group Study. Int J Gynecol Cancer 2009; 19:84-7. [PMID: 19258947 DOI: 10.1111/igc.0b013e31819914c5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
From January 1995 to December 2000, medical records of 196 patients were collected from 14 hospitals nationwide and were reviewed retrospectively. We evaluated the clinicopathologic characteristics of malignant germ cell tumors in the ovaries of South Korean women and determined the prognostic factors affecting recurrence. The mean patient age was 23.8 years (range, 4-63 years), and the median follow-up period was 67 months (range, 1-128 months). The distribution of the International Federation of Gynecology and Obstetrics stage was as follows: 128 cases (65.3%) in stage I, 27 cases (13.8%) in stage II, 39 cases (19.9%) in stage III, and 2 cases (1.0%) in stage IV. Histologically, immature teratoma was the most common tumor type (n = 68), followed by dysgerminoma (n = 54), endodermal sinus tumor (n = 38), mixed form (n = 24), and choriocarcinoma (n = 12). A fertility-sparing operation was performed in 134 patients, staging operation in 43 patients, and hysterectomy and bilateral salpingo-oophorectomy in 19 patients. Postoperative chemotherapy was administered in 166 patients, and the most common regimen was bleomycin, etoposide, and cisplatin (n = 120). Recurrence was observed in 13 patients (6.8%) and was influenced by the stage of the tumor and patient age (>40 years). The 5-year survival rate was 96.7%. During the follow-up period, 20 patients had 22 pregnancies that resulted in 17 normal deliveries at term and 5 abortions. The results of this study demonstrate that most malignant germ cell tumors of the ovary in Korean women are detected in the early stage and have excellent survival outcomes with conservative operation and platinum-based chemotherapy.
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Affiliation(s)
- Ki Heon Lee
- Department of Obstetrics and Gynecology, Kwandong University, Cheil General Hospital and Women's Healthcare Center, Seoul, Korea.
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Shah JP, Kumar S, Bryant CS, Ali-Fehmi R, Malone JM, Deppe G, Morris RT. A population-based analysis of 788 cases of yolk sac tumors: A comparison of males and females. Int J Cancer 2008; 123:2671-5. [PMID: 18767035 DOI: 10.1002/ijc.23792] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Yolk sac tumors (YST) are a rare and aggressive germ cell tumor. The objective of this study is to compare the patient characteristics and survival of YST in males and females. Demographic and clinicopathologic information were obtained from the Surveillance, Epidemiology, and End Results Program from 1973 to 2003. Statistical analysis was performed using Independent-sample t-test, chi(2) test, Kaplan-Meier methods and Cox proportional hazards regression. Seven hundred eighty-eight patients were identified, 451 (57%) were males and 337 (43%) were females. The mean age at diagnosis was similar in males and females. The age at diagnosis showed a bimodal distribution with an increased incidence in the first 4 years of life and during the 2nd to 4th decade of life. The most common site of the primary tumor was gonadal, namely testis 336 (42.6%) and ovary 257 (32.6%). Among the extragonadal sites, tumor site of origin differed in males and females. The 5-year survival of extragonadal YST (66%) was worse than gonadal YST (86%) (p < 0.05). The overall median survival for the cohort was 87 months. This was similar in males (81 months) and females (91 months) (p > 0.05). As the year of diagnosis progressed from 1973 to 2003, survival of both males and females with YST consistently improved. The bimodal age distribution of YST generates the hypothesis that sex steroids may play a role in selected YST. Although the overall survival in all YST patients has improved over the past few decades, the primary sites of origin differ in males and females and impact prognosis.
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Affiliation(s)
- Jay P Shah
- Division of Gynecology Oncology, Wayne State University and Karmanos Cancer Center, Detroit, MI, USA.
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33
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Alexandre J, Ray I, Pautier P, Bohu A, Pujade-Lauraine E. Les tumeurs malignes gynécologiques rares. ONCOLOGIE 2008. [DOI: 10.1007/s10269-008-0907-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
In a young woman with gynecologic cancer, preservation of fertility is possible. Fertility-sparing surgery may be safe in early ovarian cancer of certain histological subtypes such as ovarian tumors of low malignant potential, malignant ovarian germ cell tumors, and ovarian sex cord stromal tumors. For women with invasive epithelial ovarian cancer who have early-stage disease, fertility-sparing surgery may be an option. In some cases, fertility-sparing surgery may be followed by postoperative chemotherapy. The concept of fertility-preserving surgery in early cervical cancer has been adopted by several leading centers worldwide as an option for stage Ia and small Ib disease without the presence of lymphovascular involvement. Nonsurgical options such as hormonal therapy may be considered for women with early-stage, low-grade endometrial cancer. Improvements in cancer cure rates and the development of conservative treatments mean that many young women with early gynecologic cancer can hope to start a new pregnancy after the treatment. Patients are generally advised to wait 2 years after treatment for any malignancy before attempting pregnancy, but the optimal interval between cure and conception must be carefully determined by a multidisciplinary team including oncologist and obstetrician. Gynecologic surgery and hemotherapy can have an impact not only on fertility, but also on the course of a next pregnancy (increased risk of miscarriage and premature delivery, etc.) These risks must be taken into account by the obstetrician. Management of young women diagnosed with gynecologic cancer should be individualized, with the risk of conservative therapy balanced against the disadvantages of more radical treatment. The patient and the family should be extensively counseled. The alternatives to the traditional and standard radical procedures should be discussed, and the limitation of data regarding many conservative treatment options should be explained. The patients should be aware that by accepting fertility-sparing treatment they are assuming a small but undefined risk for recurrence of the disease. They need to know that these conservative therapeutic approaches are yet not considered "standard." Furthermore, patients need to be assessed for the realistic probabilities of achieving conception on the basis on their age, history, and infertility evaluation. Some of them will require assisted reproduction technology (ARTS) to help achieve a pregnancy, especially in vitro fertilization (IVF). They may also consider ovarian tissue, oocyte, or embryo cryopreservation before definitive cancer therapies. And, finally, patients also need to understand the risk of premature delivery and the consequences of prematurity. The care of the young patient with gynecologic malignancy is extremely complex and challenging. It necessarily requires a multidisciplinary approach with the close collaboration of gynecologist-oncologist, reproductive endocrinologist, and perinatologist.
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Affiliation(s)
- V Kesic
- Institute of Obstetrics and Gynecology, Clinical Center of Serbia, Belgrade
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35
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Chen CH, Yang MJ, Cheng MH, Yen MS, Lai CR, Wang PH. Fertility preservation with treatment of immature teratoma of the ovary. J Chin Med Assoc 2007; 70:218-21. [PMID: 17525001 DOI: 10.1016/s1726-4901(09)70362-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Fertility preservation for a patient with advanced immature teratoma of the ovary is reported. The patient, a 29-year-old woman, delivered a healthy baby after having had ovarian immature teratoma, grade 3, uncertain stage, at 13 years of age. She was initially treated with unilateral salpingo-oophorectomy and a contralateral wedge resection for tumor invasion, followed by a 6-course cisplatin+vinblastine+bleomycin regimen, a second operation, and an additional 6-course etoposide and cisplatin regimen with complete remission. The patient delivered a healthy baby 16 years after the initial treatment. Based on this successful case, intensive fertility-preserving surgery followed by chemotherapy, even in advanced-stage immature teratomas of the ovary, may be effective in preserving the reproductive function of women with malignant immature teratomas of the ovary.
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Affiliation(s)
- Chia-Hui Chen
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, and National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
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Gueye A, Narducci F, Baranzelli MC, Collinet P, Farine O, Fournier C, Vinatier D, Leblanc E. [Malignant ovarian germ cell tumours: a trial of 36 cases]. ACTA ACUST UNITED AC 2007; 35:406-19. [PMID: 17350873 DOI: 10.1016/j.gyobfe.2007.01.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2006] [Accepted: 01/03/2007] [Indexed: 11/20/2022]
Abstract
OBJECTIVE With personal results and a review of the literature, we report the eventual interest of surgical staging in malignant ovarian germ cell tumours. PATIENTS AND METHODS This was a retrospective study of 36 patients (21.5-[8-61]) with malignant ovarian germ cell tumours between January 1984 and December 2004. There were 4 groups: no 1--dysgerminoma only, no 2--immature teratoma, no 3--malignant ovarian germ cell tumours with secretion. All the patients had a minimal follow up of 18 months after treatment. We reported conservative or non-conservative surgery, if surgical staging was made and description of eventual neoadjuvant or adjuvant chemotherapies and finally the recurrences and deaths. RESULTS Stages of FIGO were: group 1--IA n=2, IC n=2, IIB n=1, IIIA n=2, IIIC n=3; group 2--IA n=3 (G1, G2, G2), IC n=1 (G3); group 3--IA n=8, IC n=4, IIA n=1, IIIA n=1, IIIB n=3, IIIC n=5. Three patients had neoadjuvant chemotherapy. All the patients had cytoreductive surgery (conservative surgery n=31) with staging in 15 cases. Twenty-six patients had adjuvant chemotherapy. Five years global survival was 92%. DISCUSSION AND CONCLUSION Surgery in a young patient with malignant ovarian germ cells tumours must be conservative (adnexectomy) (preserving fertility and because of good prognostic). In case of stage IA with part of dysgerminoma and/or immature teratoma and/or embryonal carcinoma certified by surgical staging, strict follow up could be organized (clinic, radiology, AFP, HCG). In case of more than stage IA, chemotherapy is indicated after conservative surgery and surgical staging.
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Affiliation(s)
- A Gueye
- Clinique de gynécologie, Hôpital Jeanne-de-Flandre, CHRU de Lille, Lille cedex, France
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Kitajima Y, Endo T, Hayashi T, Ishioka S, Baba T, Honnma H, Saito T. A successful IVF-pregnancy in a patient who underwent conservative surgery followed by a regimen of cisplatin, vinblastine and peplomycin to treat an advanced ovarian mixed germ cell tumour: a case report. Hum Reprod 2006; 22:850-2. [PMID: 17067995 DOI: 10.1093/humrep/del413] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Mixed germ cell tumours of the ovary, one type of malignant ovarian germ cell tumours (MOGCTs), are rare gynaecologic cancers usually affecting young women. We report the case of a patient with an advanced ovarian mixed germ cell tumour who underwent fertility-saving surgery followed by a chemotherapy regimen of cisplatin, vinblastine and peplomycin. The patient was disease-free 8 years after initial presentation. She conceived and gestated dichorionic twins after IVF-embryo transfer. To the best of our knowledge, the patient is the first to be treated successfully with the combination chemotherapy regimen and then conceive safely using assisted reproductive technology (ART).
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Affiliation(s)
- Y Kitajima
- Department of Obstetrics and Gynecology, Sapporo Medical University, School of Medicine, Sapporo, Japan
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38
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Nishio S, Ushijima K, Fukui A, Fujiyoshi N, Kawano K, Komai K, Ota S, Fujiyoshi K, Kamura T. Fertility-preserving treatment for patients with malignant germ cell tumors of the ovary. J Obstet Gynaecol Res 2006; 32:416-21. [PMID: 16882268 DOI: 10.1111/j.1447-0756.2006.00417.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM The aim of this study was to investigate whether fertility preservation influences the clinical outcome in patients with malignant germ cell tumors of the ovary (MGCTO). METHODS A case study analysis was performed on patients with MGCTO treated at Kurume University Hospital between 1986 and 2004. Thirty-five patients were included in the study, 14 with immature teratoma, 11 with dysgerminoma, eight with endodermal sinus tumor, and two with mixed germ cell tumor. Twenty-three patients had International Federation of Gynecology and Obstetrics stage I (Ia, 11; Ib, 2; Ic, 10), one had stage II, seven had stage III, and four had stage IV disease. RESULTS Five patients with stage III or IV disease received radical surgery. Thirty patients underwent conservative surgery. As the adjuvant treatment, 30 patients received chemotherapy, while five patients did not receive any chemotherapy. The overall survival rate was 97.1%. One patient died of the disease. She was 13 years old with a stage IV endodermal sinus tumor. Twelve have attempted conception, and eight have achieved at least one pregnancy (66.7%). CONCLUSIONS Irrespective of the stage of the disease, conservative surgery and adjuvant chemotherapy for MGCTO can achieve a favorable outcome in terms of survival and fertility.
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Affiliation(s)
- Shin Nishio
- Department of Obstetrics and Gynecology, Kurume University School of Medicine, Kurume, Japan.
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Zanagnolo V, Sartori E, Trussardi E, Pasinetti B, Maggino T. Preservation of ovarian function, reproductive ability and emotional attitudes in patients with malignant ovarian tumors. Eur J Obstet Gynecol Reprod Biol 2006; 123:235-43. [PMID: 15921842 DOI: 10.1016/j.ejogrb.2005.04.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2004] [Revised: 03/11/2005] [Accepted: 04/26/2005] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Although cancer is predominantly a disease of aging, an increasing number of women survive malignancies before or during their reproductive years, which may interfere with their fertility potential. Although a variety of studies have tried to document the impact of conservative treatment aimed at preserving ovarian function and reproductive ability, little information has been available regarding survivors' attitudes, emotions, and choices to have children. The aim of this study is to evaluate the reproductive history, experiences, attitudes, and emotions with regard to having children in conservatively treated patients with Stage I epithelial ovarian cancer, any stage LMP tumors, malignant ovarian germ cell tumors (MOGCTs) and Stage I sex cord-stromal tumors (SCSTs). STUDY DESIGN Between 1986 and 2000, a total of 75 patients with primary malignant ovarian tumors underwent conservative treatment. Out of 75 patients in the study, 14 women (19%) presented Stage I epithelial ovarian cancer, 23 (31%) LMP tumors, 33 (43%) MOGCTs, and five (7%) SCSTs. Information was obtained from medical records and from a questionnaire mailed to all patients who were at least 15 years old at the time of the diagnosis (68 subjects). Median time of follow-up was 102 months (35-192 months). There were four (5.2%) clinical recurrences within 35 months. Only 20 patients (49%) had tried to conceive after the completion of their treatment; of these, 15 women (75%) succeeded and delivered 19 healthy children. Seventy percent (32/41) of the respondents claimed that their disease did not have any impact on their desire to have children. Whereas 51% (21/41) fear that their ovarian disease could have damaged their reproductive potential, 76% (31/41) are not concerned about the effects of the treatment they received on offspring. The impact of the disease on the patients' attitudes toward life was reported as positive. CONCLUSION The results from our study, in agreement with the data from the literature, confirm that management of Stage I (grade 1, grade 2) epithelial ovarian cancer, any stage LMP tumors, MOGCTs and Stage I SCSTs with fertility-sparing surgery is a safe, practicable treatment option. Though preliminary, this survey provides insight into the attitudes and experiences of young women ovarian cancer survivors regarding fertility.
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Affiliation(s)
- Vanna Zanagnolo
- Institute of Obstetrics and Gynecology, University of Brescia, Italy
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40
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Gatta G, Ciccolallo L, Kunkler I, Capocaccia R, Berrino F, Coleman MP, De Angelis R, Faivre J, Lutz JM, Martinez C, Möller T, Sankila R. Survival from rare cancer in adults: a population-based study. Lancet Oncol 2006; 7:132-40. [PMID: 16455477 DOI: 10.1016/s1470-2045(05)70471-x] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Rare cancers are a challenge to clinical practice, and treatment experience, even in major cancer centres to which rare cancers are usually referred, is often limited. We aimed to study the epidemiology of rare cancers in a large population of several countries. METHODS We analysed survival by age, sex, subsite, and morphology in 57,144 adults with 14 selected rare cancers diagnosed 1983-94. Variations in survival over time and between European regions were also assessed for variations in quality of care. We also estimated the adjusted relative excess risk of death for every rare cancer. FINDINGS Overall 5-year relative survival was good (ie, >65%) for placental choriocarcinoma (85.4% [95% CI 81.4-89.5]), thyroid medullary carcinoma (72.4% [69.2-75.5]), ovarian germ-cell cancer (73.0% [70.0-76.0]), lung carcinoid (70.1% [67.3-72.9]), and cervical adenocarcinoma (65.5% [64.3-66.6]); intermediate (ie, 35-65%) for testicular cancer at age 65 years or older (64.0% [59.3-68.7]), sarcoma of extremities (60.0% [58.9-61.2]), digestive-system endocrine cancers (55.6% [54.9-56.3]), anal squamous-cell carcinoma (53.1% [51.5-54.8]), and uterine sarcoma (43.5% [42.0-44.9]); low for carcinoma of adrenal-gland cortex (32.7% [28.3-37.2]) and bladder squamous-cell carcinoma (20.4% [18.8-22.0]); and poor for angiosarcoma of liver (6.4% [1.8-11.0]) and mesothelioma (4.7% [4.3-5.2]). Survival was usually better for women than men and poor in those aged 75 years or older. Survival significantly improved over time for ovarian germ-cell cancer, sarcomas of extremities, digestive-system endocrine tumours, anal squamous-cell carcinoma, and angiosarcoma of liver. Survival in northern Europe was higher than in the other geographic groupings for most cancers. INTERPRETATION Because effective treatments are available for several of the rare cancers we assessed, further research is needed to ascertain why survival is lower in some European countries than in others, particularly in older patients. Audit of best practice for rare cancers with treatment protocols would be useful.
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Affiliation(s)
- Gemma Gatta
- Epidemiology Unit, National Cancer Institute, Milan, Italy.
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Liou WS, Yap OWS, Chan JK, Westphal LM. Innovations in fertility preservation for patients with gynecologic cancers. Fertil Steril 2005; 84:1561-73. [PMID: 16359944 DOI: 10.1016/j.fertnstert.2005.03.087] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2005] [Revised: 02/09/2005] [Accepted: 04/07/2005] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To review options for fertility preservation in women with gynecologic cancers. DESIGN Literature review. RESULT(S) We discuss the data regarding cancer treatment and fertility outcomes and current controversies for women with gynecologic cancers. CONCLUSION(S) Gynecologic cancers represent 12%-15% of cancers affecting women, and 21% of these are diagnosed in women of reproductive age. Current advances in our understanding of these diseases, along with improved multimodality treatment, allow for consideration of fertility options. For some women with gynecologic cancers, fertility-sparing treatment might be appropriate.
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Affiliation(s)
- Wen-Shiung Liou
- Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Stanford University School of Medicine, Palo Alto, California, USA
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Rossbach HC. The rule of four: a systematic approach to diagnosis of common pediatric hematologic and oncologic disorders. Fetal Pediatr Pathol 2005; 24:277-96. [PMID: 16761559 DOI: 10.1080/15227950500503652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The "Rule of Four" facilitates a rapid and focused approach to the diagnosis of the common hematologic and oncologic disorders encountered in general pediatric practice. This system relies on four recurrent but different clinical entities or laboratory tests relevant to the diagnosis of children with anemia, excessive bleeding or clotting, and common malignancies. For each disorder, there is a discussion of a variety of four lab tests or factors pertinent to a differential diagnosis.
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Affiliation(s)
- Hans-Christoph Rossbach
- Department of Pediatric Hematology/Oncology, St. Joseph Children's Hospital, 3001 W. M. L. King Jr. Blvd, Tampa, FL 33607, USA.
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Malignant ovarian mixed germ cell tumour: a rare combination. Biomed Imaging Interv J 2005; 1:e10. [PMID: 21625278 PMCID: PMC3097598 DOI: 10.2349/biij.1.2.e10] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2005] [Revised: 08/17/2005] [Accepted: 08/19/2005] [Indexed: 11/17/2022] Open
Abstract
Ovarian germ cell tumours are very rare and affect mainly young girls and women. Due to this, the conservation of reproductive potential is of great concern. One of the most remarkable advances in oncology is in the treatment of malignant ovarian germ cell tumours. Two histological groups are distinguished: dygerminomas, equivalent to testicular seminomas, and non-dysgerminomatous tumours. We report a case of a 30-year-old nulliparous woman who presented with persistent per vaginal bleeding and was found to have a malignant mixed germ cell tumour comprising of both embryonal carcinoma and choriocarcinoma.
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Rezk Y, Sheinfeld J, Chi DS. Prolonged survival following salvage surgery for chemorefractory ovarian immature teratoma: a case report and review of the literature. Gynecol Oncol 2005; 96:883-7. [PMID: 15721445 DOI: 10.1016/j.ygyno.2004.11.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2004] [Indexed: 11/28/2022]
Abstract
BACKGROUND Data regarding salvage surgery for ovarian immature teratoma (IT) are lacking despite its established role in the management of chemorefractory testicular germ cell tumors. In this report, a case of advanced IT that was salvaged by secondary cytoreduction following failure of both primary therapy and salvage chemotherapy is described, and the available literature is reviewed. CASE A 28-year-old patient underwent primary cytoreductive surgery followed by platinum-based chemotherapy for stage IIIC, grade 3, ovarian IT. Second-line chemotherapy was administered after residual disease was identified at second-look surgery. Following failure of salvage chemotherapy, aggressive secondary debulking resulted in long-term disease-free survival of over 48 months. CONCLUSION There appears to be a distinct role for salvage surgery in selected cases of chemorefractory IT. More studies are needed to further define the subset of patients who benefit most from this management approach.
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Affiliation(s)
- Youssef Rezk
- Department of Obstetrics and Gynecology, Albany Medical College, Albany, NY 12208, USA
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Schmeler KM, Mayo-Smith WW, Peipert JF, Weitzen S, Manuel MD, Gordinier ME. Adnexal Masses in Pregnancy: Surgery Compared With Observation. Obstet Gynecol 2005; 105:1098-103. [PMID: 15863550 DOI: 10.1097/01.aog.0000157465.99639.e5] [Citation(s) in RCA: 111] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To estimate whether the delay of surgery impacts the risk of adverse maternal and fetal outcomes in patients diagnosed with an adnexal mass during pregnancy. METHODS A review was performed of pregnant patients diagnosed with an adnexal mass 5 cm or greater in diameter. Data collected included age, gravity/parity, gestational age at diagnosis, and presenting symptoms. Ultrasound examinations were evaluated for mass size and complexity. Pregnancy outcome, complications, and surgical pathology were reviewed. RESULTS Between 1990 and 2003, 127,177 deliveries were performed at our institution. An adnexal mass 5 cm in diameter or greater was diagnosed in 63 (0.05%) patients. Pathologic diagnosis was available for 59 (94%) patients. The remaining 4 patients were lost to follow-up and excluded from the analysis. Antepartum surgery was performed in 17 patients (29%): 13 because of ultrasound findings that suggested malignancy and 4 secondary to ovarian torsion. The remaining patients were observed, with surgery performed in the postpartum period or at time of cesarean delivery. The majority of masses were dermoid cysts (42%). Four patients were diagnosed with ovarian cancer (6.8% of masses, 0.0032% of deliveries), and one patient (1.7%) had a tumor of low malignant potential. Antepartum surgery due to ultrasound findings that caused concern was performed on all 5 women diagnosed with a malignancy or borderline tumor, compared with 12 (22%) of the patients with benign tumors (P < .01). CONCLUSION In select cases, close observation is a reasonable alternative to antepartum surgery in patients with an adnexal mass during pregnancy.
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Affiliation(s)
- Kathleen M Schmeler
- Department of Obstetrics and Gynecology, Women & Infants' Hospital of Rhode Island, Brown University Medical School, Providence, Rhode Island, USA.
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Pauls K, Wardelmann E, Merkelbach-Bruse S, Büttner R, Zhou H. c-KIT codon 816 mutation in a recurrent and metastatic dysgerminoma of a 14-year-old girl: case study. Virchows Arch 2004; 445:651-4. [PMID: 15455230 DOI: 10.1007/s00428-004-1112-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2004] [Accepted: 07/30/2004] [Indexed: 10/26/2022]
Abstract
Dysgerminomas are rare female germ-cell tumors that correspond histologically and immunohistochemically to seminomas. Analogous to seminomas, most dysgerminomas respond very well to cisplatin- or carboplatin-based chemotherapy and to radiotherapy. KIT tyrosine kinase is crucial for normal germ-cell development, and its expression is observed in the majority of seminomas and dysgerminomas. Recently, activating KIT mutations were described in a panel of male germ-cell tumors [5, 10]. All mutations were localized in exon 17, encoding the second tyrosine kinase domain. Because receptor tyrosine kinase KIT might also be involved in the pathogenesis of dysgerminomas, we studied the expression and mutational status of a pure dysgerminoma, which was sent to our department for diagnostic reasons. The tumor revealed an exon 17 D816 V mutation in the c-KIT gene and strong KIT expression was found immunohistochemically. Clinically, the tumor was highly aggressive and resistant to carboplatin-based chemotherapy. Our case raises the question of whether exon 17 c-KIT mutations might be involved in the pathogenesis of dysgerminoma and whether exon 17 KIT mutations may predict aggressive and chemotherapy-resistant behavior of dysgerminomas.
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Sait K, Simpson C. Ovarian teratoma diagnosis and management: case presentations. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2004; 26:137-42. [PMID: 14965479 DOI: 10.1016/s1701-2163(16)30489-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Ovarian teratomas (OTs) may be of mature or immature morphologies. Mature cystic teratomas (MCTs), often referred to as dermoid cysts, are the most common germ cell tumours of the ovary in women of reproductive age. OTs are usually asymptomatic until they reach considerable size. Frequently, ultrasonography is diagnostic. Women requiring surgery for OTs should be appropriately counselled about the risks and benefits of laparoscopic and open approaches. CASE PRESENTATIONS Case I: An 18-year-old woman presented with hirsutism and irregular menses, both of which reversed after bilateral MCT removal by laparoscopy. Case II: A 47-year-old multigravid woman presented with a large unilateral OT, with a focus of malignancy. Case III: A 19-year-old woman presented with a large unilateral OT associated with gliomatosis peritonei. CONCLUSION Experienced laparoscopic surgeons should consider laparoscopy as an alternative to laparotomy in management of OT in selected cases. Women younger than 15 years of age or older than 45 years of age who have large, solid teratomas on ultrasound or positive markers for germ cell tumours are at risk for malignant variants, and for these women laparotomy is the preferred approach.
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Affiliation(s)
- Khalid Sait
- Department of Obstetrics and Gynecology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
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Ioka A, Tsukuma H, Ajiki W, Oshima A. Influence of hospital procedure volume on ovarian cancer survival in Japan, a country with low incidence of ovarian cancer. Cancer Sci 2004; 95:233-7. [PMID: 15016322 PMCID: PMC11159653 DOI: 10.1111/j.1349-7006.2004.tb02208.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The survival of ovarian cancer patients has been reported to be superior at hospitals with a high volume of operations. A population-based study was carried out to assess whether this is true in Japan, where the incidence rate is relatively low as compared with other developed countries. The Osaka Cancer Registry's data were used to investigate associations between hospital procedure volume and survival of ovarian cancer patients. Hospitals were ranked according to the number of operations for ovarian cancer performed per year (high/medium/low/very low). Survival analysis was restricted to the reported 2450 cases who lived in Osaka Prefecture (except for Osaka City) diagnosed in 1975-1995, or those who resided in Osaka City in 1993-1995, since active follow-up data on vital status 5 years after the diagnosis were available. The relative 5-year survival for all ovarian cancer cases was 38.8%, and the survival was higher with greater hospital volume (22.3% / 34.2% / 46.2% / 55.0%). After adjustment for age, histologic type and cancer stage by the Cox regression model, patients receiving care in very-low-volume hospitals were seen to have a 60% higher risk of death than patients receiving care in high-volume hospitals (P < 0.01). Although some limitations existed in this study, the results indicated that further centralization of operative treatment in high-volume hospitals might improve survival of ovarian cancer patients in Japan.
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Affiliation(s)
- Akiko Ioka
- Department of Cancer Control and Statistics, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka 537-8511, Japan.
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Lopez JM, Malpica A, Deavers MT, Ayala AG. Ovarian yolk sac tumor associated with endometrioid carcinoma and mucinous cystadenoma of the ovary. Ann Diagn Pathol 2003; 7:300-5. [PMID: 14571433 DOI: 10.1016/s1092-9134(03)00081-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The clinicopathologic and immunohistochemical findings of an unusual case of ovarian yolk sac tumor associated with endometrioid carcinoma and mucinous cystadenoma of the ovary are reported. The tumor was detected in a 51-year-old postmenopausal woman who presented with abdominal swelling and a pelvic mass. The patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy and omentectomy. The tumor was confined to the right ovary and measured 16.0 cm in greatest dimension. Microscopic examination revealed that the tumor had a yolk sac component associated with an endometrioid carcinoma, grade I, and a mucinous cystadenoma. A background of atypical endometriosis was noted. Immunoperoxidase studies showed that the yolk sac component stained diffusely with a cytokeratin cocktail and was focally positive for alpha-fetoprotein. It was negative for keratin 7. In contrast, the endometrioid carcinoma stained positive for keratin 7 in addition to the cytokeratin cocktail, but was negative for alpha-fetoprotein. After surgery, the patient received three cycles of chemotherapy. However, the disease progressed and the patient died 10 months after the diagnosis of the ovarian tumor.
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Affiliation(s)
- Jessica M Lopez
- Departamento de Patología, Hospital de Clínicas "José de San Martin", Buenos Aires, Argentina
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Swenson MM, MacLeod JS, Williams SD, Miller AM, Champion VL. Quality of life after among ovarian germ cell cancer survivors: a narrative analysis. Oncol Nurs Forum 2003; 30:380. [PMID: 12719752 DOI: 10.1188/03.onf.e48-e54] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To describe and interpret the meaning of experiences that are important to the quality of living of ovarian germ cell cancer survivors. RESEARCH APPROACH Qualitative description within a constructivist paradigm. SETTING 32 member sites of the Gynecologic Oncology Group and the University of Texas M.D. Anderson Cancer Center in Houston. PARTICIPANTS 109 women between the ages of 19-64 (median age = 36) who were enrolled on prospective clinical trials of cisplatin-based chemotherapy after surgery and disease-free for at least two years. METHODOLOGIC APPROACH As part of a larger study, narrative responses to four semistructured questions were collected at the end of a telephone interview. Using naturalistic inquiry and qualitative description techniques, content labels were assigned to units of text that seemed to encapsulate one complete thought or idea. The labeled groups were collapsed into interpreted subthemes. Finally, four general themes were constructed as representations of shared narrative responses and meanings. FINDINGS The four constructed themes are celebrating illness, experiencing empathetic affirmation, mourning losses, and valuing illness. INTERPRETATION In addition to measuring physical, psychological, and sexual functioning in women surviving ovarian germ cell cancer, nurses also must understand how these issues fit into their everyday lived experiences. The four themes may help clinicians and researchers to understand issues that are important to the quality of living of ovarian germ cell cancer survivors.
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