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Sullivan SM, Stoneham S, Lockley M, Frazier AL, Billmire DF, Poynter JN. Comparison of overall and patterns of care in patients with a malignant ovarian germ cell tumor by age in the United States: a National Cancer Database (2004-2016) analysis. Int J Gynecol Cancer 2024:ijgc-2024-005280. [PMID: 38955375 DOI: 10.1136/ijgc-2024-005280] [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: 07/04/2024] Open
Abstract
BACKGROUND Women aged ≥40 years diagnosed with a malignant ovarian germ cell tumor are more likely to have poor outcomes than their younger counterparts (aged 15-39 years). OBJECTIVE We used the National Cancer Database (NCDB) to evaluate patterns of care and overall survival for individuals diagnosed with one of the four most common histologic subtypes of malignant ovarian germ cell tumor by age group. METHODS We identified women aged 15-90 diagnosed with ovarian germ cell tumors in the NCDB (2004-2016). Logistic regression was used to compare patterns of care, demographic, and disease characteristics by age group. Cox proportional hazards regression was used to evaluate associations between a range of demographic, clinical, and treatment characteristics with overall survival. RESULTS A total of n=2998 patients who were diagnosed with one of the four most common histologic subtypes (immature teratoma, dysgerminoma, yolk sac tumor, and mixed germ cell) of ovarian germ cell tumor were included in the analysis. Patients aged ≥40 years diagnosed with ovarian germ cell tumors were more likely to have co-morbidities, a bilateral tumor, higher stage of disease, receive chemotherapy only, and have a residual tumor after resection as compared with patients aged <40 years. Moreover, women aged ≥40 years had the highest risk of death (reference: 15-24 year olds; HR=5.37, 95% CI 3.76 to 7.66) after adjustment for demographic characteristics, tumor histology, and treatment received. In stratified analyses, women aged ≥40 years had significantly worse overall survival at each disease stage and histologic subtype. CONCLUSION Findings suggest that women aged ≥40 years who are diagnosed with ovarian germ cell tumors have worse overall survival than those aged <40, independent of stage, disease characteristics, and treatment. Our study highlights the need for future research to better understand reasons for poorer outcomes in women aged ≥40 years.
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Affiliation(s)
- Shannon M Sullivan
- Department of Pediatrics, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
- Department of Laboratory Medicine and Pathology, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Sara Stoneham
- Department of Paediatric Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Michelle Lockley
- Centre for Cancer Genomics and Computational Biology, Barts Cancer Institute, Queen Mary University of London, London, UK
- Department of Gynaecological Oncology, Cancer Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - A Lindsay Frazier
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts, USA
| | - Deborah F Billmire
- Department of Pediatric Surgery, Riley Hospital for Children, Indianapolis, Indiana, USA
| | - Jenny N Poynter
- Department of Pediatrics, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
- University of Minnesota Masonic Cancer Center, Minneapolis, Minnesota, USA
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Sköld C, Jansson AK, Glimelius I. Malignant ovarian and testicular germ cell tumors: Common characteristics but different prognoses. J Intern Med 2024; 295:715-734. [PMID: 38468475 DOI: 10.1111/joim.13778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
Both ovarian and testicular germ cell tumors (GCTs) arise from the primordial germ cell and share many similarities. Both malignancies affect mainly young patients, show remarkable responsiveness to cisplatin-based therapy, and have an excellent prognosis, which also highlights the importance of minimizing long-term side effects. However, certain differences can be noted: The spreading of the disease differs, and the staging system and treatment recommendations are dissimilar. Moreover, the prognosis for ovarian GCTs is significantly inferior to that for testicular cancer, as exemplified in this review comparing the survival in Swedish patients diagnosed with testicular (1995-2022) and ovarian (1990-2018) GCTs. The 5-year overall survival in ovarian GCTs was 85.2%, versus 98.2% for testicular GCTs. How can this be explained? One reason may be the difference in knowledge, experience, and evidence because the incidence rate of testicular cancer is more than 15 times that of ovarian GCTs. Given the rarity of the disease in women and the lack of established guidelines, a comprehensive understanding of the disease and treatment decisions is challenging. The main objective of this review is to derive insights from testicular GCTs (seminoma and non-seminoma) by reviewing etiological, tumor biological, and clinical knowledge, and to thereafter suggest actions for ovarian GCTs based on this. We hypothesize that by adopting specific treatment strategies from testicular GCTs-including de-escalating adjuvant chemotherapy for low-risk patients and implementing more standardized and intensive treatment protocols in cases of relapse-we can improve the prognosis and minimize long-term side effects in ovarian GCT patients.
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Affiliation(s)
- Camilla Sköld
- Department of Immunology, Genetics and Pathology, Cancer Precision Medicine, Uppsala University, Uppsala, Sweden
| | - Anna K Jansson
- Department of Immunology, Genetics and Pathology, Cancer Precision Medicine, Uppsala University, Uppsala, Sweden
| | - Ingrid Glimelius
- Department of Immunology, Genetics and Pathology, Cancer Precision Medicine, Uppsala University, Uppsala, Sweden
- Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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3
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Hosny G, Ahmed OA, Ahmed RM, Fadel SA. Expression of p16 Tumor Suppressor Protein in Malignant Ovarian Germ Cell Tumors; Immunohistochemical Study. Int J Surg Pathol 2024; 32:66-74. [PMID: 37170541 DOI: 10.1177/10668969231168358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND Malignant ovarian germ cell tumors represent small percentage of malignant ovarian neoplasms but they affect significantly young age group. AIM OF THE STUDY To investigate the immunohistochemical expression of p16 tumor suppressor protein in malignant ovarian germ cell tumors. MATERIALS AND METHODS Twenty-two malignant ovarian germ cell tumors (five dysgerminoma, eight immature teratoma, and nine yolk sac tumors), twenty mature cystic teratoma tumors and twenty normal ovarian tissue were immunohistochemically stained with p16 monoclonal antibody. Ki67 immunohistochemical staining was done for malignant ovarian germ cell tumors to assess proliferation. RESULTS We found that p16 tumor suppressor protein is overexpressed in all malignant ovarian germ cell tumors in both nuclear and cytoplasmic locations compared to control and to mature cystic teratoma (p-value <0.001). Cytoplasmic p16 expression was significantly correlated to Ki67 proliferation index in malignant ovarian germ cell tumors (p-value = 0.033, r = 0.445). CONCLUSION Overexpression of p16 in malignant ovarian germ cell tumors denotes that dysfunction of the cyclin dependent kinase pathway is involved in tumorigenesis of malignant ovarian germ cell tumors.
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Affiliation(s)
- Ghada Hosny
- Department of Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Omar A Ahmed
- Department of Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Rania Makboul Ahmed
- Department of Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Sabah Ahmed Fadel
- Department of Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
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Liu YL, Manning-Geist BL, Knezevic A, Deng L, Bromberg M, Funt SA, Meisel JL, Zivanovic O, Roche KL, Sonoda Y, Gardner GJ, Grisham RN, O'Cearbhaill RE, Tew WP, Abu-Rustum NR, Chi DS, Aghajanian C, Feldman DR. Predicting outcomes in female germ cell tumors using a modified International Germ Cell Cancer Collaborative Group classification system to guide management. Gynecol Oncol 2023; 170:93-101. [PMID: 36669327 PMCID: PMC10023473 DOI: 10.1016/j.ygyno.2022.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 12/19/2022] [Accepted: 12/29/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE We previously developed preoperative and pre-chemotherapy modified versions of the male International Germ Cell Cancer Collaborative Group (IGCCCG) prognostic model and assessed it in female patients with germ cell tumors (GCTs). We sought to validate these modified IGCCCG (mIGCCCG) models in a new cohort. METHODS We queried institutional databases for female patients with GCTs treated at Memorial Sloan Kettering Cancer Center from 1/1/1990-6/1/2020. The mIGCCCG model classifies patients with non-dysgerminomas as good, intermediate, or poor risk based on tumor markers using male IGCCCG cutoffs and absence/presence of non-pulmonary/peritoneal visceral metastasis. In dysgerminomas, good- and intermediate-risk groups are defined by absence/presence of non-pulmonary/peritoneal visceral metastasis. Progression-free survival (PFS) and overall survival (OS) were estimated for each group in the validation and combined original and validation cohorts. Associations between individual clinical factors and outcomes were evaluated. RESULTS Among 183 female patients with GCTs, clinical characteristics and outcomes were similar between the original (n = 93) and validation (n = 90) cohorts. In multivariable models, higher stage, older age, and non-dysgerminoma histology predicted worse PFS and OS (p < 0.05). Among 162 patients who received chemotherapy, preoperative and pre-chemotherapy mIGCCCG models were significantly associated with PFS and OS (p < 0.001 for all groups). With the preoperative model, 3-year PFS rates were 94%, 76%, and 50% in the good-, intermediate-, and poor-risk patients, respectively; OS rates were 96%, 86%, and 52%, respectively. Even within stage groups, mIGCCCG risk classifications were associated with clinical outcomes. CONCLUSIONS A female-specific mIGCCCG risk model effectively stratifies patients and should be incorporated into clinical trials.
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Affiliation(s)
- Ying L Liu
- Department of Medicine, Memorial Sloan Kettering Cancer, New York, NY, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
| | - Beryl L Manning-Geist
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer, New York, NY, USA
| | - Andrea Knezevic
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer, New York, NY, USA
| | - Luxue Deng
- Atlantic Health Systems, Morristown, NJ, USA
| | - Maria Bromberg
- Department of Medicine, Memorial Sloan Kettering Cancer, New York, NY, USA
| | - Samuel A Funt
- Department of Medicine, Memorial Sloan Kettering Cancer, New York, NY, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Jane L Meisel
- Department of Medicine, Winship Cancer Institute, Emory, Atlanta, GA, USA
| | - Oliver Zivanovic
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Kara Long Roche
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Yukio Sonoda
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Ginger J Gardner
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Rachel N Grisham
- Department of Medicine, Memorial Sloan Kettering Cancer, New York, NY, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Roisin E O'Cearbhaill
- Department of Medicine, Memorial Sloan Kettering Cancer, New York, NY, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - William P Tew
- Department of Medicine, Memorial Sloan Kettering Cancer, New York, NY, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Nadeem R Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Dennis S Chi
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Carol Aghajanian
- Department of Medicine, Memorial Sloan Kettering Cancer, New York, NY, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Darren R Feldman
- Department of Medicine, Memorial Sloan Kettering Cancer, New York, NY, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA
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5
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Minig L, Gracia Segovia M, Arencibia O, Zorrero C, Marti L, García Pineda V, Cespedes J, Niguez I, Gil-Ibanez B, Diaz-Feijoo B, Fidalgo S, Valencia I, Alonso-Gutierrez T, Gonzalez L, Veiga-Fernandez A, Chacon E, Negredo I, Azcona Sutil L, Gorostidi M, Zapardiel I. Oncological outcomes among young women with non-epithelial ovarian cancer: the YOC-Care study (Young Ovarian Cancer - Care). Int J Gynecol Cancer 2023:ijgc-2022-004162. [PMID: 36796862 DOI: 10.1136/ijgc-2022-004162] [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: 02/18/2023] Open
Abstract
OBJECTIVE To determine oncological outcomes and associated prognostic factors in women younger than 45 years diagnosed with non-epithelial ovarian cancer. METHODS A retrospective, multicenter Spanish study was performed including women with non-epithelial ovarian cancer younger than 45 years between January 2010 and December 2019. All types of treatments and stages at diagnosis with at least 12 months of follow-up were collected. Women with missing data, epithelial cancers, borderline or Krukenberg tumors, and benign histology, as well as patients with previous or concomitant cancer, were excluded. RESULTS A total of 150 patients were included in this study. The mean±SD age was 31.45±7.45 years. Histology subtypes were divided into germ cell (n=104, 69.3%), sex-cord (n=41, 27.3%), and other stromal tumors (n=5, 3.3%). Median follow-up time was 58.6 (range: 31.10-81.91) months. Nineteen (12.6%) patients presented with recurrent disease with a median time to recurrence of 19 (range: 6-76) months. Progression-free survival and overall survival did not significantly differ among histology subtypes (p=0.09 and 0.26, respectively) and International Federation of Gynecology and Obstetrics (FIGO) stage (I-II vs III-IV) with p=0.08 and p=0.67, respectively. Univariate analysis identified sex-cord histology with the lowest progression-free survival. Multivariate analysis showed that body mass index (BMI) (HR=1.01; 95% CI 1.00 to 1.01) and sex-cord histology (HR=3.6; 95% CI 1.17 to 10.9) remained important independent prognostic factors for progression-free survival. Independent prognostic factors for overall survival were BMI (HR=1.01; 95% CI 1.00 to 1.01) and residual disease (HR=7.16; 95% CI 1.39 to 36.97). CONCLUSIONS Our study showed that BMI, residual disease, and sex-cord histology were prognostic factors associated with worse oncological outcomes in women younger than 45 years diagnosed with non-epithelial ovarian cancers. Even though the identification of prognostic factors is relevant to identify high-risk patients and guide adjuvant treatment, larger studies with international collaboration are essential to clarify oncological risk factors in this rare disease.
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Affiliation(s)
- Lucas Minig
- Gynecologic Oncology Unit, IMED Hospitales, Valencia, Spain
| | | | - Octavio Arencibia
- Gynecology Department, University Maternal Hospital Canary Islands, Las Palmas, Spain
| | - Cristina Zorrero
- Gynecology Department, CEU Cardenal Herrera University, Moncada, Comunitat Valenciana, Spain
| | - Lola Marti
- Gynecological Oncology, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain
| | | | - Juan Cespedes
- Gynecology Department, Hospital Universitario Donostia, San Sebastian, País Vasco, Spain
| | - Isabel Niguez
- Gynecology Department, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Blanca Gil-Ibanez
- Gynecologic Oncology Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Berta Diaz-Feijoo
- Gynecologic Oncology Unit, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
| | - Soledad Fidalgo
- Gynecology Department, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Irene Valencia
- Gynecology Department, Hospital Universitario de Puerto Real, Puerto Real, Andalucía, Spain
| | | | - Lorena Gonzalez
- Gynecology Department, Hospital Universitario de Torrejón, Torrejon de Ardoz, Madrid, Spain
| | | | - Enrique Chacon
- Gynecologic Oncology, Universidad de Navarra, Pamplona, Navarra, Spain
| | - Isabel Negredo
- Gynecology Department, Miguel Servet University Hospital, Zaragoza, Aragón, Spain
| | - Leticia Azcona Sutil
- Gynecology Department, Hospital Universitario Virgen Macarena, Sevilla, Andalucía, Spain
| | - Mikel Gorostidi
- Gynecology Department, Hospital Universitario Donostia, San Sebastian, País Vasco, Spain
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Abstract
Ovarian germ cell tumors are a diverse group of benign and malignant neoplasms that occur in a wide age range, but with a predilection for younger age group. The majority are represented by the frequently encountered mature cystic teratomas. Malignant germ cell tumors are uncommon, and in some cases have a characteristic clinical presentation. However, from a histologic standpoint these tumors can sometimes be challenging to diagnose due to overlapping morphology with epithelial, and in some cases sex cord tumors. In these cases, a panel of immunohistochemical stains often facilitates the correct diagnosis. This review article discusses the clinicopathologic findings and pertinent ancillary studies of both common and uncommon germ cell tumors of the ovary.
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Affiliation(s)
- Preetha Ramalingam
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas. USA.
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7
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Trama A, Bernasconi A, Botta L, Byrne J, Grabow D, Reulen RC, Calaminus G, Terenziani M. Late mortality reduction among survivors of germ cell tumors in childhood and adolescence in Europe: A report from the PanCareSurFup cohort. Pediatr Blood Cancer 2022; 69:e29991. [PMID: 36184796 DOI: 10.1002/pbc.29991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/17/2022] [Accepted: 08/22/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Data on late mortality from pediatric germ cell tumors (GCTs) are limited to small case series. Our population-based study aimed to investigate excess risk of death in survivors of GCT in childhood and adolescence, whether long-term mortality changed over time and by period of diagnosis. METHODS The PanCare Childhood and Adolescent Cancer Survivor Care and Follow-Up Studies (PanCareSurFup) cohort includes 2773 five-year survivors diagnosed under 21 years of age with gonadal and extragonadal GCT (from 1940 to 2008). We calculated standardized mortality ratios (SMRs) and absolute excess risks (AERs). We fitted a Cox's model to assess the impact of treatment period. We estimated 10-year survival and calculated average percentage changes between periods of diagnosis (1970-1979, 1980-1989, 1990-1999) to assess whether late mortality decreased. RESULTS GCT survivors had an almost four-fold excess risk of dying compared to general population. The risk of death for patients treated after 1980 was nearly halved compared to patients treated before 1980. Survivors diagnosed in 1990-1999 had a 10-year survival rate of 99%, which was 2.4% and 1.1% higher than for patients treated in 1970-1979 and 1980-1989, respectively. CONCLUSIONS This is the largest population-based study in Europe and showed a decrease in long-term mortality for survivors of GCTs in childhood and adolescence over the last decades. After the introduction of platinum compound in 1980, which is a paradigm of success compared to the previous treatments, no major changes in drug therapies have been made to treat GCTs in the last 40 years. However, GCT survivors maintain an excessive risk of death that requires long-term care.
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Affiliation(s)
- Annalisa Trama
- Evaluative Epidemiology Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alice Bernasconi
- Evaluative Epidemiology Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Laura Botta
- Evaluative Epidemiology Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Desiree Grabow
- German Childhood Cancer Registry, Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Johannes-Gutenberg University Mainz, Mainz, Germany
| | - Raoul C Reulen
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Monica Terenziani
- Pediatric Oncology Unit, Department of Medical Oncology and Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Pure Ovarian Dysgerminoma in a Postmenopausal Patient: A Case Report and Review of the Management. Gynecol Oncol Rep 2022; 43:101068. [PMID: 36212092 PMCID: PMC9535265 DOI: 10.1016/j.gore.2022.101068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/07/2022] [Accepted: 09/11/2022] [Indexed: 12/02/2022] Open
Abstract
Pure dysgerminomas in postmenopausal females are rare. Ovarian dysgerminoma symptoms are non-specific. Treatment options have traditionally included surgical resection and chemotherapy.
Background A pure ovarian dysgerminoma in a postmenopausal female is a rare phenomenon. Case A 65-year-old female presented with a large pelvic mass. Following surgical debulking, the patient was diagnosed with FIGO Stage IIB ovarian dysgerminoma. She was treated with three cycles of etoposide and cisplatin and has been disease-free for 12 months. Conclusion Dysgerminomas in postmenopausal females are uncommon. Gynecologic oncologists should be familiar with the pathological diagnosis and treatment recommendations to achieve optimal outcomes.
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Singh A, Sinha P, Vashistha P, Akhoon IS, Afrin S. Ovarian tumors, discordance between clinical and radiological findings: A case series. Trop Doct 2022; 52:431-439. [PMID: 35579891 DOI: 10.1177/00494755221101755] [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: 11/16/2022]
Abstract
The five major types of ovarian tumors in females of different age groups are discussed here with respect to discordance between ultrasonography, clinical features and histopathology findings. The importance of clinical examination cannot be denied in such cases as total dependence on investigation modalities may lead to wrong diagnosis and treatment. Five such cases admitted in the year 2017-2018 at Era's Lucknow medical college and hospital were selected for this series. All the cases had varied presentation, and diagnosis in each case was difficult as the nature of the masses differed markedly from the radiological findings. Even in expert hands, a radiological conclusion must go hand in hand with a proper clinical correlation.
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Affiliation(s)
| | | | | | | | - Saba Afrin
- Era's Lucknow medical college Lucknow, India
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10
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Sköld C, Koliadi A, Enblad G, Stålberg K, Glimelius I. Parity is associated with better prognosis in ovarian germ cell tumors, but not in other ovarian cancer subtypes. Int J Cancer 2021; 150:773-781. [PMID: 34648676 DOI: 10.1002/ijc.33844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/10/2021] [Accepted: 09/22/2021] [Indexed: 11/09/2022]
Abstract
Ovarian cancer is influenced by reproductive factors, with a reduced risk of epithelial ovarian cancer in parous women. Nonepithelial ovarian cancer frequently affects young women and often precedes or occurs during the childbearing years. However, the impact of reproductive factors on ovarian cancer survival remains unclear: in epithelial ovarian cancer, data are conflicting, and subtype-specific associations have not been examined, and in nonepithelial ovarian cancer, it has not been studied. Using Swedish registers, we evaluated associations between women's reproductive history and cancer-specific mortality by subtype of epithelial and nonepithelial ovarian cancer in 3791 women born 1953 and later, diagnosed from 1990 to 2018. Hazard ratios (HRs) with 95% confidence intervals (95% CIs) were calculated using Cox-proportional hazard models. Parity was associated with a 78% decreased risk of cause-specific mortality in 243 women with germ cell tumors (GCTs) (parous vs nulliparous, adjusted for age at diagnosis: HR: 0.22 [95% CI 0.07-0.62]), with a decreased risk with increasing number of births (per birth: HR: 0.60 [95% CI 0.38-0.95]). We found no evidence of associations between parity and cause-specific mortality among the 334 patients with sex-cord stromal tumors, nor among the 3214 patients with epithelial ovarian cancer; neither overall, nor by subtype. In conclusion, in our large, population-based study, parity was associated with a clearly better prognosis in GCTs but not in the other ovarian cancer subtypes. Future research on how hormone exposure impacts GCT development may lead to a better understanding of mechanisms affecting survival.
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Affiliation(s)
- Camilla Sköld
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Anthoula Koliadi
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Gunilla Enblad
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Karin Stålberg
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Ingrid Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.,Department of Medicine, Division of Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden
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11
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Sas I, Şerban DM, Tomescu LC, Nicolae N. Ovarian dysgerminoma in pregnancy: A case report. Medicine (Baltimore) 2021; 100:e25364. [PMID: 33832117 PMCID: PMC10545259 DOI: 10.1097/md.0000000000025364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/02/2021] [Accepted: 03/11/2021] [Indexed: 01/12/2023] Open
Abstract
RATIONALE Although dysgerminomas are relatively uncommon among all ovarian neoplasms, representing for only about 2%, they account for 32.8 percent of malignant ovarian germ cell tumors. Their association with pregnancy is extremely rare; due to the low frequency of occurrence, there are few recommendations regarding pregnancy management; therefore, it is important to discuss and summarize the treatment strategy. PATIENT CONCERNS We present the case of a 25 years patient, gestation 1, para 1, who was hospitalized in the clinic at 38/39 weeks of gestation at the beginning of labor. Following the ultrasound examination, a hypoechogenic lesion on the uterine fundus was found, suggestive of subterranean fibroid. After caesarean section, right adnexectomy was performed; the histopathological examination revealed, unexpectedly, the diagnosis of dysgerminoma. DIAGNOSES Dysgerminoma as associated with pregnancy. INTERVENTIONS Birth by Caesarean section and right adnexectomy. No other medical complications occurred. OUTCOMES The histopathological and immunohistochemical examinations were consistent with the pure dysgerminoma. Oncology was staged AI, with the monitoring of markers and abdominal and pelvic magnetic resonance imaging at 3, 6, 9, and 12 months. LESSONS Dysgerminoma is the most common ovarian malignancy associated with pregnancy with a good fetal maternal outcome. If these tumors are discovered accidentally during caesarean section, tumor markers and magnetic resonance imaging scanning should be done postoperatively to plan optimal treatment.
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12
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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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Morin J, Peard L, Saltzman AF. Gonadal malignancy in patients with differences of sex development. Transl Androl Urol 2020; 9:2408-2415. [PMID: 33209714 PMCID: PMC7658134 DOI: 10.21037/tau-19-726] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Differences of sexual development (DSD) are known to be associated with an elevated risk of malignant and pre-malignant tumors. However, given the rarity of DSD and tumors in patients with DSD, more robust, large scale, prospective literature is required to truly determine the extent of this association, long-term outcomes and the nuances associated with the wide variety of DSD diagnoses. In addition, the spectrum of diagnoses and nomenclature has been ever-changing, limiting assessment of long-term patient outcomes. This review aims to provide an overview of the pathogenesis of DSD conditions, potential malignancies associated with the diagnoses, the available screening for malignancy, and the most recent data on stratification for each DSD diagnosis and association with malignancy.
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Affiliation(s)
- Jacqueline Morin
- Department of Urology, University of Kentucky, Lexington, KY, USA
| | - Leslie Peard
- Department of Urology, University of Kentucky, Lexington, KY, USA
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Morin J, Peard L, Vanadurongvan T, Walker J, Dönmez Mİ, Saltzman AF. Oncologic outcomes of pre-malignant and invasive germ cell tumors in patients with differences in sex development - A systematic review. J Pediatr Urol 2020; 16:576-582. [PMID: 32564942 DOI: 10.1016/j.jpurol.2020.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 04/14/2020] [Accepted: 05/04/2020] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To describe the rates of GCNIS-free and GCT-free pathology based on age at gonadal surgery and to describe long-term oncologic outcomes in patients with DSD who have GCNIS or GCT at the time of gonadal surgery. STUDY DESIGN A systematic review was conducted using MEDLINE to identify patients with DSD who underwent gonadal surgery. DSD diagnoses were stratified based on malignancy risk. GCNIS/GCT and GCT-free survival by age of gonadal surgery, RFS and OS were calculated using the Kaplan-Meier method, with groups compared using log-rank testing. RESULTS 386 articles from 1951 to 2017 were included (2037 patients). Median age at gonadal surgery was 17 years (y) (IQR 11-20), median follow-up was 60 months (m) (IQR 30-68.1). GCNIS/GCT- and GCT-free survival at the time of gonadal surgery was lowest for those in the high/intermediate risk group (p < 0.001) but decreased sharply around age 15y, regardless of risk category. 5y RFS and OS was similar for those with no GCNIS/GCT and GCNIS and was worse for those with GCT (p < 0.001). DISCUSSION When patients undergo gonadal surgery, regardless of indication (i.e. prophylactic vs. tumor), it appears that GCTs are more commonly found when surgery is done around age 15 y or older, despite risk category. This is similar to ovarian and testicular GCTs. Patients with GCNIS can be reassured that long-term oncologic outcomes are excellent. While RFS and OS for GCTs are not as good as for ovarian and testicular GCTs (95%), they are still >80%. This similar trend was found in a COG review of 9 patients with DSD and ovarian GCT. There were several limitations to this study. This is a retrospective analysis that included aa wide time frame of publications. The indication for surgical intervention was not addressed in the majority of publications. Thus these data provide pathologic outcomes based on age at gonadal surgery rather than the age at which GCNIS/GCT develops over a lifetime, if at all. CONCLUSIONS The risk of GCNIS or GCT at the time of gonadal surgery appears to increase with age, accelerating between 15 and 20y regardless of risk category. 5y RFS and OS for those with GCNIS is equivalent to those without GCNIS/GCT but is worse for those with GCT. These data may be used when counseling families on timing of gonadal surgery and quantification of outcomes should GCNIS or malignancy be identified.
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Affiliation(s)
- Jacqueline Morin
- Department of Urology, University of Kentucky, Lexington, KY, USA
| | - Leslie Peard
- Department of Urology, University of Kentucky, Lexington, KY, USA
| | - Timothy Vanadurongvan
- Department of Surgery, Division of Urology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jonathan Walker
- Department of Surgery, Division of Urology, University of Colorado School of Medicine, Aurora, CO, USA
| | - M İrfan Dönmez
- Department of Surgery, Division of Urology, University of Colorado School of Medicine, Aurora, CO, USA
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A prospective study on cancer risk after total hip replacements for 41,402 patients linked to the Cancer registry of Norway. BMC Musculoskelet Disord 2020; 21:599. [PMID: 32900364 PMCID: PMC7487465 DOI: 10.1186/s12891-020-03605-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 08/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Concerns have been raised that implants used in total hip replacements (THR) could lead to increased cancer risk. Several different materials, metals and fixation techniques are used in joint prostheses and different types of articulation can cause an increased invasion of particles or ions into the human body. METHODS Patients with THR registered in the Norwegian Arthroplasty Register during 1987-2009 were linked to the Cancer registry of Norway. Patients with THR due to osteoarthritis, under the age of 75 at time of surgery, were included. Standardized incidence ratios (SIR) were applied to compare cancer risk for THR patients to the general population. Types of THR were divided into cemented (both components), uncemented (both components), and hybrid (cemented femoral and uncemented acetabular components). To account for selection mechanisms, time dependent covariates were applied in Cox-regression, adjusting for cancer risk the first 10 years after surgery. The analyses were adjusted for age, gender and if the patient had additional THR-surgery in the same or the opposite hip. The study follows the STROBE guidelines. RESULTS Comparing patients with THR to the general population in Norway we found no differences in cancer risk. The overall SIR for the THR-patients after 10 years follow-up was 1.02 (95% CI: 0.97-1.07). For cemented THR, the SIR after 10 years follow-up was 0.99 (95% CI: 0.94-1.05), for uncemented, 1.16 (95% CI: 1.02-1.30), and for hybrid 1.12 (95% CI: 0.91-1.33). Adjusted Cox analyses showed that patients with uncemented THRs had an elevated risk for cancer (hazard ratio: HR = 1.24, 95% CI: 1.05-1.46, p = 0.009) when compared to patients with cemented THRs after 10 years follow-up. Stratified by gender the increased risk was only present for men. The risk for patients with hybrid THRs was not significantly increased (HR = 1.07, 95% CI: 0.85-1.35, p = 0.55) compared to patients with cemented THRs. CONCLUSIONS THR patients had no increased risk for cancer compared to the general population. We found, however, that receiving an uncemented THR was associated with a small increased risk for cancer compared to cemented THR in males, but that this may be prone to unmeasured confounding.
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The individualized significance of lymphadenectomy across all age groups and histologies in malignant ovarian germ cell tumors. Arch Gynecol Obstet 2020; 302:1441-1450. [PMID: 32888090 DOI: 10.1007/s00404-020-05772-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 08/26/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the therapeutic role of lymphadenectomy on patients with malignant ovarian germ cell tumor (MOGCT) and to investigate the risk factors of lymph node metastasis. METHODS Patients of MOGCT between 1988 and 2013 with definite lymph node information were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Survival curves were estimated using the Kaplan-Meier method, and Cox regression analyses were performed to evaluate the effects of clinical and pathologic variables on survival. RESULTS 2424 MOGCT patients with information on lymph nodes were included. Of the entire cohort, 46.2% patients received lymphadenectomy. The most common (42.2%) histologic type was teratoma, and 70.6% patients had FIGO stage I disease. Cox proportional model verified that age, grade, and log odds of positive lymph nodes (LODDS) were independent prognostic factors. Subgroup analysis showed that the association between the lymph node resection and better survival in the different age cohort. CONCLUSIONS Lymphadenectomy is not recommended for children (0-14 years). For patients 40 years of age and older, and for those who have the dysgerminoma type or endodermal sinus type, lymphadenectomy had an outstanding therapeutic role. As a parameter to assess lymph node status, LODDS could be used to classify MOGCTs.
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Veneris JT, Mahajan P, Frazier AL. Contemporary management of ovarian germ cell tumors and remaining controversies. Gynecol Oncol 2020; 158:467-475. [DOI: 10.1016/j.ygyno.2020.05.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 05/06/2020] [Indexed: 12/19/2022]
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Derquin F, Floquet A, Hardy-Bessard AC, Edeline J, Lotz JP, Alexandre J, Pautier P, Angeles MA, Delanoy N, Lefeuvre-Plesse C, Cancel M, Treilleux I, Augereau P, Lavoue V, Kalbacher E, Berton Rigaud D, Selle F, Nadeau C, Gantzer J, Joly F, Guillemet C, Pomel C, Favier L, Abdeddaim C, Venat-Bouvet L, Provansal M, Fabbro M, Kaminsky MC, Lortholary A, Lecuru F, Coquard IR, de La Motte Rouge T. Need for risk-adapted therapy for malignant ovarian germ cell tumors: A large multicenter analysis of germ cell tumors' patients from French TMRG network. Gynecol Oncol 2020; 158:666-672. [PMID: 32624235 DOI: 10.1016/j.ygyno.2020.06.491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/12/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Malignant ovarian germ cell tumors are rare tumors, affecting young women with a generally favorable prognosis. The French reference network for Rare Malignant Gynecological Tumors (TMRG) aims to improve their management. The purpose of this study is to report clinicopathological features and long-term outcomes, to explore prognostic parameters and to help in considering adjuvant strategy for stage I patients. PATIENTS AND METHODS Data from patients with MOGCT registered among 13 of the largest centers of the TMRG network were analyzed. We report clinicopathological features, estimated 5-year event-free survival (5y-EFS) and 5-year overall survival (5y-OS) of MOGCT patients. RESULTS We collected data from 147 patients including 101 (68.7%) FIGO stage I patients. Histology identifies 40 dysgerminomas, 52 immature teratomas, 32 yolk sac tumors, 2 choriocarcinomas and 21 mixed tumors. Surgery was performed in 140 (95.2%) patients and 106 (72.1%) received first line chemotherapy. Twenty-two stage I patients did not receive chemotherapy. Relapse occurred in 24 patients: 13 were exclusively treated with upfront surgery and 11 received surgery and chemotherapy. 5y-EFS was 82% and 5y-OS was 92.4%. Stage I patients who underwent surgery alone had an estimated 5y-EFS of 54.6% and patients receiving adjuvant chemotherapy 94.4% (P < .001). However, no impact on estimated 5y-OS was observed: 96.3% versus 97.8% respectively (P = .62). FIGO stage, complete primary surgery and post-operative alpha fetoprotein level significantly correlated with survival. CONCLUSION Adjuvant chemotherapy does not seem to improve survival in stage I patients. Active surveillance can be proposed for selected patients with a complete surgical staging.
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Affiliation(s)
- F Derquin
- Medical Oncology Department, Centre Hospitaliser Yves Le Foll, Saint Brieuc, France
| | - A Floquet
- Medical Oncology Department, Institut Bergonié, Bordeaux, France
| | | | - J Edeline
- Medical Oncology Department, Centre Eugène Marquis, Rennes, France
| | - J P Lotz
- Medical Oncology Department, Sorbonne University, APHP, Paris, France
| | - J Alexandre
- Medical Oncology Department, Hôpital Cochin, APHP, Paris, France
| | - P Pautier
- Medical Oncology Department, Institut Gustave Roussy, Villejuif, France
| | - M A Angeles
- Surgical Oncology Department, Institut Claudius Regaud, Toulouse, France
| | - N Delanoy
- Medical Oncology Department, Hôpital Européen Georges Pompidou, APHP, Paris, France
| | | | - M Cancel
- Medical Oncology Department, Centre Hospitalier Universitaire Bretonneau, Tours, France
| | - I Treilleux
- Medical Oncology Department, Centre Léon Bérard, Lyon, France
| | - P Augereau
- Medical Oncology Department, Institut de Cancérologie de l'Ouest, Angers, France
| | - V Lavoue
- Gynecology Department, Centre Hospitalier Universitaire, Rennes, France
| | - E Kalbacher
- Medical Oncology Department, Centre Hospitalier Régional Universitaire, Besançon, France
| | - D Berton Rigaud
- Medical Oncology Department, Institut de Cancérologie de l'Ouest, Nantes, France
| | - F Selle
- Diaconnesses Hospital Group, Paris, France
| | - C Nadeau
- Gynecology Department, CHU de Poitiers, Poitiers, France
| | - J Gantzer
- Medical Oncology Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - F Joly
- Medical Oncology Department, Centre François Baclesse, Caen, France
| | - C Guillemet
- Medical Oncology Department, Centre Henri-Becquerel, Rouen, France
| | - C Pomel
- Medical Oncology Department, Centre Jean Perrin, Clermont-Ferrand, France
| | - L Favier
- Medical Oncology Department, Centre Georges François Leclerc, Dijon, France
| | - C Abdeddaim
- Medical Oncology Department, Centre Oscar Lambret, Lille, France
| | - L Venat-Bouvet
- Medical Oncology Department, CHU Dupuytren, Limoges, France
| | - M Provansal
- Medical Oncology Department, Institut Paoli Calmettes, Marseille, France
| | - M Fabbro
- Medical Oncology Department, Institut régional du Cancer Montpellier, Montpellier, France
| | - M C Kaminsky
- Medical Oncology Department, Institut de Cancérologie de Lorraine - Alexis Vautrin, Vandoeuvre-Les-Nancy, France
| | - A Lortholary
- Medical Oncology Department, Hôpital Privé du Confluent, Nantes, France
| | - F Lecuru
- Medical Oncology Department, Hôpital Européen Georges Pompidou, APHP, Paris, France
| | - I Ray Coquard
- Medical Oncology Department, Centre Léon Bérard, Lyon, France
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Nasioudis D, Mastroyannis SA, Latif NA, Ko EM. Trends in the surgical management of malignant ovarian germcell tumors. Gynecol Oncol 2020; 157:89-93. [PMID: 32008791 DOI: 10.1016/j.ygyno.2020.01.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 01/20/2020] [Accepted: 01/21/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate trends in the surgical management of young women and pediatric patients with malignant ovarian germ cell tumors (MOGCTs) and associated survival outcomes. MATERIALS AND METHODS Using the Surveillance, Epidemiology, and End Results database we identified patients under 40 years who underwent surgery between 1994 and 2014. The Joinpoint Regression Program was employed to investigate the presence of temporal trends and calculate average annual percent change (AAPC) rates. For analysis purposes two age groups were formed; pediatric/adolescent (≤21 yrs) and young adult (22-40 yrs). Histology was categorized into dysgerminoma, immature teratoma, yolk-sac tumor, mixed germ cell tumor and other histology. Cancer specific survival was compared using log-rank tests. RESULTS A total of 2238 patients were identified, with median age 21 years. Only 12.4% underwent hysterectomy. One third underwent omentectomy, and one half underwent lymphadenectomy (LND). A decrease in the rate of omentectomy (AAPC: -2.15, 95% CI: -3.4, -0.9) and hysterectomy (AAPC: -3.31, 95% CI: -6.1, -0.4) was observed. There was no change in the rate of LND (AAPC: 0.17, 95% CI: -0.7, 1.1). Pediatric patients were less likely to undergo omentectomy (30.2% vs 35.5%, p < 0.001), hysterectomy (3.5% vs 22%, p < 0.001) and LND (45.6% vs 54.7%, p < 0.001). There were no apparent survival differences according to the performance of hysterectomy, omentectomy or LND, when stratified by early (stage I) and advanced stage (II-IV), (p > 0.05). CONCLUSIONS Pediatric patients with MOGCTs undergo less extensive surgical staging. A trend towards less extensive surgical procedures for young women over time was observed, without an apparent detrimental effect on cancer specific survival.
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Affiliation(s)
- Dimitrios Nasioudis
- Division of Gynecologic Oncology, University of Pennsylvania Health System, Philadelphia, PA, USA.
| | - Spyridon A Mastroyannis
- Division of Gynecologic Oncology, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Nawar A Latif
- Division of Gynecologic Oncology, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Emily M Ko
- Division of Gynecologic Oncology, University of Pennsylvania Health System, Philadelphia, PA, USA
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Newton C, Murali K, Ahmad A, Hockings H, Graham R, Liberale V, Sarker SJ, Ledermann J, Berney DM, Shamash J, Banerjee S, Stoneham S, Lockley M. A multicentre retrospective cohort study of ovarian germ cell tumours: Evidence for chemotherapy de-escalation and alignment of paediatric and adult practice. Eur J Cancer 2019; 113:19-27. [PMID: 30954883 PMCID: PMC6522056 DOI: 10.1016/j.ejca.2019.03.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/14/2019] [Accepted: 03/02/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Adult guidelines recommend BEP (bleomycin, etoposide, cisplatin) for all ovarian germ cell tumours, causing debilitating toxicities in young patients who will survive long term. Paediatricians successfully reduce toxicities by using lower bleomycin doses and substituting carboplatin for cisplatin, while testicular and paediatric immature teratomas (ITs) are safely managed with surgery alone. AIM The aim was to determine whether reduced-toxicity treatment could rationally be extended to patients older than 18 years. METHODS Multicentre cohort study was carried out in four large UK cancer centres over 12 years. RESULTS One hundred thirty-eight patients were enrolled. Overall survival was 93%, and event-free survival (EFS) was 72%. Neoadjuvant/adjuvant chemotherapy (82% BEP) caused 27 potentially chronic toxicities, and one patient subsequently died from acute lymphoblastic leukaemia. There was no difference in histology, stage or grade in patients ≤/>18 years, and EFS was not different in these age groups (≤18:28% and >18:28%; log-rank P = 0.96). Histological subtype powerfully predicted EFS (log-rank P = 4.9 × 10-7). Neoadjuvant/adjuvant chemotherapy reduced future relapse/progression in dysgerminoma (n = 37, chemo:0% vs. no chemo:20%), yolk sac tumour (n = 23, 26.3% vs.75%) and mixed germ cell tumour (n = 32, 40%vs.70%) but not in IT (n = 42, 33% vs.15%). Additionally, we observed no radiological responses to chemotherapy in ITs, pathological IT grade did not predict EFS (univariate hazard ratio 0.82, 95% confidence interval: 0.57-1.19, P = 0.94) and there were no deaths in this subtype. CONCLUSION Survival was excellent but chemotherapy toxicities were severe, implying significant overtreatment. Our data support the extension of reduced-toxicity, paediatric regimens to adults. Our practice-changing findings that IT was chemotherapy resistant and pathological grade uninformative strongly endorse exclusive surgical management of ovarian ITs at all ages.
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Affiliation(s)
- C Newton
- Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK; University College Hospital, 235 Euston Road London, NW1 2BU, UK; University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8HW, UK; University of Bristol, Senate House, Tyndall Avenue, Bristol BS8 1TH, UK
| | - K Murali
- The Royal Marsden Hospital, 203 Fulham Rd, Chelsea, London SW3 6JJ, UK
| | - A Ahmad
- The Wolfson Institute, CRUK Barts Cancer Centre, Queen Mary University London, Charterhouse Square, London EC1M 6BQ, UK; Cancer Intelligence, Cancer Research UK, Angel Building, 407 St John Street, London EC1V 4AD, UK
| | - H Hockings
- Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK; Centre for Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - R Graham
- University College Hospital, 235 Euston Road London, NW1 2BU, UK
| | - V Liberale
- University College Hospital, 235 Euston Road London, NW1 2BU, UK
| | - S-J Sarker
- Centre for Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK; Research Department of Medical Education, UCL Medical School, Royal Free Campus, Hampstead, London NW3 2PR, UK
| | - J Ledermann
- University College Hospital, 235 Euston Road London, NW1 2BU, UK
| | - D M Berney
- Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK; Centre for Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - J Shamash
- Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK
| | - S Banerjee
- The Royal Marsden Hospital, 203 Fulham Rd, Chelsea, London SW3 6JJ, UK
| | - S Stoneham
- University College Hospital, 235 Euston Road London, NW1 2BU, UK
| | - M Lockley
- Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK; University College Hospital, 235 Euston Road London, NW1 2BU, UK; Centre for Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK.
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Nasioudis D, Chapman-Davis E, Frey MK, Caputo TA, Witkin SS, Holcomb K. Prognostic significance of residual disease in advanced stage malignant ovarian germ cell tumors. Int J Gynecol Cancer 2019; 29:554-559. [DOI: 10.1136/ijgc-2018-000013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 09/18/2018] [Accepted: 09/25/2018] [Indexed: 12/22/2022] Open
Abstract
ObjectiveTo investigate the prognostic significance of complete gross resection following cytoreductive surgery for patients with advanced stage malignant ovarian germ cell tumors.MethodsThe National Cancer Data Base was accessed and patients diagnosed with an advanced stage (II-IV) malignant ovarian germ cell tumor who underwent primary cytoreductive surgery between 2011 and 2014 were selected for further analysis. For analysis purposes two groups were formed: patients with complete gross resection and those with macroscopic residual disease. Demographic and clinico-pathological characteristics were compared with the chi-square and Mann–Whitney U test. Univariate survival analysis was performed with the log-rank test after generation of Kaplan–Meier curves, while a Cox proportional hazard model was constructed to evaluate mortality after controlling for confounders.ResultsA total of 343 patients who met the inclusion criteria were identified. Residual disease status was available for 276 patients: the rate of complete gross resection was 69.2 %. By univariate analysis there was no difference in overall survival between patients in the complete gross resection and macroscopic residual disease groups, P= 0.26; 3-year overall survival rates: 86.4 % and 82.8 %, respectively. No difference in overall survival was noted following stratification by histology; P = 0.64 and P = 0.24 for dysgerminoma and non-dysgerminoma tumor groups. After controlling for stage IV disease, histology and the administration of chemotherapy, macroscopic residual disease was not associated with a worse mortality (HR: 1.22, 95% CI: 0.61 to 2.46).ConclusionsMacroscopic residual disease following primary cancer-directed surgery was not associated with a worse prognosis in a cohort of patients with advanced stage malignant ovarian germ cell tumors.
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Robertson JA, Sanday K, Nicklin J. Malignant ovarian germ cell tumours in the post-menopausal population. Aust N Z J Obstet Gynaecol 2018; 59:285-287. [PMID: 30277261 DOI: 10.1111/ajo.12897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 08/12/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Malignant ovarian germ cell tumours (MOGCT) are uncommon in the general population and very rare in post-menopausal women. AIMS To evaluate the demographics, treatment and survival of post-menopausal women with MOGCT treated at the Queensland Centre for Gynaecological Cancer (QCGC) and compare these with pre-menopausal women. MATERIALS AND METHODS Retrospective analysis was performed of the QCGC database from January 1981 to February 2017. The disease course of post-menopausal women was compared with pre-menopausal women affected by MOGCT over the same period and compared with the world literature. RESULTS There were six post-menopausal women with MOGCT treated at the QCGC compared with 166 pre-menopausal women. In the post-menopausal group of women, there was no mortality directly attributed to germ cell ovarian disease compared with 10 (6.0%) women in the pre-menopausal group. CONCLUSIONS Malignant ovarian germ cell tumours are a very rare condition in post-menopausal women. Despite some suggestion in the world literature that survival outcomes are worse in this population, this was not found in our study.
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Affiliation(s)
| | - Karen Sanday
- Queensland Centre for Gynaecological Cancer, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - James Nicklin
- Queensland Centre for Gynaecological Cancer, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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Zogbi L, Gonçalves CV, Tejada VF, Martins D, Karam F, Machado Dos Santos S, Caldeira RR, Senhorin GZ, Lauz S. Treatment of bilateral ovarian dysgerminoma with 11-year follow-up: A case report. Ann Med Surg (Lond) 2018; 33:50-52. [PMID: 30186597 PMCID: PMC6122391 DOI: 10.1016/j.amsu.2018.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 07/04/2018] [Accepted: 08/13/2018] [Indexed: 01/30/2023] Open
Abstract
Introduction Malignant ovarian germ cell tumors (MOGCTs) are rare malignancies with an incidence of about 0.5/100,000. They account for less than 5% of all ovarian tumors, of which 32.8% are dysgerminomas, the female analogue of seminomas. These tumors occur in all age groups, with peak incidence below the age of 20 years in women. Aim To describe the case of a bilateral ovarian dysgerminoma treatment with 11-year follow-up. Methods Case report with details regarding clinical history, surgical treatment, chemotherapy and follow up. We include a brief literature review. Results The patient underwent radical surgery for an advanced dysgerminoma, 20 cm in length, that compromised the contralateral ovary and sigmoid. Neoplastic cells were found in ascitic fluid. Subsequently, she underwent adjuvant chemotherapy according to a standard protocol. She has survived disease-free for more than 11 years. Conclusions Dysgerminoma is a malignant neoplasm that, similar to other cancers, is easier to treat when diagnosed early. However, cures may be obtained even in advanced cases.
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Affiliation(s)
- Luciano Zogbi
- Faculdade de Medicina (FAMED) - Universidade Federal do Rio Grande (FURG), Rio Grande city, Rio Grande do Sul State, Brazil
| | - Carla Vitola Gonçalves
- Faculdade de Medicina (FAMED) - Universidade Federal do Rio Grande (FURG), Rio Grande city, Rio Grande do Sul State, Brazil
| | - Victor Felipe Tejada
- Faculdade de Medicina (FAMED) - Universidade Federal do Rio Grande (FURG), Rio Grande city, Rio Grande do Sul State, Brazil
| | - Daiane Martins
- Faculdade de Medicina (FAMED) - Universidade Federal do Rio Grande (FURG), Rio Grande city, Rio Grande do Sul State, Brazil
| | - Fabine Karam
- Faculdade de Medicina (FAMED) - Universidade Federal do Rio Grande (FURG), Rio Grande city, Rio Grande do Sul State, Brazil
| | - Sílvia Machado Dos Santos
- Faculdade de Medicina (FAMED) - Universidade Federal do Rio Grande (FURG), Rio Grande city, Rio Grande do Sul State, Brazil
| | - Roberta Raseira Caldeira
- Faculdade de Medicina (FAMED) - Universidade Federal do Rio Grande (FURG), Rio Grande city, Rio Grande do Sul State, Brazil
| | - Gisele Zanetti Senhorin
- Faculdade de Medicina (FAMED) - Universidade Federal do Rio Grande (FURG), Rio Grande city, Rio Grande do Sul State, Brazil
| | - Susi Lauz
- Faculdade de Medicina (FAMED) - Universidade Federal do Rio Grande (FURG), Rio Grande city, Rio Grande do Sul State, Brazil
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Wang Y, Yang J, Yu M, Cao D, Zhang Y, Zong X, Shen K. Ovarian yolk sac tumor in postmenopausal females: A case series and a literature review. Medicine (Baltimore) 2018; 97:e11838. [PMID: 30113473 PMCID: PMC6112915 DOI: 10.1097/md.0000000000011838] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Ovarian yolk sac tumors (YSTs) are the second most common histologic type of ovarian germ cell tumors. Most patients are adolescent and young women, while cases in postmenopausal women were rarely reported. Due to its rarity, we know little about the treatment and prognosis of postmenopausal patients with ovarian YSTs. We reported 3 cases of mixed ovarian YST in postmenopausal females reviewed the related current English literature. PATIENT CONCERNS The ages of the three patients were 61, 58 and 77 respectively. The three patients came to the hospital because of the abdominal discomfort or tenderness, and the third patient also has vaginal bleeding. DIAGNOSES Imaging examination revealed pelvic mass with cystic and solid components. The elevated serum AFP level and pathologcial examination confirmed mixed ovarian YST. INTERVENTIONS All patients received surgery and chemotherapy. Two patients received PEB (cisplatin, etoposide, and bleomycin) chemotherapy initially and one patient received TC (paclitaxel carboplatin) chemotherapy. OUTCOMES One patient relapsed 8 months after diagnosis and underwent re-cytoreductive surgery. The three patients all survived at last follow-up. LESSONS The diagnosis of postmenopausal ovarian YST is relatively difficult and it can coexist with other germ cell or epithelial tumors. Postmenopausal ovarian YSTs are aggressive, and may have a worse prognosis compared with those in young patients. More aggressive treatment is needed. When YST mixed with epithelial cancer components, adjuvant chemotherapy regimen should include platinum-based chemotherapy aiming at both epithelial ovarian cancer and germ cell tumors.
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Stafman LL, Maizlin II, Dellinger M, Gow KW, Goldfarb M, Nuchtern JG, Langer M, Vasudevan SA, Doski JJ, Goldin AB, Raval M, Beierle EA. Disparities in fertility-sparing surgery in adolescent and young women with stage I ovarian dysgerminoma. J Surg Res 2017; 224:38-43. [PMID: 29506849 DOI: 10.1016/j.jss.2017.11.046] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 09/29/2017] [Accepted: 11/15/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND In many cancers, racial and socioeconomic disparities exist regarding the extent of surgery. For ovarian dysgerminoma, fertility-sparing (FS) surgery is recommended whenever possible. The aim of this study was to investigate rates of FS versus non-fertility-sparing (NFS) procedures for stage I ovarian dysgerminoma in adolescents and young adults (AYAs) by ethnicity/race and socioeconomic status. MATERIALS AND METHODS The National Cancer Data Base was queried for patients with ovarian dysgerminoma from 1998 to 2012. After selecting patients aged 15-39 y with stage I disease, a multivariate regression analysis was performed, and rates of FS and NFS procedures were compared, first according to ethnicity/race, and then by socioeconomic surrogate variables. RESULTS Among the 687 AYAs with stage I ovarian dysgerminoma, there was no significant difference in rates of FS and NFS procedures based on ethnicity/race alone (P = 0.17), but there was a significant difference in procedure type for all three socioeconomic surrogates. The uninsured had higher NFS rates (30%) than those with government (21%) or private (19%) insurance (P = 0.036). Those in the poorest ZIP codes had almost twice the rate of NFS procedures (31%) compared with those in the most affluent ZIP codes (17%). For those in the least-educated regions, 24% underwent NFS procedures compared to 14% in the most-educated areas (P = 0.027). CONCLUSIONS AYAs with stage I ovarian dysgerminoma in lower socioeconomic groups were more likely to undergo NFS procedures than those in higher socioeconomic groups, but there was no difference in rates of FS versus NFS procedures by ethnicity/race. Approaches aimed at reducing socioeconomic disparities require further examination.
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Affiliation(s)
- Laura L Stafman
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ilan I Maizlin
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Matthew Dellinger
- Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Seattle, Washington
| | - Kenneth W Gow
- Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Seattle, Washington
| | - Melanie Goldfarb
- Department of Surgery, John Wayne Cancer Institute at Providence St. John's Health Center, Santa Monica, California
| | - Jed G Nuchtern
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Monica Langer
- Department of Surgery, Maine Children's Cancer Program, Tufts University, Portland, Maine
| | - Sanjeev A Vasudevan
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - John J Doski
- Department of Surgery, Methodist Children's Hospital of South Texas, University of Texas Health Science Center-San Antonio, San Antonio, Texas
| | - Adam B Goldin
- Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Seattle, Washington
| | - Mehul Raval
- Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Elizabeth A Beierle
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
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Socioeconomic disparities affect survival in malignant ovarian germ cell tumors in AYA population. J Surg Res 2017; 222:180-186.e3. [PMID: 28988685 DOI: 10.1016/j.jss.2017.09.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 08/15/2017] [Accepted: 09/12/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Malignant ovarian germ cell tumors (MOGCTs) are a rare form of ovarian malignancy. Socioeconomic status (SES) has been shown to affect survival in several gynecologic cancers. We examined whether SES impacted survival in adolescent and young adults (AYAs) with MOGCT. MATERIALS AND METHODS The National Cancer Data Base was used to identify AYAs (aged 15-39 years) with MOGCT from 1998 to 2012. Three SES surrogate variables identified were as follows: insurance type, income quartile, and education quartile. Pooled variance t-tests and chi-square tests were used to compare tumor characteristics, the time from diagnosis to staging/treatment, and clinical outcome variables for each SES surrogate variable, while controlling for age and race/ethnicity in a multivariate model. Kaplan-Meier survival estimates were calculated using the log-rank test. RESULTS A total of 3125 AYAs with MOGCT were identified. Subjects with lower SES measures had higher overall stage and T-stage MOGCTs at presentation. There was no significant difference in the time to staging/treatment, extent of surgery, or use of chemotherapy by SES. Subjects from a lower education background, from a lower income quartile, and without insurance had decreased survival (P ≤ 0.02 for all). Controlling for overall stage and T-stage, the difference in survival was no longer significant. CONCLUSIONS AYAs with MOGCT from lower SES backgrounds presented with more advanced stage disease. Further studies that focus on the underlying reasons for this difference are needed to address these disparities.
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Nasioudis D, Chapman-Davis E, Frey MK, Caputo TA, Holcomb K. Management and prognosis of ovarian yolk sac tumors; an analysis of the National Cancer Data Base. Gynecol Oncol 2017; 147:296-301. [PMID: 28803748 DOI: 10.1016/j.ygyno.2017.08.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 08/07/2017] [Accepted: 08/08/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate the clinico-pathological characteristics, management and prognosis of women diagnosed with ovarian yolk sac tumors (OYSTs). METHODS The U.S National Cancer Data Base was queried for women diagnosed with OYST between 2004 and 2014. Overall survival (OS) was calculated following generation of Kaplan-Meir curves. Univariate analysis was performed with the log-rank test. A Cox model was constructed to determine independent predictors of mortality. RESULTS A total of 561 women were identified with a median age of 23years. The majority (58.5%) had early stage (I-II), while 29.6% and 11.9% had stage III and IV disease respectively. Five-year OS for women with stage I, II, III and IV disease were 94.8%, 97.1%, 70.9% and 51.6% respectively, p<0.001. Better 5-yr OS was observed for adolescents (94.4%) and young adults (89.3%) compared to older premenopausal (67.6%) and postmenopausal women (30.6%), p<0.001. Omentectomy, hysterectomy and lymph node sampling/dissection (LND) were not associated with better OS. Women who received adjuvant chemotherapy had superior OS compared to those who did not, p=0.016. Early disease stage, younger age and receipt of adjuvant chemotherapy, but not LND were independently associated with better mortality. CONCLUSIONS Women with OYST commonly present with early stage disease. Administration of adjuvant chemotherapy, early stage and younger age are associated with superior outcomes.
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Affiliation(s)
- Dimitrios Nasioudis
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA; Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
| | - Eloise Chapman-Davis
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA
| | - Melissa K Frey
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA
| | - Thomas A Caputo
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA
| | - Kevin Holcomb
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA
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Pyle LC, Nathanson KL. A practical guide for evaluating gonadal germ cell tumor predisposition in differences of sex development. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2017; 175:304-314. [PMID: 28544305 DOI: 10.1002/ajmg.c.31562] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 04/12/2017] [Accepted: 04/13/2017] [Indexed: 01/16/2023]
Abstract
Differences of Sex Development (DSD) includes a wide spectrum of etiologies and phenotypes. A subset of individuals with DSDs are predisposed to gonadal germ cell tumor (GCT). In this setting, GCT risk varies widely, depending on the DSD molecular etiology and penetrance. Prognostication based on molecular diagnosis remains challenging, as natural history data specific to recently identified molecular causes of DSD is lacking. In this review, we provide a framework for the clinical geneticist to consider GCT tumor risk in the patient with DSD. We discuss germ cell development and etiology of GCT growth, along with parameters to consider when recommending prophylactic gonadectomy including fertility, hormonal output, and malignant GTC treatment outcomes. Shortly after the 2006 reorganization of DSD nomenclature, literature reviews of natural history publications stratified GCT risk by a chromosomal, pathological, and hormonal taxonomy. Our 2017 literature review reveals a larger body of publications. However, the broad DSD GCT risk stratification within the 2006 taxonomy remains stable. We discuss precise GCT risk assessment for specific diagnoses, including androgen insensitivity, Smith-Lemli-Opitz, and 46,XY with MAP3K1 mutations and gonadal dysgenesis, as examples. We also examine the GCT risk in non-DSD syndromes, in addition to the cancer risks in DSD patients with dimorphic gonads and genitalia. This review is intended to provide a nuanced assessment of relative germ cell tumor risk in the DSD patient, including modern precise molecular diagnosis, for use by the clinical geneticist.
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Affiliation(s)
- Louise C Pyle
- Translational Medicine/Human Genetics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Katherine L Nathanson
- Translational Medicine/Human Genetics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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Zhao Q, Yang J, Cao D, Han J, Xu K, Liu Y, Shen K. Tailored therapy and long-term surveillance of malignant germ cell tumors in the female genital system: 10-year experience. J Gynecol Oncol 2016; 27:e26. [PMID: 27029747 PMCID: PMC4823357 DOI: 10.3802/jgo.2016.27.e26] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 12/21/2015] [Accepted: 12/23/2015] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To explore the appropriate treatment of malignant germ cell tumor (MGCT) in the female genital system, and to analyze the factors influencing both therapeutic response and survival outcome. METHODS A cohort of 230-Chinese women diagnosed with MGCT of the genital system was retrospectively reviewed and prospectively followed. The demographic and pathological features, extent of disease and surgery, treatment efficiency, recurrence and survival were analyzed. RESULTS MGCTs from different genital origins shared a similar therapeutic strategy and response, except that all eight vaginal cases were infantile yolk sac tumors. The patients' cure rate following the initial treatment, 5-year overall survival and disease-free survival (DFS) were 85.02%, 95.00%, and 86.00%, respectively. Although more extensive excision could enhance the remission rate; it did not improve the patients' survival. Instead, the level of the medical institution, extent of surgery and disease were independent prognostic factors for relapse (p<0.05). Approximately 20% of patients had recurrent or refractory disease, more than half of whom were in remission following secondary cytoreductive surgery with salvage chemotherapy. CONCLUSION Fertility-sparing surgery with or without standardized PEB/PVB (cisplatin, etoposide/vincristine, and bleomycin) chemotherapy is applicable for female MGCTs of different origins. Comprehensive staging is not required; nor is excessive debulking suggested. Appropriate cytoreduction by surgery and antineoplastic medicine at an experienced medical institution can bring about an excellent prognosis for these patients.
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Affiliation(s)
- Qianying Zhao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jiaxin Yang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Dongyan Cao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jiangna Han
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Kaifeng Xu
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yongjian Liu
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Keng Shen
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
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Gupta M, Jindal R, Saini V. An Incidental Finding of Bilateral Dysgerminoma During Cesarean Section: Dilemmas in Management. J Clin Diagn Res 2016; 10:QD04-5. [PMID: 27656514 DOI: 10.7860/jcdr/2016/20163.8319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 06/16/2016] [Indexed: 11/24/2022]
Abstract
Dysgerminoma is an uncommon malignant tumour arising from germ cells of ovary. It occurs mostly in the reproductive age group. Its association with pregnancy is rare. Its management remains a challenge especially in an unsuspected case. We present a case of a woman, aged 28-year-old gravida2 para1 who reported to us at 36 weeks' pregnancy with severe preeclampsia and previous caesarean section. On ultrasound she was reported as having subserosal fibroids with single live fetus of 35 weeks and 3 days gestation. She delivered a live baby by caesarean section done for failed induction. Intraoperatively bilateral ovarian masses were found and removed which were later confirmed to be dysgerminoma on histopathological examination. As she was not diagnosed dysgerminoma pre-operatively, complete work up i.e., tumour markers and MRI was not done, leading to dilemmas in management. Though standard protocols for management of dysgerminoma with pregnancy exist, yet management of these incidentally diagnosed dysgerminomas remains a dilemma.
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Affiliation(s)
- Mamta Gupta
- Senior Consultant and Head of Department, Department of Obstetrics and Gynaecology, Hindu Rao Hospital , Delhi, India
| | - Rita Jindal
- Specialist, Department of Obstetrics and Gynaecology, Hindu Rao Hospital , Delhi, India
| | - Vandana Saini
- Senior Specialist, Department of Obstetrics and Gynaecology, Hindu Rao Hospital , Delhi, India
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Calzas Rodríguez J, Carmen Juarez Morales MD, Casero MAR. Death by bleomycin pulmonary toxicity in ovarian dysgerminoma with pathologic complete response to chemotherapy. A case report. Respir Med Case Rep 2016; 18:48-50. [PMID: 27330950 PMCID: PMC4913162 DOI: 10.1016/j.rmcr.2016.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 04/14/2016] [Accepted: 04/15/2016] [Indexed: 11/29/2022] Open
Abstract
With cisplatin-based chemotherapy, most patients with ovarian dysgerminoma will survive long-term. Bleomycin is an important part of ovarian germ cell tumors (OGCT) treatment, and its dose-limiting toxicity is the development of pulmonary toxicity and it is increased in patients older than 40 years. We report the case of an elderly patient with an unresectable ovarian dysgerminoma who received neoadjuvant chemotherapy and who developed fatal bleomycin pulmonary toxicity (BPT) after surgery. A monitoring of pulmonary function is not routinely recommended for detecting BPT, although together with carefully assessment for symptoms or signs suggestive of pulmonary toxicity is the best way to reduce the risk of BPT. The frequency of pulmonary events in older patients makes us to think about the possibility of either reduce the dose of bleomycin or removing it from the BEP in ovarian GCT.
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Nasioudis D, Ramer I, Sisti G, Fambrini M. Risk of Second Primary Tumors After Childhood and Adolescent Ovarian Malignancies: A SEER Analysis (1973-2011). J Pediatr Adolesc Gynecol 2015; 28:522-5. [PMID: 26152647 DOI: 10.1016/j.jpag.2015.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 02/24/2015] [Accepted: 03/17/2015] [Indexed: 10/23/2022]
Abstract
STUDY OBJECTIVE To calculate the incidence of second primary tumors (SPTs) in patients previously diagnosed with malignant ovarian tumors in childhood and adolescence. This is an area of interest given the high survival rate and, thus, the long disease-free period that these patients face. DESIGN AND PARTICIPANTS We conducted a retrospective study following a cohort of patients between 1973 and 2011. Using the National Cancer Institute's Surveillance, Epidemiology and End-Result (SEER) database, we identified patients with an ovarian malignant tumor diagnosed at 19 years of age or younger. RESULTS Of the 806 patients included in our study, 28 patients developed an SPT after the diagnosis of malignant ovarian tumor. This cohort had higher risk of solid tumors (standardized incidence ratio [SIR] 1.85, 95% CI 1.15 to 2.83) and lymphohematologic malignancies (SIR 5.28, 95% CI 2.12 to 10.88) compared with the general population. There is a higher incidence of lymphoma (SIR 4.25, 95% CI 1.16 to 10.89) and acute nonlymphocytic leukemia (SIR 19.65, 95% CI 4.05 to 57.42), following initial diagnosis of ovarian malignancy during childhood or adolescence. CONCLUSION The association between ovarian malignancy during childhood or adolescence and lymphoma has not been previously described. Increased incidence of acute nonlymphocytic leukemia supports previous data, underlying the need for long-term follow-up and surveillance of these patients.
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Affiliation(s)
- Dimitrios Nasioudis
- Department of Gynecology, General Military Hospital of Athens, Athens, Greece
| | - Ilana Ramer
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Giovanni Sisti
- Department of Science for Woman and Child Health, University of Florence, Florence, Italy.
| | - Massimiliano Fambrini
- Department of Science for Woman and Child Health, University of Florence, Florence, Italy
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Trétarre B, Molinié F, Woronoff AS, Bossard N, Bessaoud F, Marrer E, Grosclaude P, Guizard AV, Delafosse P, Bara S, Velten M, Lapôtre-Ledoux B, Ligier K, Léone N, Arveux P, Uhry Z. Ovarian cancer in France: Trends in incidence, mortality and survival, 1980–2012. Gynecol Oncol 2015; 139:324-9. [DOI: 10.1016/j.ygyno.2015.09.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 09/10/2015] [Accepted: 09/13/2015] [Indexed: 10/23/2022]
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Meisel JL, Woo KM, Sudarsan N, Eng J, Patil S, Jacobsen EP, Murali R, Gardner GJ, Bosl GJ, Aghajanian C, Feldman DR. Development of a risk stratification system to guide treatment for female germ cell tumors. Gynecol Oncol 2015; 138:566-72. [PMID: 26115974 DOI: 10.1016/j.ygyno.2015.06.029] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 06/18/2015] [Accepted: 06/22/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Due to their rarity, little is known about prognostic factors in female germ cell tumors (GCTs) or outcomes following systemic therapy. Management is largely based on studies of male GCT and epithelial ovarian cancer. METHODS Chart review was performed for all females with GCT seen at Memorial Sloan Kettering Cancer Center (MSKCC) from 1990 to 2012. Patients receiving chemotherapy were stratified using a modification of the male IGCCCG risk system, and the classifier was correlated with outcome. RESULTS Of 93 patients, 92 (99%) underwent primary surgery and 85 (92%) received chemotherapy. Modified IGCCCG classification was significantly associated with progression-free survival (PFS) and overall survival (OS), both when applied preoperatively and pre-chemotherapy (p<0.001 for all four analyses). Progression after initial chemotherapy (n=29) was detected by imaging in 14 (48%) patients, by serum tumor markers in 6 (21%) patients, and by multiple methods in the rest. Seven (29%) of 24 patients treated with salvage chemotherapy achieved long-term PFS, including 4/6 who received high-dose chemotherapy (HDCT) as initial salvage versus 3/16 treated with other initial salvage regimens. The estimated 3-year OS rate was 84% (95% CI, 76-92%), with a trend favoring dysgerminoma over non-dysgerminoma histologies (p=0.12). CONCLUSIONS Modified IGCCCG classification was prognostic for female GCT patients in this cohort and identified a poor-risk group who may benefit from more intensive first-line chemotherapy. Both imaging and tumor marker evaluation were important in identifying relapses after first-line chemotherapy. The majority of long-term remissions with salvage therapy were achieved with initial salvage HDCT.
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Affiliation(s)
- Jane L Meisel
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Kaitlin M Woo
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Nora Sudarsan
- Department of Medicine, St. Luke's Roosevelt Hospital Center, Continuum Cancer Centers, New York, NY, United States
| | - Jana Eng
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Sujata Patil
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Erin P Jacobsen
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Rajmohan Murali
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, United States; Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Ginger J Gardner
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - George J Bosl
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Carol Aghajanian
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Darren R Feldman
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
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Chen CA, Lin H, Weng CS, Wen KC, Lu CH, Chou HH, Huang YF, Kang CY, Ho CM, Yu MH, Chou CY. Outcome of 3-day bleomycin, etoposide and cisplatin chemotherapeutic regimen for patients with malignant ovarian germ cell tumours: a Taiwanese Gynecologic Oncology Group study. Eur J Cancer 2015; 50:3161-7. [PMID: 25459394 DOI: 10.1016/j.ejca.2014.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Revised: 10/03/2014] [Accepted: 10/05/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND The combination of bleomycin, etoposide and cisplatin (BEP) is currently the most widely used treatment for malignant ovarian germ cell tumours (MOGCTs). The aim of this study was to evaluate the efficacy and adverse effects of the 3-day BEP regimen in Taiwan. The prognostic factors of the MOGCT patients were also analysed. PATIENTS AND METHODS Two hundred and thirty-nine cases of MOGCTs were identified from the Taiwanese Gynecologic Oncology Group database, and 204 of those who received postoperative BEP chemotherapy were then analysed. RESULTS The estimated rate of no evidence of disease was 94.0% for 204 patients with adjuvant BEP regimen. Seven grade 3/4 haematological adverse effects including four subjects with neutropenia, one with pancytopenia and two with neutropenic fever were recorded in the 853 total courses of chemotherapeutic cycles. The rates of haematological and non-haematological adverse effects were 0.82% and 2.3%, respectively. No treatment-related mortality was noted. In the analysis of prognostic factors, only tumour stage had a significant impact on disease recurrence (95% confidence interval (CI), 4.2–94.4, p < 0.001) and disease-related mortality (95% CI, 2.2–163.9, p = 0.007). CONCLUSIONS The current 3-day adjuvant BEP regimen was effective and safe for patients with MOGCTs.
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