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Pashankar F, Hanley K, Lockley M, Stoneham S, Nucci MR, Reyes-Múgica M, Elishaev E, Vang R, Veneris J, Rytting H, Olson T, Hazard K, Covens A, Arora R, Billmire D, Al-Ibraheemi A, Ulbright TM, Frazier L, Hirsch MS. Addressing the diagnostic and therapeutic dilemmas of ovarian immature teratoma: Report from a clinicopathologic consensus conference. Eur J Cancer 2022; 173:59-70. [PMID: 35863107 DOI: 10.1016/j.ejca.2022.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 06/03/2022] [Accepted: 06/06/2022] [Indexed: 11/24/2022]
Abstract
Ovarian immature teratoma is a rare subtype of germ cell tumour that can be pure or associated with non-teratomatous germ cell tumour elements and is graded based on extent of the immature neuroectodermal component. Immature teratoma (IT) can also be associated with somatic differentiation in the form of sarcoma, carcinoma, or extensive immature neuroectodermal elements and may produce low levels of serum alpha-fetoprotein. Variable interpretation of these issues underlies diagnostic and management dilemmas, resulting in substantial practice differences between paediatric and adult women with IT. The Malignant Germ Cell International Consortium (MaGIC) convened oncologists, surgeons, and pathologists to address the following crucial clinicopathologic issues related to IT: (1) grading of IT, (2) definition and significance of 'microscopic' yolk sac tumour, (3) transformation to a somatic malignancy, and (4) interpretation of serum tumour biomarkers. This review highlights the discussion, conclusions, and suggested next steps from this clinicopathologic conference.
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Affiliation(s)
- Farzana Pashankar
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Krisztina Hanley
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Michelle Lockley
- Department of Medical Oncology, University College Hospital, University College London Hospital, NHS Foundation Trust, London, UK; Centre for Cancer Genomics and Computational Biology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Sara Stoneham
- Department of Pediatrics University College Hospital, University College London Hospital, NHS Foundation Trust, London, UK
| | - Marisa R Nucci
- Department of Pathology, Women's and Perinatal Division, Brigham and Women's Hospital; Harvard Medical School, Boston, MA, USA
| | - Miguel Reyes-Múgica
- Department of Pathology, University of Pittsburg Medical Center, Pittsburg, PA, USA
| | - Esther Elishaev
- Department of Pathology, University of Pittsburg Medical Center, Pittsburg, PA, USA
| | - Russell Vang
- Department of Pathology, Johns Hopkins Hospital, Baltimore, MD, USA
| | | | - Heather Rytting
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Thomas Olson
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Atlanta, GA, USA
| | - Kim Hazard
- Department of Pathology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Al Covens
- Division of Gyneacologic Oncology, University of Toronto, Sunnybrook Health Science Centre, Toronto, ON
| | - Rupali Arora
- Department of Gyneacology, University College Hospital, University College London Hospital, NHS Foundation Trust, London, UK
| | - Deborah Billmire
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Alyaa Al-Ibraheemi
- Harvard Medical School, Boston, MA, USA; Department of Pathology, Boston Children's Hospital, Boston, MA, USA
| | - Thomas M Ulbright
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Lindsay Frazier
- Harvard Medical School, Boston, MA, USA; Dana Farber/Boston Children's Cancer and Blood Center, Boston, MA, USA
| | - Michelle S Hirsch
- Department of Pathology, Women's and Perinatal Division, Brigham and Women's Hospital; Harvard Medical School, Boston, MA, USA.
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Velasco Palma A, Riquelme Sánchez E, Schulze Maroto M, Villarroel del Pino L, Leach FS. [Immunohistochemical and molecular analyis of mismatch repair genes in germ cell tumors]. Actas Urol Esp 2005; 29:198-206. [PMID: 15881919 DOI: 10.1016/s0210-4806(05)73223-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
UNLABELLED Correction of misincorporated nucleotides during DNA replication (mismatch repair) distinguishes histologically similar cancers with distinct biological and clinical behavior. We investigated expression of two mismatch repair genes in testis cancer to determine the expression pattern in histologically distinct subtypes, correlate expression with genetic instability and correlate expression and genetic instability with clinical outcome. PATIENTS AND METHODS 118 cases of testis cancer were analyzed. Immunohistochemical analysis of paraffin embedded specimens utilized monoclonal antibody for hMLH1 and hMSH2 mismatch repair proteins. Genetic instability was determined by comparing genomic DNA from microdissected matched normal and tumor cells. PCR amplification of 10 genetic markers assessed loss of heterozygosity and/or microsatellite instability. RESULTS hMSH2 staining was associated with pathologic stage (p < 0.001) while hMLH1 staining was associated with cancer specific survival (p = 0.036). Genetic instability was detected in 94% of low hMLH1 and 92% of low hMSH2 staining tumors. Relapse and cancer specific death correlated with genetic instability (p = 0.01 and 0.04 respectively). Overall 9% of tumors exhibited reduced mismatch repair expression, microsatellite instability and an unfavorable clinical outcome. CONCLUSIONS Mismatch repair expression and genetic instability define testis cancers with distinct molecular properties and clinical behavior. In conjunction with pathologic examination and serum tumor markers, mismatch repair expression may be an important determinant for clinical management of men with this malignancy.
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Affiliation(s)
- A Velasco Palma
- Departamento de Urología, Facultad de Medicina, Pontificia Universidad Católica de Chile.
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