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Gică N, Peltecu G, Chirculescu R, Gică C, Stoicea MC, Serbanica AN, Panaitescu AM. Ovarian Germ Cell Tumors: Pictorial Essay. Diagnostics (Basel) 2022; 12:diagnostics12092050. [PMID: 36140449 PMCID: PMC9498179 DOI: 10.3390/diagnostics12092050] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/11/2022] [Accepted: 08/19/2022] [Indexed: 11/16/2022] Open
Abstract
Ovarian germ cell tumors of the ovary represent a histologically heterogenous group of tumors with a high incidence at reproductive age. Patients with this pathology are very often young women with amenorrhea. The aim of this article is to present a pictorial essay of this rare pathology and to promote a national tumor registry and protocol. The treatment is individualized according to age, and fertility-sparing surgery is the actual standard of surgical treatment for young patients in early stage of the disease.
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Affiliation(s)
- Nicolae Gică
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Filantropia Clinical Hospital, 011132 Bucharest, Romania
| | - Gheorghe Peltecu
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Filantropia Clinical Hospital, 011132 Bucharest, Romania
- Correspondence:
| | - Raluca Chirculescu
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Filantropia Clinical Hospital, 011132 Bucharest, Romania
| | - Corina Gică
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Filantropia Clinical Hospital, 011132 Bucharest, Romania
| | | | - Andreea Nicoleta Serbanica
- Department of Pediatrics, Fundeni Clinical Institute, Department of Pediatrics Hematology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Anca Maria Panaitescu
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Filantropia Clinical Hospital, 011132 Bucharest, Romania
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He Z, Lu Y, Xie C. Fast-growing immature ovarian teratoma during pregnancy: a case report and a review of the literature. BMC Pregnancy Childbirth 2022; 22:519. [PMID: 35761185 PMCID: PMC9237990 DOI: 10.1186/s12884-022-04857-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 06/22/2022] [Indexed: 11/18/2022] Open
Abstract
Background Immature ovarian teratoma is one of the three common malignant ovarian germ cell tumors. However, immature ovarian teratoma in pregnancy is very rare. Due to the rare occurrence, there is little evidence regarding its diagnosis, optimal management, and prognosis. Hence, we present a case of immature teratoma diagnosed during pregnancy, and analyze its clinicopathological features, management and prognosis. Case presentation A 28-year-old woman underwent a sonographic examination revealed no abnormality in the bilateral adnexal area before 29 weeks gestational age (WGA). At 29 WGA, ultrasound demonstrated a 9.7 × 8.5 × 6.4 cm complex structure in the left adnexal area. At 30 WGA, repeated ultrasound revealed rapid growth of tumor mass, measuring 25.0 × 15.0 × 13.7 cm. An elective cesarean section combined with exploratory laparotomy was performed at 33 WGA. Intraoperative frozen pathological examination suggested left ovarian immature teratoma. Then, she underwent a complete staging surgery. Subsequently, the patient received 4 cycles of bleomycin-etoposide-cisplatin (BEP) chemotherapy. After 18 months of follow-up, there is no sign of tumor recurrence till now. Conclusions This case report suggests that the benefits and risks of timely treatment for patients and fetuses should be fully assessed by a multidisciplinary team. The early diagnosis, the timing of surgery and chemotherapy, the choice of chemotherapy for BEP will determine the prognosis. Surgery and combination chemotherapy with BEP play an important role in the treatment of immature teratomas in pregnancy, and could gain successful and satisfactory outcomes for mother and fetus.
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Homaei Shandiz F, Emadi Torghabeh A. Management of ovarian immature teratoma grade-II in pregnancy, two cases report and literature review. Clin Case Rep 2021; 9:e04456. [PMID: 34267917 PMCID: PMC8271255 DOI: 10.1002/ccr3.4456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/08/2021] [Accepted: 05/31/2021] [Indexed: 11/07/2022] Open
Abstract
Postoperative chemotherapy during pregnancy after first trimester is essential for patients with initial disease stage 1, grade 2 ovarian immature teratoma and it associates with lower disease progression and recurrence.
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Affiliation(s)
- Fatemeh Homaei Shandiz
- Cancer Research CenterMashhad University of Medical SciencesMashhadIran
- Faculty of MedicineDepartment of Radiotherapy and OncologyMashhad University of Medical SciencesMashhadIran
| | - Ali Emadi Torghabeh
- Cancer Research CenterMashhad University of Medical SciencesMashhadIran
- Faculty of MedicineDepartment of Radiotherapy and OncologyMashhad University of Medical SciencesMashhadIran
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Feto-maternal outcomes of pregnancy complicated by ovarian malignant germ cell tumor: a systematic review of literature. Eur J Obstet Gynecol Reprod Biol 2014; 181:145-56. [DOI: 10.1016/j.ejogrb.2014.07.047] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 07/19/2014] [Accepted: 07/29/2014] [Indexed: 12/26/2022]
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Guo YL, Zhang YL, Zhu JQ. Prognostic value of serum α-fetoprotein in ovarian yolk sac tumors: A systematic review and meta-analysis. Mol Clin Oncol 2014; 3:125-132. [PMID: 25469282 DOI: 10.3892/mco.2014.417] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 09/03/2014] [Indexed: 12/22/2022] Open
Abstract
This study was conducted to determine the prognostic value of serum α-fetoprotein (AFP) levels in patients with ovarian yolk sac tumor (OYST). We performed a systematic review and meta-analysis to assess the associations between serum AFP level and prognosis in OYST. A total of 12 quantitative studies met the inclusion criteria. Preoperative AFP was not found to be associated with overall survival (OS) [odds ratio (OR)=0.84, 95% confidence interval (CI): 0.43-1.62] in OYST. However, a high postoperative AFP level was associated with worse OS (OR=0.16, 95% CI: 0.05-0.48) and relapse-free survival (RFS) (OR=0.18, 95% CI: 0.08-0.43) compared to a low postoperative AFP level in patients with OYST. In addition, a postoperative AFP level of >1,000 ng/ml was associated with a decrease in OS (OR=0.16, 95% CI: 0.05-0.50) and RFS (OR=0.21, 95% CI: 0.08-0.57). In conclusion, the postoperative, but not the preoperative, AFP level was found to be a prognostic factor in patients with OYST. In particular, a postoperative AFP level of >1,000 ng/ml was an indicator of poor prognosis in patients with OYST.
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Affiliation(s)
- Yang-Long Guo
- Department of Gynecologic Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, P.R. China
| | - Ying-Li Zhang
- Department of Gynecologic Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, P.R. China
| | - Jian-Qing Zhu
- Department of Gynecologic Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, P.R. China
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Grimm D, Woelber L, Trillsch F, Keller-v.Amsberg G, Mahner S. Clinical management of epithelial ovarian cancer during pregnancy. Eur J Cancer 2014; 50:963-71. [DOI: 10.1016/j.ejca.2013.12.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 12/06/2013] [Accepted: 12/25/2013] [Indexed: 12/27/2022]
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Tariel O, Huissoud C, Rudigoz R, Dubernard G. Tumeurs ovariennes présumées bénignes lors de la grossesse. ACTA ACUST UNITED AC 2013; 42:842-55. [DOI: 10.1016/j.jgyn.2013.09.038] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Matsushita H, Tani H. Successful infertility treatment following fertility-sparing surgery and chemotherapy for ovarian immature teratoma: a case report and a literature review. Reprod Med Biol 2011; 10:193-198. [PMID: 29699094 DOI: 10.1007/s12522-011-0083-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Accepted: 03/31/2011] [Indexed: 11/25/2022] Open
Abstract
Introduction Malignant ovarian germ cell tumors (MOGCTs) are highly chemosensitive tumors most commonly found in adolescent girls and young women. However, patients with advanced disease can now be successfully cured with fertility-sparing surgery and adjuvant chemotherapy, resulting in childbearing. Case A 24-year-old nulliparous Japanese woman was diagnosed as having a stage IIIc immature teratoma. After fertility-sparing surgery, she received four cycles of chemotherapy consisting of cisplatin, etoposide, and pepleomycin. She married at the age of 34, but did not conceive due to sexual dysfunction of her husband. At the age of 38, intrauterine insemination was performed following ovulation induction with clomid and human menopausal gonadotrophin, which resulted in a singleton pregnancy. A healthy female infant was delivered at 38 weeks' gestation. Conclusion Treatment might sometimes be needed for infertile women with a history of MOGCTs, but further studies are needed to determine whether infertility treatment, including ovulation induction, is appropriate.
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Affiliation(s)
- Hiroshi Matsushita
- Department of Obstetrics and Gynecology Shizuoka General Hospital 4-27-1 Kitaando, Aoi-ku 420-8527 Shizuoka Japan
| | - Hirohiko Tani
- Department of Obstetrics and Gynecology Shizuoka General Hospital 4-27-1 Kitaando, Aoi-ku 420-8527 Shizuoka Japan
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Aggarwal P, Kehoe S. Ovarian tumours in pregnancy: a literature review. Eur J Obstet Gynecol Reprod Biol 2011; 155:119-24. [DOI: 10.1016/j.ejogrb.2010.11.023] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Revised: 10/30/2010] [Accepted: 11/30/2010] [Indexed: 10/18/2022]
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Kwon YS, Mok JE, Lim KT, Lee IH, Kim TJ, Lee KH, Shim JU. Ovarian cancer during pregnancy: clinical and pregnancy outcome. J Korean Med Sci 2010; 25:230-4. [PMID: 20119575 PMCID: PMC2811289 DOI: 10.3346/jkms.2010.25.2.230] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2008] [Accepted: 04/24/2009] [Indexed: 11/20/2022] Open
Abstract
The aim of this study is to evaluate the clinical feature and pregnancy outcome in patients with ovarian cancer diagnosed during pregnancy. We retrospectively analyzed the medical records of 27 patients diagnosed with ovarian cancer during pregnancy at Cheil General Hospital & Women's Healthcare Center from January 1996 to December 2006. Mean age of the patients was 29.1 yr (range 23-40), and a mean follow-up period was 57 months (range 7-112 months). Of 27 patients, 15 (55.5%) had borderline malignancies, 7 (25.9%) had epithelial malignancies and 5 (18.6%) had germ cell tumors. A total of 26 patients received a conservative surgery preserving pregnancy. The mean time for surgical intervention during pregnancy was 20 weeks of gestational age. Of the 27 patients, 26 had full term delivery of a healthy baby without any congenital malformation. Only one patient with epithelial ovarian cancer had a relapse at 19 months after the first conservative operation with adjuvant chemotherapy. There were few data for managing patients with ovarian cancer diagnosed during pregnancy. This study results could help establish a guideline for management of ovarian malignancy complicating pregnancy.
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Affiliation(s)
- Yong-Soon Kwon
- Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University, College of Medicine, Seoul, Korea
| | - Jung-Eun Mok
- Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University, College of Medicine, Seoul, Korea
| | - Kyung-Taek Lim
- Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University, College of Medicine, Seoul, Korea
| | - In-Ho Lee
- Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University, College of Medicine, Seoul, Korea
| | - Tae-Jin Kim
- Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University, College of Medicine, Seoul, Korea
| | - Ki-Heon Lee
- Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University, College of Medicine, Seoul, Korea
| | - Jae-Uk Shim
- Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University, College of Medicine, Seoul, Korea
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Ghaemmaghami F, Abbasi F, Abadi AGN. A favorable maternal and neonatal outcome following chemotherapy with etoposide, bleomycin, and cisplatin for management of grade 3 immature teratoma of the ovary. J Gynecol Oncol 2009; 20:257-9. [PMID: 20041106 DOI: 10.3802/jgo.2009.20.4.257] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2009] [Revised: 09/15/2009] [Accepted: 09/18/2009] [Indexed: 11/30/2022] Open
Abstract
Ovarian cancer rarely complicates pregnancy. Usually these malignancies consist of germ cell tumors. Preserving maternal safety along with favorable neonatal outcome is a subject of debate in the management of ovarian cancer during pregnancy. In this report, the authors describe a 25-year-old primigravid woman who was diagnosed to with an ovarian immature teratoma which was diagnosed at 13th weeks of pregnancy during a routine sonography. She underwent oophorectomy at week 21 of her gestation. Then she received three cycles of BEP regimen (bleomycin, etoposide, and cisplatin) during her pregnancy until week 37 of gestation. At 36 weeks she delivered a male baby with mild glandular hypospadia who was otherwise normal. Management of immature teratoma after the first trimester of pregnancy is similar to non-pregnant patients and is safe for both the mother and the fetus.
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Affiliation(s)
- Fatemeh Ghaemmaghami
- Department of Gynecology Oncology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Abstract
OBJECTIVE To evaluate the clinicopathologic prognostic factors in malignant ovarian germ cell tumors. METHODS We reviewed the medical records of 70 patients treated from 1990 to 2006 at our center. Clinical data including demographics, stage, surgery, chemotherapy, survival, menses status, and fertility were collected from patients' charts. RESULTS Median age was 22 years (range, 9-68). The histologic subtypes included 36 dysgerminomas, 11 yolk sac tumors, 3 immature teratomas, 1 embryonal carcinomas, and 19 mixed types. The most striking clinicopathologic finding was a history of concomitant immunosuppressant therapy, which was observed in 2 patients. Two patients had contralateral sex-cord tumors at presentation and follow-up. During a median follow-up period of 4.6 years, 11 patients had recurrence. The median time to recurrence was 8 months (6-28 months). Recurrences appeared in the abdominopelvic cavity in 9 out of 11 patients. Only one could be salvaged with second-line chemotherapy. Cumulative survival rate was 97% and 60% in patients with dysgerminoma and nondysgerminoma, respectively. Nondysgerminoma histology and residual tumor after surgery were unfavorable prognostic factors (P < 0.001 and P = 0.015). Fertility-sparing surgery was as effective as radical surgery among all eligible patients. Of patients with known menstrual status, 96% had regular menses. Of the 8 patients who opted for conception among these patients, 7 delivered healthy infants. CONCLUSIONS Nondysgerminomas have an aggressive clinical course. New treatment strategies are needed for eradication of abdominopelvic disease at initial diagnosis and recurrent setting. Occurrence of malignant ovarian germ cell tumors may be associated with immunosuppression in some patients. Sex-cord stromal tumors may present with bilateral involvement. It is possible to maintain fertility after fertility-sparing surgery followed by chemotherapy.
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Rupture of a malignant ovarian tumor in pregnancy presenting as acute abdomen. Arch Gynecol Obstet 2009; 281:959-61. [DOI: 10.1007/s00404-009-1294-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2009] [Accepted: 11/09/2009] [Indexed: 11/24/2022]
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Marret H, Lhommé C, Lécuru F, Canis M, Léveque J, Golfier F, Morice P. [French recommendations for ovarian cancer management during pregnancy]. ACTA ACUST UNITED AC 2009; 37:752-63. [PMID: 19709917 DOI: 10.1016/j.gyobfe.2009.07.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Evaluation of the fetus using prenatal ultrasound has resulted in increased detection of asymptomatic adnexal masses during pregnancy. Such masses are rarely malignant (1/10 000 to 1/50 000 pregnancies), but the possibility of borderline or cancer must be considered. It is a common assumption by both patients and physicians that if an ovarian cancer is diagnosed during pregnancy, treatment necessitates sacrificing the well-being of the fetus. However, in most cases, it is possible to offer appropriate treatment to the mother without placing the fetus at serious risk. The care of a pregnant woman with cancer involves evaluation of sometimes competing maternal and fetal risks and benefits. These recommendation approaches attempt to balance these risks and benefits; however, they should be considered advisory and should not replace specific interdisciplinary consultation with specialists in maternal-fetal medicine, gynecologic oncology, and pediatrics, as well as imaging and pathology, as needed. Second level ultrasound including Doppler is needed. MRI is not often necessary, and CA 125 is of low contribution. We suggest surgery be performed after 15 SA for ovarian masses which (1) persist into the second trimester, (2) are greater than 5 to 10 cm in diameter, or (3) have solid or mixed solid and cystic ultrasound characteristics. During antepartum surgical staging and debulking, homolateral salpingo-oophorectomy and peritoneal cytology and exploration are necessary. Women found to have advanced stage epithelial ovarian cancer should consider having completion of the debulking of the reproductive organs at the conclusion of the pregnancy. If chemotherapy is indicated, we recommend delaying administration, if possible, after the delivery or at least after 20 SA in order to minimize the potential fetal toxicity.
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Affiliation(s)
- H Marret
- Service de gynécologie, hôpital Bretonneau, centre hospitalo-universitaire de Tours, 37044 Tours cedex 1, France.
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Affiliation(s)
- J Palmer
- Department of Gynaecological Oncology, Royal Hallamshire Hospital, Sheffield, UK.
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Behtash N, Karimi Zarchi M, Modares Gilani M, Ghaemmaghami F, Mousavi A, Ghotbizadeh F. Ovarian carcinoma associated with pregnancy: a clinicopathologic analysis of 23 cases and review of the literature. BMC Pregnancy Childbirth 2008; 8:3. [PMID: 18205951 PMCID: PMC2266699 DOI: 10.1186/1471-2393-8-3] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2007] [Accepted: 01/20/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to analyze and describe cases of ovarian cancer in pregnant women treated at our center and to review the literature concerned, and to discuss the rationale for therapy. METHODS Twenty-Three patients of ovarian malignancies during pregnancy were treated at Vali- Asr Hospital between 1991 and 2002. Data on treatment and follow-up were evaluated. RESULTS The incidence of ovarian carcinoma associated with pregnancy in our series was 0.083/1000 deliveries. Eleven (47.8%) were found with ovarian malignant germ cell tumors, five (21.7%) with low malignant potential tumors, four (17.4%) with invasive epithelial tumors, and three (13%) with sex cord stromal tumors. Seventeen (73.9%) of the patients were diagnosed in stage I and had complete remission. Five of the six in advanced stage died. The mean follow-up was 36.3 months. The prognosis was significantly related with stage and histological type (P < 0.05). Sixteen healthy live babies were recorded in this group, and two premature newborn died of respiratory distress syndrome. Chemotherapy was administered to 44% of the patients, in two cases during pregnancy. Overall survival at 5 years was 61%. In most of case conservative surgical treatment could be performed with adequate staging and debulking. CONCLUSION Early finding of ascitis by ultrasound and persistent large ovarian mass during pregnancy may be related to malignancy and advanced stage. Pregnant women in advanced stage of ovarian cancer seem to have poor prognosis.
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Affiliation(s)
- Nadereh Behtash
- Gynecologic Oncology Fellowship from Tehran University Of Medical Science, Shahid Sadoughi University Of Medical Science, Shahid Sadoughi Hospital, Yazd, Iran.
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Noun M, Ennachit M, Boufettal H, Elmouatacim K, Samouh N. [The ovarian immature teratoma with gliomatosis peritonei]. ACTA ACUST UNITED AC 2007; 36:595-601. [PMID: 17537589 DOI: 10.1016/j.jgyn.2007.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Revised: 03/27/2007] [Accepted: 04/18/2007] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We return a case of ovarian immature teratoma with peritoneal gliomatose at a woman aged of 20 years. MATERIAL AND METHODS The diagnosis discovered following pelvic mass increasing volume and treaty by a one-sided annexectomy, with chemotherapy. RESULTS Eighty-seven cases have been published in the literature. Although potential for recurrence is high, the risk of malignancy is very low. CONCLUSION Ovarian immature teratoma is a malignant germ cell tumor and represents less than 1% of ovarian malignant tumors. Tissues are derived from the three germ layers (endo-, meso- and ectoderm). Tumor grading is based on the amount of immature neuroepithelium present. The prognosis is directly correlated to histological grade. Rapid (fast) growth leads to large tumors with an early diagnosis. Gliomatosis peritonei is a rare situation, characterized by the recurrence of peritoneal implants after the surgical treatment of ovarian teratoma. This entity does not modify the good prognosis of mature teratomas, but we recommend regular follow-up.
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Affiliation(s)
- M Noun
- Service de gynécologie-obstétrique C, maternité Lalla-Mériem, hôpital Ibn-Rochd de Casablanca, Casablanca, Maroc
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Chen CH, Yang MJ, Cheng MH, Yen MS, Lai CR, Wang PH. Fertility preservation with treatment of immature teratoma of the ovary. J Chin Med Assoc 2007; 70:218-21. [PMID: 17525001 DOI: 10.1016/s1726-4901(09)70362-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Fertility preservation for a patient with advanced immature teratoma of the ovary is reported. The patient, a 29-year-old woman, delivered a healthy baby after having had ovarian immature teratoma, grade 3, uncertain stage, at 13 years of age. She was initially treated with unilateral salpingo-oophorectomy and a contralateral wedge resection for tumor invasion, followed by a 6-course cisplatin+vinblastine+bleomycin regimen, a second operation, and an additional 6-course etoposide and cisplatin regimen with complete remission. The patient delivered a healthy baby 16 years after the initial treatment. Based on this successful case, intensive fertility-preserving surgery followed by chemotherapy, even in advanced-stage immature teratomas of the ovary, may be effective in preserving the reproductive function of women with malignant immature teratomas of the ovary.
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Affiliation(s)
- Chia-Hui Chen
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, and National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
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Machado F, Vegas C, Leon J, Perez A, Sanchez R, Parrilla JJ, Abad L. Ovarian cancer during pregnancy: analysis of 15 cases. Gynecol Oncol 2007; 105:446-50. [PMID: 17292456 DOI: 10.1016/j.ygyno.2007.01.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2006] [Revised: 12/07/2006] [Accepted: 01/02/2007] [Indexed: 10/23/2022]
Abstract
GOAL Our goal was to analyze and describe cases of ovarian cancer in pregnant women treated at our hospital. METHOD Retrospective study based on clinical histories from patients diagnosed and treated at our hospital for ovarian cancer and pregnancy from 1987 to 2005. RESULTS Fifteen cases of ovarian cancer were diagnosed among pregnant women; the ratio is 0.11/1000 deliveries. Among them, 66.6% of patients were asymptomatic, and 86.6% had been diagnosed via ultrasound. Of the diagnosed tumors, 40% were malignant epithelial tumors, 26.6% of them were of low malignant potential. The 20% were germinal cell tumors. Of these primary ovarian malignancies, the 59.9% were stage I. The remaining 20% were metastatic tumors. Forty percent of the total were treated conservatively (salpingo-oophorectomy) and 60% with hysterectomy and bilateral salpingo-oophorectomy. Chemotherapy was administered to 66.6% of the patients, in two cases during pregnancy. Eighty percent of the newborns were healthy and presented no sequelae or malformations. Global survival at 5 years was 76%. CONCLUSIONS Ovarian cancer is rare in pregnant women. Most malignant ovarian neoplasias in pregnant women are at early stages and are associated with good prognosis both for the mother and for the neonate.
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Affiliation(s)
- Francisco Machado
- Department of Obstetrics and Gynecology, Hospital Virgen de la Arrixaca, Murcia, Spain.
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De Backer A, Madern GC, Oosterhuis JW, Hakvoort-Cammel FGAJ, Hazebroek FWJ. Ovarian germ cell tumors in children: a clinical study of 66 patients. Pediatr Blood Cancer 2006; 46:459-64. [PMID: 16206211 DOI: 10.1002/pbc.20633] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Ovarian germ cell tumors are rare in childhood. The aim of this study is to review clinical presentation, management, and outcome in a two-center series of girls with ovarian germ cell tumor. PROCEDURE The records of 66 patients (median age 9 years) with histologically proven ovarian germ cell tumor (either benign or malignant), treated over a 44-year-span, were reviewed. RESULTS Pain and an abdominal mass were the most frequent symptoms. The tumors were right-sided in 35, left-sided in 28, and bilateral in 3. Most patients (52) were stage I, 4 were stage II, 6 stage III, and 1, with liver metastases, stage IV. Sixteen patients had an emergency operation for tumor torsion. Unilateral salpingo-oophorectomy was the most frequently performed procedure (n = 46), and ovarian-sparing tumorectomy was performed in 9 patients (one bilaterally). Histologically, teratomas were found most frequently (mature: 45, immature: 9), followed by mixed tumors (n = 7), yolk sac tumors (n = 3), dysgerminoma (n = 2), gonadoblastoma (n = 2), and embryonal carcinoma (n = 1). Surgical removal of the tumor with or without the ovary and/or adnex was the sole treatment in 55 patients, chemotherapy was administered in 10 and radiotherapy + chemotherapy in one. Intra-operative spillage of tumoral fluid occurred in six; this did not influence outcome in five. Recurrence was observed in three patients. Two patients, with malignant disease, died. The 64 survivors are now between 8 months and 44 years after treatment. CONCLUSIONS With a recurrence rate of 4.5% and a mortality rate of 3%, this series confirms the excellent prognosis for girls with ovarian germ cell tumor (GCT).
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Affiliation(s)
- Antoine De Backer
- Department of Pediatric Surgery, Academic Hospital, Free University of Brussels, Brussels, Belgium.
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Zhao XY, Huang HF, Lian LJ, Lang JH. Ovarian cancer in pregnancy: a clinicopathologic analysis of 22 cases and review of the literature. Int J Gynecol Cancer 2006; 16:8-15. [PMID: 16445603 DOI: 10.1111/j.1525-1438.2006.00422.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The aim of this study was to summarize our experience of ovarian cancer diagnosed during pregnancy, to review the literature concerned, and to discuss the rationale for therapy. Twenty-two patients of ovarian malignancies complicating pregnancy were treated at Peking Union Medical College Hospital between 1985 and 2003. Data on treatment and follow-up were reviewed, and their outcomes were analyzed by survival analysis. The incidence of ovarian carcinoma complicating pregnancy in the series was 0.073/1000 pregnancies. Nine (40.9%) were found with ovarian malignant germ cell tumors, six (27.3%) with low malignant potential tumors, five (22.7%) with invasive epithelial tumors, and two (9.1%) with sex cord stromal tumors. Sixteen (72.7%) of the patients were diagnosed in stage I and had achieved complete remission. Four of the five in advanced stage died. Ascites presenting at diagnosis implies advanced disease and gloomy prognosis. The mean follow-up was 47.8 months. The prognosis was significantly related with stage and histologic type (P < 0.05). Thirteen healthy live babies were recorded in this group, and one premature newborn died of respiratory distress syndrome. The clinical characters and prognosis of ovarian cancers complicating pregnancy are similar to those of nonpregnant, reproductive-age women. Management depends on histology of the tumor, stage of the tumor, and the term of the pregnancy. In most of cases, conservative surgical treatment could be performed with adequate staging and debulking equal to the treatment of nonpregnant women. Chemotherapy is not contraindicated during the second or third trimester, but the choice of couple must be considered.
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Affiliation(s)
- X Y Zhao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China 100730.
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Ayhan A, Taskiran C, Bozdag G, Altinbas S, Altinbas A, Yuce K. Endodermal sinus tumor of the ovary: The Hacettepe University experience. Eur J Obstet Gynecol Reprod Biol 2005; 123:230-4. [PMID: 16026921 DOI: 10.1016/j.ejogrb.2005.04.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2004] [Accepted: 04/18/2005] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the treatment regimens used for patients with endodermal sinus tumors (EST), and also to examine the prognostic value of surgicopathological variables. STUDY DESIGN Twenty-two patients treated for pure EST, and seven patients who had mixed germ cell tumors with EST components were included. Initial surgery consisting of surgical staging to achieve optimal debulking was the principal mode of therapy. Data were obtained from patients' files, a special gynecologic oncology database, and pathology records. RESULTS The median age at the time of diagnosis was 18 (range 8-45). Sixteen patients had stage I (55%), and 13 (45%) had stage II-IV disease. As an adjuvant therapy 18 patients (62%) received platin-based chemotherapy, three patients (10%) had non-platin-based chemotherapy, four patients (14%) had radiotherapy, and four patients (14%) had combined radiotherapy plus non-platin-based chemotherapy. The 5-year disease-free and overall survival rates were 47 and 48%, respectively. Survival rates were dismal in patients with stage II-IV disease (P < 0.001). Platin-based chemotherapy achieved significant survival benefit (P = 0.03 and P < 0.001, respectively). Fertility-saving surgery had an overall survival no worse than those who underwent more extensive surgery. There was no significant survival difference with respect to age, histology, and tumor size. CONCLUSION Fertility-sparing surgery with a postoperative platin-based combination chemotherapy should be the selected mode of treatment.
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Affiliation(s)
- Ali Ayhan
- Hacettepe University, Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Kadin Hastaliklari ve Doğum A.D., Hamamönü-Ankara, Turkey.
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Abstract
Ovarian tumors during pregnancy are very rare; however, a cancer diagnosis causes distress to the couple. Reassurance is paramount, and the first consideration should be given to the safety of the mother. If both mother and fetus can be preserved, treatment to minimize the risks to both should be planned accordingly. It is imperative to care for the patient with a multidisciplinary team that includes a high-risk obstetrician, a gynecologic oncologist, and a medical oncologist specialized in gynecologic cancers.
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Affiliation(s)
- Hamid Sayar
- Cancer Research and Treatment Center, Division of Hematology Oncology, University of New Mexico, 900 Camino de Salud NE, Albuquerque, NM 87131, USA.
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Chen MJ, Yang JH, Mao TL, Ho HN, Yang YS. Successful pregnancy in a gonadectomized woman with 46,XY gonadal dysgenesis and gonadoblastoma. Fertil Steril 2005; 84:217. [PMID: 16009184 DOI: 10.1016/j.fertnstert.2004.11.087] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2004] [Revised: 11/30/2004] [Accepted: 11/30/2004] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To present a case of successful pregnancy after conservative bilateral gonadectomy without adjuvant chemotherapy and radiotherapy in a 46,XY gonadal dysgenetic woman with gonadoblastoma and malignant germ cell tumor. DESIGN Case report. SETTING Infertility center in university hospital. PATIENT(S) An 18-year-old female with 46,XY karyotype underwent bilateral gonadectomy, and the pathology revealed gonadoblastoma with malignant mixed germ cell tumor. INTERVENTION(S) Chromosomal analysis, bilateral gonadectomy, donor oocyte, and IVF program. MAIN OUTCOME MEASURE(S) Tumor markers and pregnancy result. RESULT(S) The patient was free from tumor recurrence after 13 years' follow-up. A successful twin pregnancy was achieved after oocyte donation and IVF. CONCLUSION(S) Gonadectomy without adjuvant therapies could be done in 46,XY gonadal dysgenetic women with gonadoblastoma in view of preservation of future fertility.
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Affiliation(s)
- Mei-Jou Chen
- Department of Obstetrics and Gynecology, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
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Boran N, Tulunay G, Caliskan E, Köse MF, Haberal A. Pregnancy outcomes and menstrual function after fertility sparing surgery for pure ovarian dysgerminomas. Arch Gynecol Obstet 2004; 271:104-8. [PMID: 15007601 DOI: 10.1007/s00404-004-0601-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2002] [Accepted: 10/23/2003] [Indexed: 11/28/2022]
Abstract
MATERIALS AND METHODS The medical records of 23 patients with pure ovarian dysgerminoma treated by conservative surgery at SSK Ankara Maternity Hospital between 1991 and 2001 were reviewed retrospectively. Pregnancy outcomes and menstrual function after conservative surgery were analyzed. RESULTS Seven patients (30%) were incompletely staged and were assumed to be stage IA due to intraoperative findings. Fifteen patients (70%) were surgically staged. As a result 15 patients (65.2%) were diagnosed to be stage I while 2 patients (8.6%) were staged II and 6 patients (26%) were staged III. Wedge biopsy of contralateral ovary was performed in 17 patients (74%) and tumor was diagnosed in 2 (11.7%). Adjuvant chemotherapy was applied in 16 (70%) of the cases. BEP (bleomycin, etoposide, and cisplatin) was the most frequently used regimen (39%). Recurrences were seen in 3 (13%) patients. The sites of recurrences were contralateral ovary in all cases. Recurrences were treated with surgery and radiotherapy. None of the patients died of disease. Nine patients were sexually active. Five of these patients had prior live births. Three of the primiparous patients delivered after treatment. Five pregnancies occurred in 3 nulliparous patients at the time of primary surgery. Three of these reached term and healthy babies were delivered. One pregnancy was terminated at 18 weeks of gestation due to anencephaly and a dilatation and curettage was performed at 6th week in another patient. Menstrual problems occurred in 4 (17.3%) of the 23 patients. CONCLUSION Fertility sparing treatments are safe in patients with pure ovarian dysgerminoma.
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Affiliation(s)
- Nurettin Boran
- SSK Ankara Maternity and Women's Health Teaching Hospital, Saglik sok. No: 18/3, 06410 Yenisehir, Ankara, Turkey.
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Van Den Broecke R, Pennings G, Van Der Elst J, Liu J, Dhont M. Ovarian tissue cryopreservation: therapeutic prospects and ethical reflections. Reprod Biomed Online 2003; 3:179-184. [PMID: 12513851 DOI: 10.1016/s1472-6483(10)62032-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Along with improved survival, methods to preserve or restore the fertility potential of young women and children treated with cytotoxic chemotherapy or pelvic radiotherapy have been developed or are in the offing. Surgery, radiotherapy and chemotherapy can all impact on the future ovarian function, but patient and disease tailored application and use of preventive measures can limit ovarian damage. When the loss of reproductive ovarian function is unavoidable, different alternatives to preserve fertility or at least to restore the procreative potential are available. Creation of embryos by IVF, oocyte donation and cryopreservation of mature or immature oocytes are potential issues, the advantages and limitations of which are discussed. Recently, ovarian tissue cryopreservation has spurred interest in the medical literature as well as in the lay press as a method for preservation and restoring fertility. Considering the available data and current state of knowledge, we want to stress that this methodology is still in an experimental phase and we would like to caution against unwarranted enthusiasm of physicians and patients. The medical information preceding the informed consent should mention the actual uncertainties of this method. Moreover, the imperative character of the offer and in particular for paediatric oncological patients, the force of the moral rules that define parental obligations towards children should not be ignored.
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Affiliation(s)
- Rudy Van Den Broecke
- Department of Gynaecologic Oncology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
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