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Lee JS, Lee JY, Kim KH, Park SH, Koh EJ, Kim SK, Phi JH. The Role of Early and Delayed Surgery for Infants with Congenital Brain Tumors. Cancer Res Treat 2024; 56:909-919. [PMID: 38186242 PMCID: PMC11261196 DOI: 10.4143/crt.2023.1174] [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: 10/31/2023] [Accepted: 12/26/2023] [Indexed: 01/09/2024] Open
Abstract
PURPOSE The present study aimed to evaluate the role of early and delayed surgery in congenital brain tumors and analyze the clinical outcomes of infantile brain tumors. MATERIALS AND METHODS We performed a retrospective cohort study on 69 infantile brain tumors at a single institution from January 2008 to June 2023. Outcomes were assessed as early mortality (within 30 days following surgery) to evaluate the risk of early surgery in congenital brain tumors. Outcomes of recurrence and overall survival were analyzed in infantile brain tumors. RESULTS Surgery-related early mortality appeared to occur in young and low-body-weight patients. Cut-off values of age and body weight were found to be 1.3 months and 5.2 kg to avoid early mortality. Three patients (3/10, 30%) showed early mortality in the early surgery group, and early mortality occurred in one patient (1/14, 7.14%) in the delayed surgery group, whose tumor was excessively enlarged. Younger age at diagnosis (< 3 months of age; hazard ratios [HR], 7.1; 95% confidence intervals [CI], 1.4 to 35.6; p=0.018) and leptomeningeal seeding (LMS; HR, 30.6; 95% CI, 3.7 to 253.1; p=0.002) were significant independent risk factors for high mortality in infantile brain tumors. CONCLUSION We suggest delaying surgery until the patient reaches 1.3 months of age and weighs over 5.2 kg with short-term imaging follow-up unless tumors grow rapidly in congenital brain tumors. Younger ages and the presence of LMS are independent risk factors for high mortality in infantile brain tumors.
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Affiliation(s)
- Jong Seok Lee
- Division of Pediatric Neurosurgery, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Yeoun Lee
- Division of Pediatric Neurosurgery, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Korea
- Neural Development and Anomaly Laboratory, Department of Anatomy and Cell Biology, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung Hyun Kim
- Division of Pediatric Neurosurgery, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sung-Hye Park
- Department of Pathology, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Eun Jung Koh
- Division of Pediatric Neurosurgery, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Ki Kim
- Division of Pediatric Neurosurgery, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Korea
- Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Hoon Phi
- Division of Pediatric Neurosurgery, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Korea
- Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
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2
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Fichtner A, Nettersheim D, Bremmer F. Pathogenesis and pathobiology of testicular germ cell tumours: a view from a developmental biological perspective with guidelines for pathological diagnostics. Histopathology 2024. [PMID: 38922953 DOI: 10.1111/his.15249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/26/2024] [Accepted: 06/06/2024] [Indexed: 06/28/2024]
Abstract
Testicular germ cell tumours (GCT) are divided into three different subtypes (types I-III) regarding to their developmental origin, histological differences and molecular features. Type I GCT develop from disturbed primordial germ cells and most commonly occur in children and young adolescents, which is why they are referred to as prepubertal GCT. Type II GCT develop from a non-invasive germ cell neoplasia in situ (GCNIS) and show an isochromosome 12p (i12p) or gain of 12p material as a common and characteristic molecular alteration. Type III GCT originate from distorted postpubertal germ cells (e.g. spermatogonia) in adult patients and have changes on chromosome 9 with amplification of the DMRT1 gene. Type I GCT encompass prepubertal-type teratomas and yolk-sac tumours (YST). Type II GCT include seminoma, embryonal carcinoma, choriocarcinoma, postpubertal-type teratoma and postpubertal-type YST. Types I and II GCT both show similar morphology, but are separated from each other by the detection of a GCNIS and an i12p in type II GCT. For type II GCT it is especially important to detect non-seminomatous elements, as these tumours have a worse biological behaviour and need a different treatment to seminomas. In contrast to types I and II GCT, type III tumours are equivalent to spermatocytic tumours and usually occur in elderly men, with few exceptions in young adults. The development of types I and II GCT seems to depend not upon driver mutations, but rather on changes in the epigenetic landscape. Furthermore, different pluripotency associated factors (e.g. OCT3/4, SOX2, SOX17) play a crucial role in GCT development and can be used as immunohistochemical markers allowing to distinguish the different subtypes from each other in morphologically challenging tissue specimens. Especially in metastatic sites, a morphological and immunohistochemical diagnostic algorithm is important to detect small subpopulations of each non-seminomatous GCT subtype, which are associated with a poorer prognosis and need a different treatment. Furthermore, primary extragonadal GCT of the retroperitoneum or mediastinum develop from misguided germ cells during embryonic development, and might be challenging to detect in small tissue biopsies due to their rarity at corresponding sites. This review article summarises the pathobiological and developmental aspects of the three different types of testicular GCT that can be helpful in the histopathological examination of tumour specimens by pathologists.
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Affiliation(s)
| | - Daniel Nettersheim
- Department of Urology, Urological Research Laboratory, Translational UroOncology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Center for Integrated Oncology Aachen, Bonn, Cologne Düsseldorf (CIO ABCD), Lighthouse Project: Germ Cell Tumours, Düsseldorf, Germany
| | - Felix Bremmer
- Institute of Pathology, University Medical Center, Göttingen, Germany
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3
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Schultewolter JH, Rissmann A, von Schweinitz D, Frühwald M, Blattmann C, Fischer L, Lange BS, Wessalowski R, Fröhlich B, Behnisch W, Schmid I, Reinhard H, Dürken M, Hundsdörfer P, Heimbrodt M, Vokuhl C, Schönberger S, Schneider DT, Seitz G, Looijenga L, Göbel U, von Kries R, Reutter H, Calaminus G. Non-Syndromic and Syndromic Defects in Children with Extracranial Germ Cell Tumors: Data of 2610 Children Registered with the German MAKEI 96/MAHO 98 Registry Compared to the General Population. Cancers (Basel) 2024; 16:2157. [PMID: 38893276 PMCID: PMC11172205 DOI: 10.3390/cancers16112157] [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: 04/19/2024] [Revised: 05/23/2024] [Accepted: 06/03/2024] [Indexed: 06/21/2024] Open
Abstract
GCTs are developmental tumors and are likely to reflect ontogenetic and teratogenetic determinants. The objective of this study was to identify syndromes with or without congenital anomalies and non-syndromic defects as potential risk factors. Patients with extracranial GCTs (eGCTs) registered in MAKEI 96/MAHO 98 between 1996 and 2017 were included. According to Teilum's holistic concept, malignant and benign teratomas were registered. We used a case-control study design with Orphanet as a reference group for syndromic defects and the Mainz birth registry (EUROCAT) for congenital anomalies at birth. Co-occurring genetic syndromes and/or congenital anomalies were assessed accordingly. Odds ratios and 95% confidence intervals were calculated and p-values for Fisher's exact test with Bonferroni correction if needed. A strong association was confirmed for Swyer (OR 338.6, 95% CI 43.7-2623.6) and Currarino syndrome (OR 34.2, 95% CI 13.2-88.6). We additionally found 16 isolated cases of eGCT with a wide range of syndromes. However, these were not found to be significantly associated following Bonferroni correction. Most of these cases pertained to girls. Regarding non-syndromic defects, no association with eGCTs could be identified. In our study, we confirmed a strong association for Swyer and Currarino syndromes with additional congenital anomalies.
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Affiliation(s)
| | - Anke Rissmann
- Malformation Monitoring Centre Saxony-Anhalt, Medical Faculty, Otto-von-Guericke University, 39106 Magdeburg, Germany;
| | - Dietrich von Schweinitz
- Dr. von Haunersches Kinderspital, Department of Paediatric Surgery, University of Munich, 80539 Munich, Germany;
| | - Michael Frühwald
- Department of Pediatric and Adolescent Medicine, University Medical Center Augsburg, 86159 Augsburg, Germany;
| | - Claudia Blattmann
- Centre for Childhood, Adolescents and Female Medicine, Paediatrics 5 (Oncology, Hämatology, Immunology), Olgahospital Klinikum Stuttgart, 70174 Stuttgart, Germany;
| | - Lars Fischer
- Clinic for Childhood and Adolescent Medicine, Paediatric Oncology, University Hospital Leipzig (Universitätsklinikum Leipzig AöR), 04103 Leipzig, Germany;
| | - Björn Sönke Lange
- Clinic for Childhood and Adolescent Medicine, Paediatric Haematology and Oncology, University Hospital Dresden, 01307 Dresden, Germany;
| | - Rüdiger Wessalowski
- Clinic for Paediatric Hematology, Oncology and Immunology, University Childrens Hospital Düsseldorf, 40225 Düsseldorf, Germany; (R.W.); (U.G.)
| | - Birgit Fröhlich
- Clinic for Paediatric Hematology and Oncology, University of Münster, 48149 Münster, Germany;
| | - Wolfgang Behnisch
- Department of Paediatric Haematology and Oncology, University Childrens Hospital Heidelberg, 69120 Heidelberg, Germany;
| | - Irene Schmid
- Dr. von Haunersches Kinderspital, Department of Paediatric Haematology and Oncology, University of Munich, 80539 Munich, Germany;
| | - Harald Reinhard
- Department of Paediatric Haematology and Oncology, Asklepios Hospital Sankt Augustin, 53757 St. Augustin, Germany;
| | - Matthias Dürken
- Clinic for Childhood and Adolescent Medicine, Paediatric Haematology and Oncology, Medical Faculty Mannheim, University of Heidelberg, 69117 Heidelberg, Germany;
| | - Patrick Hundsdörfer
- Clinic for Childhood and Adolescent Medicine, Oncology Haematology, HELIOS Clinic Berlin-Buch, 13125 Berlin, Germany;
| | - Martin Heimbrodt
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, 53127 Bonn, Germany; (M.H.); (G.C.)
| | - Christian Vokuhl
- Department of Pathology, Section Paidopathology, University Hospital Bonn, 53127 Bonn, Germany;
| | - Stefan Schönberger
- Department of Pediatric Hematology and Oncology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany;
| | - Dominik T. Schneider
- Clinic of Paediatrics, Klinikum Dortmund, University Witten/Herdecke, 58448 Witten, Germany;
| | - Guido Seitz
- Department of Pediatric Surgery and Urology, University Hospital Giessen-Marburg, Campus Marburg, 35037 Marburg, Germany;
- Department of Pediatric Surgery, University Hospital Giessen-Marburg, Campus Giessen, 35392 Giessen, Germany
| | - Leendert Looijenga
- Princess Máxima Center for Pediatric Oncology, 3584 Utrecht, The Netherlands;
| | - Ulrich Göbel
- Clinic for Paediatric Hematology, Oncology and Immunology, University Childrens Hospital Düsseldorf, 40225 Düsseldorf, Germany; (R.W.); (U.G.)
| | - Rüdiger von Kries
- Division of Epidemiology, Institute of Social Pediatrics and Adolescent Medicine, LMU Munich, 80539 Munich, Germany;
| | - Heiko Reutter
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, 91054 Erlangen, Germany;
| | - Gabriele Calaminus
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, 53127 Bonn, Germany; (M.H.); (G.C.)
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Ortega-Ruiz OR, Acevedo-Castillo CD, Pérez-Ruano LA, Caro-Osorio E. Simultaneous spine extradural and intradural teratomas in a pediatric patient: A rare presentation with insights in the flawed migration of germ cells theory. Childs Nerv Syst 2024; 40:1011-1017. [PMID: 38429504 DOI: 10.1007/s00381-024-06317-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 02/08/2024] [Indexed: 03/03/2024]
Abstract
Spinal teratomas are infrequent lesions in the pediatric population. These lesions can be extradural, intradural or intramedullary. We present a case of an 8-month-old boy that was assessed for underdevelopment of motor milestones. The neurologic examination revealed hyporeflexia, decreased sensation and flaccid paraplegia. MRI of the spine revealed two simultaneous and independent lesions in the extradural and intradural compartment. A laminectomy was performed for the T4-T7 vertebrae with total resection of both lesions. The histopathological analysis confirmed both lesions to be mature cystic teratomas. At the 1-year follow-up, the patient remained with no recovery of neurological function. A debate takes place regarding the etiology of formation of these lesions in the spine. The simultaneous presentation of two independent lesions in this patient could contribute to define the flawed migration of germ cells theory as the etiology for formation of teratomatous lesions in the spine.
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Affiliation(s)
- Omar R Ortega-Ruiz
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo León, México
- Department of Neurosurgery, Hospital Zambrano Hellion, TecSalud, Av. Batallon de San Patricio 112, Real San Agustín, 66,260 San Pedro Garza García, Nuevo León, Mexico
| | - Carlos D Acevedo-Castillo
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo León, México
- Department of Neurosurgery, Hospital Zambrano Hellion, TecSalud, Av. Batallon de San Patricio 112, Real San Agustín, 66,260 San Pedro Garza García, Nuevo León, Mexico
| | - Luis Alejandro Pérez-Ruano
- Department of Neurosurgery, Hospital Zambrano Hellion, TecSalud, Av. Batallon de San Patricio 112, Real San Agustín, 66,260 San Pedro Garza García, Nuevo León, Mexico
| | - Enrique Caro-Osorio
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo León, México.
- Department of Neurosurgery, Hospital Zambrano Hellion, TecSalud, Av. Batallon de San Patricio 112, Real San Agustín, 66,260 San Pedro Garza García, Nuevo León, Mexico.
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5
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Toll SA, Flore LA, Gorsi HS, Marupudi NI, Mody S, Kupsky W, Wang ZJ. Intracranial Germinoma in Two Caucasian American Siblings With Autism Spectrum Disorder. J Pediatr Hematol Oncol 2024; 46:106-111. [PMID: 38277627 DOI: 10.1097/mph.0000000000002821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 12/17/2023] [Indexed: 01/28/2024]
Abstract
Intracranial germ cell tumors (IGCTs) comprise 3% to 5% of all pediatric brain tumors in the West, with a significantly higher prevalence in Asia. Although these tumors are histologically diverse, repeated somatic variants have been demonstrated. Chromosomal aneuploidies, such as Klinefelter and Down syndromes, are associated with IGCTs, but no familial germline tumor syndromes are currently known. Here, we report the novel case of 2 American siblings with underlying autism spectrum disorder who developed intracranial germinoma within months of each other, in the absence of external risk factors. Extensive genetic testing was performed, including karyotyping, chromosomal microarray, and whole exome and whole genome sequencing, and did not identify any variants accounting for the phenotypes. Despite the absence of overlapping variants, a recent retrospective review demonstrated a threefold greater prevalence of autism spectrum disorder in patients with intracranial germinoma compared with national prevalence. This report highlights the complexity of tumor development, as well as the need for further research regarding IGCTs in a neurodivergent population.
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Affiliation(s)
- Stephanie A Toll
- Department of Pediatrics, Division of Hematology/Oncology
- Central Michigan University School of Medicine, Mt Pleasant
| | - Leigh Anne Flore
- Department of Pediatrics, Division of Genetics, Children's Hospital of Michigan
- Central Michigan University School of Medicine, Mt Pleasant
| | - Hamza S Gorsi
- Department of Pediatrics, Division of Hematology/Oncology
- Central Michigan University School of Medicine, Mt Pleasant
| | | | - Swati Mody
- Central Michigan University School of Medicine, Mt Pleasant
- Department of Radiology, C.S. Mott Children's Hospital, Ann Arbor, MI
| | - William Kupsky
- Department of Pathology, Detroit Medical Center, Detroit
| | - Zhihong Joanne Wang
- Department of Pediatrics, Division of Hematology/Oncology, Children's Hospital of Richmond, Richmond, VA
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6
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Sato D, Tanaka S, Takami H, Takayanagi S, Rai Y, Hinata M, Katano A, Saito N. Histopathological, Demographic, and Clinical Signatures of Medulla Oblongata Germ Cell Tumors: A Case Report With the Review of Literature. Cureus 2024; 16:e51861. [PMID: 38327946 PMCID: PMC10848086 DOI: 10.7759/cureus.51861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 02/09/2024] Open
Abstract
The medulla oblongata is one of the rarest sites of occurrence for germ cell tumors (GCTs) of the central nervous system. As there is scant data regarding epidemiology, clinical presentations, optimal intervention, and long-term prognosis, we aimed to delineate the features of this rare entity by presenting our representative case and performing a quantitative review of the literature. A 24-year-old woman presented to our department with vertigo and swallowing difficulties. Magnetic resonance imaging revealed a homogenously enhanced exophytic lesion arising from the medulla oblongata and extending to the fourth ventricle. Surgical resection was performed and a histological diagnosis of pure germinoma was made. The patient underwent chemotherapy and whole-ventricular irradiation. No recurrence has been experienced for 4 months after the surgery. According to the literature, the prognosis of GCTs at the medulla oblongata seems no worse than those at typical sites. Striking features including occurrence at an older age, female preponderance, and a predominance of germinoma were noteworthy. The pattern of local recurrence suggests extensive radiation coverage is not a prerequisite. Special attention is needed for cardiac and respiratory functions as the main factors eliciting mortality.
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Affiliation(s)
- Daisuke Sato
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, JPN
| | - Shota Tanaka
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, JPN
| | - Hirokazu Takami
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, JPN
| | | | - Yurie Rai
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, JPN
| | - Munetoshi Hinata
- Department of Pathology and Diagnostic Pathology, The University of Tokyo Hospital, Tokyo, JPN
| | - Atsuto Katano
- Department of Radiology, The University of Tokyo Hospital, Tokyo, JPN
| | - Nobuhito Saito
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, JPN
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7
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Fichtner A, Marx A, Ströbel P, Bremmer F. Primary germ cell tumours of the mediastinum: A review with emphasis on diagnostic challenges. Histopathology 2024; 84:216-237. [PMID: 37994540 DOI: 10.1111/his.15090] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/12/2023] [Accepted: 10/20/2023] [Indexed: 11/24/2023]
Abstract
This article will review current aspects of the histopathological, immunohistochemical and molecular analysis of primary mediastinal germ cell tumours (PMGCTs) as well as their aetiological, epidemiological, clinical and therapeutic features. PMGCTs represent an important differential diagnosis in the spectrum of mediastinal tumours, and their diagnosis is usually made on small tissue samples from core needle biopsies in combination with diagnostic imaging and serum tumour markers. As in lymphomas, a small biopsy is often the only viable tumour sample available from these patients, as they receive chemotherapy prior to eventual surgical resection. Pathologists therefore need to apply an efficient combination of immunohistochemical markers to confirm the diagnosis of a PMGCT and to exclude morphological mimics.
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Affiliation(s)
- Alexander Fichtner
- Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany
| | - Alexander Marx
- Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany
| | - Philipp Ströbel
- Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany
| | - Felix Bremmer
- Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany
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8
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Takami H, Satomi K, Fukuoka K, Nakamura T, Tanaka S, Mukasa A, Saito N, Suzuki T, Yanagisawa T, Sugiyama K, Kanamori M, Kumabe T, Tominaga T, Tamura K, Maehara T, Nonaka M, Asai A, Yokogami K, Takeshima H, Iuchi T, Kobayashi K, Yoshimoto K, Sakai K, Nakazato Y, Matsutani M, Nagane M, Nishikawa R, Ichimura K. Distinct patterns of copy number alterations may predict poor outcome in central nervous system germ cell tumors. Sci Rep 2023; 13:15760. [PMID: 37735187 PMCID: PMC10514291 DOI: 10.1038/s41598-023-42842-3] [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: 04/02/2023] [Accepted: 09/15/2023] [Indexed: 09/23/2023] Open
Abstract
We have previously reported that 12p gain may predict the presence of malignant components and poor prognosis for CNS germ cell tumor (GCT). Recently, 3p25.3 gain was identified as an independent predictor of poor prognosis for testicular GCT. Eighty-one CNS GCTs were analyzed. Copy number was calculated using methylation arrays. Five cases (6.2%) showed 3p25.3 gain, but only among the 40 non-germinomatous GCTs (NGGCTs) (5/40, 12.5%; p = 0.03). Among NGGCTs, those with a yolk sac tumor component showed a significantly higher frequency of 3p25.3 gain (18.2%) than those without (1.5%; p = 0.048). NGGCTs with gain showed significantly shorter progression-free survival (PFS) than those without (p = 0.047). The 3p25.3 gain and 12p gain were independent from each other. The combination of 3p25.3 gain and/or 12p gain was more frequent among NGGCTs with malignant components (69%) than among those without (29%; p = 0.02). Germinomas containing a higher number of copy number alterations showed shorter PFS than those with fewer (p = 0.03). Taken together, a finding of 3p25.3 gain may be a copy number alteration specific to NGGCTs and in combination with 12p gain could serve as a marker of negative prognosis or treatment resistance. Germinoma with frequent chromosomal instability may constitute an unfavorable subgroup.
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Affiliation(s)
- Hirokazu Takami
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Kaishi Satomi
- Department of Pathology, Kyorin University Faculty of Medicine, 6-20-2, Shinkawa, Mitaka City, Tokyo, 181-8611, Japan
| | - Kohei Fukuoka
- Departments of Hematology/Oncology, Saitama Children's Medical Center, 1-2, Shintoshin, Chuo-ku, Saitama City, Saitama, 330-8777, Japan
| | - Taishi Nakamura
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, 3-9, Fukuura, Kanazawa-ku, Yokohama City, Kanagawa, 236-0004, Japan
| | - Shota Tanaka
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Akitake Mukasa
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
- Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Tomonari Suzuki
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka City, Saitama, 350-1298, Japan
| | - Takaaki Yanagisawa
- Department of Neurosurgery, Jikei University, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Kazuhiko Sugiyama
- Department of Clinical Oncology and Neuro-Oncology Program, Faculty of Medicine, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Masayuki Kanamori
- Department of Neurosurgery, Tohoku University School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai City, Miyagi, 980-8574, Japan
| | - Toshihiro Kumabe
- Department of Neurosurgery, Tohoku University School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai City, Miyagi, 980-8574, Japan
- Department of Neurosurgery, Kitasato University, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0374, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai City, Miyagi, 980-8574, Japan
| | - Kaoru Tamura
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-0034, Japan
| | - Taketoshi Maehara
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-0034, Japan
| | - Masahiro Nonaka
- Department of Neurosurgery, Kansai Medical University Hospital, 2-3-1, Shinmachi, Hirakata City, Osaka, 573-1191, Japan
| | - Akio Asai
- Department of Neurosurgery, Kansai Medical University Hospital, 2-3-1, Shinmachi, Hirakata City, Osaka, 573-1191, Japan
| | - Kiyotaka Yokogami
- Department of Neurosurgery, University of Miyazaki Faculty of Medicine, 5200, Kihara, Kiyotakecho, Miyazaki, 889-1692, Japan
| | - Hideo Takeshima
- Department of Neurosurgery, University of Miyazaki Faculty of Medicine, 5200, Kihara, Kiyotakecho, Miyazaki, 889-1692, Japan
| | - Toshihiko Iuchi
- Department of Neurosurgery, Chiba Cancer Center, 666-2, Nitona-cho, Chuo-ku, Chiba, 260-0801, Japan
| | - Keiichi Kobayashi
- Department of Neurosurgery, Kyorin University Faculty of Medicine, 6-20-2, Shinkawa, Mitaka City, Tokyo, 181-8611, Japan
| | - Koji Yoshimoto
- Department of Neurosurgery, Kyusyu University Hospital, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Keiichi Sakai
- Shinshu Ueda Medical Center, 1-27-21, Midorigaoka, Ueda City, Nagano, 386-8610, Japan
| | - Yoichi Nakazato
- Department of Pathology, Hidaka Hospital, 886, Nakaomachi, Takasaki City, Gunma, 370-0001, Japan
| | - Masao Matsutani
- Gotanda Rehabilitation Hospital, 8-20, Nishi-gotanda, Shinagawa-ku, Tokyo, 141-0031, Japan
| | - Motoo Nagane
- Department of Neurosurgery, Kyorin University Faculty of Medicine, 6-20-2, Shinkawa, Mitaka City, Tokyo, 181-8611, Japan
| | - Ryo Nishikawa
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka City, Saitama, 350-1298, Japan
| | - Koichi Ichimura
- Department of Brain Disease Translational Research, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
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9
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Krivega M, Zimmer J, Slezko A, Frank-Herrmann P, Rehnitz J, Hohenfellner M, Bettendorf M, Luzarowski M, Strowitzki T. Genomic instability in individuals with sex determination defects and germ cell cancer. Cell Death Discov 2023; 9:173. [PMID: 37217472 PMCID: PMC10202957 DOI: 10.1038/s41420-023-01470-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/28/2023] [Accepted: 05/12/2023] [Indexed: 05/24/2023] Open
Abstract
The ability to transmit genetic information through generations depends on the preservation of genome integrity. Genetic abnormalities affect cell differentiation, causing tissue specification defects and cancer. We addressed genomic instability in individuals with Differences of Sex Development (DSD), characterized by gonadal dysgenesis, infertility, high susceptibility for different types of cancer, especially Germ Cell Tumors (GCT), and in men with testicular GCTs. Whole proteome analysis of leukocytes, supported by specific gene expression assessment, and dysgenic gonads characterization, uncovered DNA damage phenotypes with altered innate immune response and autophagy. Further examination of DNA damage response revealed a reliance on deltaTP53, which was compromised by mutations in the transactivation domain in DSD-individuals with GCT. Accordingly, drug-induced rescue of DNA damage was achieved by autophagy inhibition but not by stabilization of TP53 in DSD-individuals' blood in vitro. This study elucidates possibilities for prophylactic treatments of DSD-individuals, as well as new diagnostic approaches of GCT.
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Affiliation(s)
- Maria Krivega
- Research Group of Gonadal Differentiation and Embryonic Development, Department of Gynecological Endocrinology & Fertility Disorders, Women Hospital, University of Heidelberg, 69120, Heidelberg, Germany.
| | - Jutta Zimmer
- Research Group of Gonadal Differentiation and Embryonic Development, Department of Gynecological Endocrinology & Fertility Disorders, Women Hospital, University of Heidelberg, 69120, Heidelberg, Germany
| | - Anna Slezko
- Research Group of Gonadal Differentiation and Embryonic Development, Department of Gynecological Endocrinology & Fertility Disorders, Women Hospital, University of Heidelberg, 69120, Heidelberg, Germany
| | - Petra Frank-Herrmann
- Department of Gynecological Endocrinology & Fertility Disorders, Women Hospital, University of Heidelberg, 69120, Heidelberg, Germany
| | - Julia Rehnitz
- Department of Gynecological Endocrinology & Fertility Disorders, Women Hospital, University of Heidelberg, 69120, Heidelberg, Germany
| | - Markus Hohenfellner
- Department of Urology, University Hospital Heidelberg, 69120, Heidelberg, Germany
| | - Markus Bettendorf
- Division of Pediatric Endocrinology, Children's Hospital, University of Heidelberg, 69120, Heidelberg, Germany
| | - Marcin Luzarowski
- Core Facility for Mass Spectrometry & Proteomics, ZMBH, University of Heidelberg, 69120, Heidelberg, Germany
| | - Thomas Strowitzki
- Department of Gynecological Endocrinology & Fertility Disorders, Women Hospital, University of Heidelberg, 69120, Heidelberg, Germany
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10
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Jabłońska I, Goławski M, Nowicka E, Drosik-Rutowicz K, Trybus A, Tarnawski R, Miszczyk M. Intracranial Germinoma-Association between Delayed Diagnosis, Altered Clinical Manifestations, and Prognosis. Cancers (Basel) 2023; 15:2789. [PMID: 37345126 DOI: 10.3390/cancers15102789] [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: 05/04/2023] [Accepted: 05/15/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Intracranial germinoma is a rare malignant neoplasm of the central nervous system (CNS) that occurs in children and young adults. The aim of our study was to assess the initial manifestation of the disease, and to find differences in outcomes dependent on time of diagnosis. METHODS The study group consisted of 35 consecutive patients (adults and children) who were treated for intracranial germinoma with radiotherapy at a tertiary centre, and their data were retrospectively collected. We evaluated time from the first symptoms to diagnosis and divided patients into early and delayed diagnosis groups. Delayed diagnosis has been defined as the time from initial presentation to final diagnosis longer than six months. RESULTS A total of 17 (48.6%) of the patients had delayed diagnoses. Patient survival data spanned a median of six (interquartile range 3-12) years. At the time of the diagnosis, patients presented exclusively neurological symptoms in 16 (45.7%) cases, exclusively endocrinological symptoms in five (14.3%) cases, and mixed symptoms in the remaining cases (n = 14; 40.0%). Patients with neurological symptoms had shorter time (p < 0.001) from first symptoms to the final diagnosis (5.91 months) than in patients without them (19.44 months). The delayed diagnosis group presented significantly smaller tumour size (mean maximal dimension 2.35 cm) compared to early diagnosis group (3.1 cm). The 5-year and 10-year survival rates of our patients were 94.3% and 83.4%, respectively. Patients with a delayed diagnosis (n = 17) had a significantly worse (p = 0.02) 10-year OS (63%) compared to the early diagnosis group (n = 18; OS = 100%). Importantly, in five patients (14.29%), initial manifestation occurred before radiological signs of the disease. CONCLUSION Our study stresses the need for timely diagnosis in intracranial germinoma, as a delay has a significant impact on the prognosis. In particular, if the tumour is small or causes exclusively endocrinological symptoms, the diagnosis may be difficult and delayed.
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Affiliation(s)
- Iwona Jabłońska
- IIIrd Department of Radiotherapy and Chemotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, 44-102 Gliwice, Poland
| | - Marcin Goławski
- Department of Pharmacology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland
| | - Elżbieta Nowicka
- IIIrd Department of Radiotherapy and Chemotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, 44-102 Gliwice, Poland
| | - Katarzyna Drosik-Rutowicz
- Ist Department of Radiotherapy and Chemotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, 44-102 Gliwice, Poland
| | - Anna Trybus
- IIIrd Department of Radiotherapy and Chemotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, 44-102 Gliwice, Poland
| | - Rafał Tarnawski
- IIIrd Department of Radiotherapy and Chemotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, 44-102 Gliwice, Poland
| | - Marcin Miszczyk
- IIIrd Department of Radiotherapy and Chemotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, 44-102 Gliwice, Poland
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11
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Mayeur S, Lhermitte B, Gantzer J, Molitor A, Stemmelen T, Meyer S, Kolmer A, Kurtz JE, Bahram S, Carapito R. Genomic profiling of a metastatic anaplastic melanocytic neuroectodermal tumor arising from a mature thymic teratoma as part of a mediastinal germ cell tumor. Cold Spring Harb Mol Case Stud 2023; 9:mcs.a006257. [PMID: 37160315 DOI: 10.1101/mcs.a006257] [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: 11/17/2022] [Accepted: 04/11/2023] [Indexed: 05/11/2023] Open
Abstract
Following chemotherapy, a mediastinal germ cell tumor can lead to a mature teratoma that is composed of tissues derived from all three germ layers. Although teratoma is usually curable, in rare cases it can give rise to various somatic tumors and exceptionally it undergoes melanocytic neuroectodermal tumor (MNT) transformation, a process that is not well-described. We report a patient with a postchemotherapy thymic teratoma associated with an MNT component who, 10 years later, additionally presented a vertebral metastasis corresponding to an anaplastic MNT. Using exome sequencing of the mature teratoma, the MNT and its metastatic vertebral anaplastic MNT components, we identified 19 somatic mutations shared by at least two components. Six mutations were common to all three components, and three of them were located in the known cancer-related genes KRAS (p.E63K), TP53 (p.P222X), and POLQ (p.S447P). Gene set enrichment analysis revealed that the melanoma tumorigenesis pathway was enriched in mutated genes including the four major driver genes KRAS, TP53, ERBB4, and KDR, indicating that these genes may be involved in the development of the anaplastic MNT transformation of the teratoma. To our knowledge, this is the first molecular study realized on MNT. Understanding the clinicopathological and molecular characteristics of these tumors is essential to better understand their development and to improve therapeutics.
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Affiliation(s)
- Sylvain Mayeur
- Laboratoire d'ImmunoRhumatologie Moléculaire, Plateforme GENOMAX, INSERM UMR_S 1109, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, ITI TRANSPLANTEX NG, Strasbourg Federation of Translational Medicine (FMTS), Strasbourg University, Strasbourg 67091, France
- Department of Pathology, Strasbourg University Hospitals, Strasbourg 67200, France
| | - Benoit Lhermitte
- Department of Pathology, Strasbourg University Hospitals, Strasbourg 67200, France
| | - Justine Gantzer
- Pôle d'oncologie médico-chirurgicale et d'hématologie, ICANS-Europe, Strasbourg 67200, France
| | - Anne Molitor
- Laboratoire d'ImmunoRhumatologie Moléculaire, Plateforme GENOMAX, INSERM UMR_S 1109, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, ITI TRANSPLANTEX NG, Strasbourg Federation of Translational Medicine (FMTS), Strasbourg University, Strasbourg 67091, France
| | - Tristan Stemmelen
- Laboratoire d'ImmunoRhumatologie Moléculaire, Plateforme GENOMAX, INSERM UMR_S 1109, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, ITI TRANSPLANTEX NG, Strasbourg Federation of Translational Medicine (FMTS), Strasbourg University, Strasbourg 67091, France
| | - Sébastien Meyer
- Laboratoire d'ImmunoRhumatologie Moléculaire, Plateforme GENOMAX, INSERM UMR_S 1109, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, ITI TRANSPLANTEX NG, Strasbourg Federation of Translational Medicine (FMTS), Strasbourg University, Strasbourg 67091, France
| | - Aline Kolmer
- Laboratoire d'ImmunoRhumatologie Moléculaire, Plateforme GENOMAX, INSERM UMR_S 1109, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, ITI TRANSPLANTEX NG, Strasbourg Federation of Translational Medicine (FMTS), Strasbourg University, Strasbourg 67091, France
| | - Jean-Emmanuel Kurtz
- Pôle d'oncologie médico-chirurgicale et d'hématologie, ICANS-Europe, Strasbourg 67200, France
| | - Seiamak Bahram
- Laboratoire d'ImmunoRhumatologie Moléculaire, Plateforme GENOMAX, INSERM UMR_S 1109, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, ITI TRANSPLANTEX NG, Strasbourg Federation of Translational Medicine (FMTS), Strasbourg University, Strasbourg 67091, France;
- Laboratoire d'Immunologie, Plateau Technique de Biologie, Pôle de Biologie, Nouvel Hôpital Civil, Strasbourg 67091, France
| | - Raphael Carapito
- Laboratoire d'ImmunoRhumatologie Moléculaire, Plateforme GENOMAX, INSERM UMR_S 1109, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, ITI TRANSPLANTEX NG, Strasbourg Federation of Translational Medicine (FMTS), Strasbourg University, Strasbourg 67091, France;
- Laboratoire d'Immunologie, Plateau Technique de Biologie, Pôle de Biologie, Nouvel Hôpital Civil, Strasbourg 67091, France
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12
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Burnham EL, Tomita T. Histogenesis of intracranial germ cell tumors: primordial germ cell vs. embryonic stem cell. Childs Nerv Syst 2023; 39:359-368. [PMID: 36595083 DOI: 10.1007/s00381-022-05808-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/14/2022] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Intracranial germ cell tumor (iGCT) is a rare disorder and often occurs during childhood and adolescence. iGCTs are frequently localized in pineal region and hypothalamic-neurohypophyseal axis (HNA). In spite of well-established clinical and pathological entity, histogenesis of iGCTs remains unsettled. Current theories of histogenesis of iGCTs include germ cell theory (from primordial germ cells (PGCs) of aberrant migration) and stem cell theory (transformed embryonic stem (ES) cells). In order to comprehend the histogenesis, we revisit the origin, migration, and fate of the human PGCs, and their transformation processes to iGCT. DISCUSSION In "germ cell theory," transformation of ectopic PGCs to iGCT is complex and involves multiple transcription factors. Germinoma is derived from ectopic PGCs and is considered a prototype of all GCTs. Non-germinomatous germ cell tumors (NGGCTs) develop from more differentiated counterparts of embryonic and extra-embryonic tissues. However, there is a distinct genomic/epigenomic landscape between germinoma and NGGCT. ES cells transformed from ectopic PGCs through molecular dysregulation or de-differentiation may become the source of iGCT. "Stem cell theory" is transformation of endogenous ES cells or primitive neural stem cell to iGCTs. It supports histological diversity of NGGCTs because of ES cell's pluripotency. However, neural stem cells are abundantly present along the subependymal zone; therefore, it does not explain why iGCTs almost exclusively occur in pineal and HNA locations. Also, the vast difference of methylation status between germinoma and NGGCT makes it difficult to theorize all iGCTs derive from the common cellular linage. CONCLUSION Transformation of PGCs to ES cells is the most logical mechanism for histogenesis of iGCT. However, its detail remains an enigma and needs further investigations.
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Affiliation(s)
- Emma L Burnham
- Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Tadanori Tomita
- Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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13
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Wong TT, Tsai ML, Chang H, Hsieh KLC, Ho DMT, Lin SC, Yen HJ, Chen YW, Lee HL, Yang TF. Brain and Spinal Tumors Originating from the Germ Line Cells. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1405:421-455. [PMID: 37452948 DOI: 10.1007/978-3-031-23705-8_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Primary central nervous system germ cell tumors (CNS GCTs) are part of the GCTs in children and adults. This tumor entity presents with geographic variation, age, and sex predilection. There are two age peaks of incidence distribution at the first few months of life and in adolescence. CNS GCTs are heterogeneous in histopathological subtypes, locations, and tumor marker (AFP, β-hCG) secretions. In the WHO CNS tumor classification, GCTS are classified as germinoma and nongerminomatous GCT (NGGCT) with different subtypes (including teratoma). Excluding mature teratoma, the remaining NGGCTs are malignant (NGMGCT). In teratoma, growing teratoma syndrome and teratoma with somatic-type malignancy should be highlighted. The common intracranial locations are pineal region, neurohypophysis (NH), bifocal pineal-NH, basal ganglia, and cerebral ventricle. Above 50% of intracranial GCTs (IGCTs) present obstructive hydrocephalus. Spinal tumors are rare. Age, locations, hydrocephalus, and serum/CSF titer of β-hCG correlate with clinical manifestations. Delayed diagnosis is common in tumors arising in neurohypophysis, bifocal, and basal ganglia resulting in the increasing of physical dysfunction and hormonal deficits. Staging work-up includes CSF cytology for tumor cells and contrast-enhanced MRI of brain and spine for macroscopic metastasis before treatment commences. The therapeutic approach of CNS GCTs integrates locations, histopathology, staging, tumor marker level, and therapeutic classification. Treatment strategies include surgical biopsy/excision, chemotherapy, radiotherapy (single or combination). Secreting tumors with consistent imaging may not require histopathological diagnosis. Primary germinomas are highly radiosensitive and the therapeutic aim is to maintain high survival rate using optimal radiotherapy regimen with/without chemotherapy combination. Primary NGNGCTs are less radiosensitive. The therapeutic aim is to increase survival utilizing more intensive chemotherapy and radiotherapy. The negative prognostic factors are residue disease at the end of treatment and serum or CSF AFP level >1000 ng/mL at diagnosis. In refractory or recurrent NMGGCTs, besides high-dose chemotherapy, new therapy is necessary. Molecular profiling and analysis help for translational research. Survivors of pediatric brain tumors frequently experience cancer-related cognitive dysfunction, physical disability, pituitary hormone deficiency, and other CNS complications after cranial radiotherapy. Continuous surveillance and assessment may lead to improvements in treatment protocols, transdisciplinary interventions, after-treatment rehabilitation, and quality of life.
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Affiliation(s)
- Tai-Tong Wong
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, 110, Taiwan.
- Pediatric Brain Tumor Program, Taipei Cancer Center, Taipei Medical University, Taipei, 110, Taiwan.
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Taipei Medical University Hospital, Taipei Medical University, Taipei, 110, Taiwan.
- Neuroscience Research Center, Taipei Medical University Hospital, Taipei, 110, Taiwan.
| | - Min-Lan Tsai
- Pediatric Brain Tumor Program, Taipei Cancer Center, Taipei Medical University, Taipei, 110, Taiwan
- Department of Pediatrics, College of Medicine, Taipei Medical University Hospital, Taipei Medical University, Taipei, 110, Taiwan
| | - Hsi Chang
- Pediatric Brain Tumor Program, Taipei Cancer Center, Taipei Medical University, Taipei, 110, Taiwan
| | - Kevin Li-Chun Hsieh
- Pediatric Brain Tumor Program, Taipei Cancer Center, Taipei Medical University, Taipei, 110, Taiwan
- Department of Medical Imaging, College of Medicine, Taipei Medical University Hospital, Taipei Medical University, Taipei, 110, Taiwan
| | - Donald Ming-Tak Ho
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, 112, Taiwan
- Department of Pathology and Laboratory Medicine, Cheng Hsin General Hospital, Taipei, 112, Taiwan
| | - Shih-Chieh Lin
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, 112, Taiwan
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsiu-Ju Yen
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Yi-Wei Chen
- Division of Radiation Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsin-Lun Lee
- Pediatric Brain Tumor Program, Taipei Cancer Center, Taipei Medical University, Taipei, 110, Taiwan
- Department of Radiation Oncology, Taipei Medical University Hospital, Taipei, 110, Taiwan
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, 110, Taiwan
| | - Tsui-Fen Yang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan, ROC
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14
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Julson JR, Beierle EA. Embryology and surgical anatomy of pediatric solid tumors. Semin Pediatr Surg 2022; 31:151233. [PMID: 36423516 PMCID: PMC10084944 DOI: 10.1016/j.sempedsurg.2022.151233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- J R Julson
- Division of Pediatric Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - E A Beierle
- Division of Pediatric Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35233, USA.
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15
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Giunta EF, Ottaviano M, Mosca A, Banna GL, Rescigno P. Standard versus high-dose chemotherapy in mediastinal germ cell tumors: a narrative review. MEDIASTINUM (HONG KONG, CHINA) 2022; 6:6. [PMID: 35340836 PMCID: PMC8841545 DOI: 10.21037/med-21-29] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/22/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The aim of this review is to analyze feasibility and toxicities of high-dose chemotherapy (HDCT) in comparison to standard dose chemotherapy (SDCT) in patients affected by mediastinal germ cell tumors (MGCTs), discussing factors that may affect therapeutic choices, such as: management of residual disease, early response predictors for chemotherapeutic efficacy and determinants of chemotherapeutic resistance. In this review, we discuss the main clinical experiences with HDCT and SDCT in germ cell tumor (GCT) patients specifically in those affected by MGCT. BACKGROUND MGCTs represent a very small subset characterized by a poor prognosis, despite improvements in their clinical management and in understanding their biology. From early 1970s, HDCT has become an alternative to SDCT for both first-line and salvage therapeutic settings in advanced GCT patients. Several HDCT schedules-either cisplatin or carboplatin-based-have been tested so far, both in clinical randomized trial and in single-center experiences, with divergent results in terms of clinical outcomes and tolerability. Moreover, the majority of these studies included, but were not exclusively designed for, advanced MGCT patients, making difficult to infer data for this specific subset. METHODS an extended review of literature through PubMed was conducted using the keywords "mediastinal germinal cell tumors", "standard dose chemotherapy" and "high dose chemotherapy". CONCLUSIONS HDCT regimens could not be considered to date a standard option as first-line therapy in advanced MGCT patients, whilst they could be an alternative to SDCT regimens in relapsed tumors after proper patient selection.
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Affiliation(s)
- Emilio Francesco Giunta
- Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Margaret Ottaviano
- Oncology Unit, Ospedale del Mare, Naples, Italy
- CRCTR Coordinating Rare Tumors Reference Center of Campania Region, Naples, Italy
| | - Alessandra Mosca
- Multidisciplinary Outpatient Oncology Clinic, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - Giuseppe Luigi Banna
- Department of Oncology, Portsmouth Hospitals University NHS Trust, Portsmouth PO2 8QD, UK
| | - Pasquale Rescigno
- Interdisciplinary Group for Translational Research and Clinical Trials, Urological Cancers (GIRT-Uro), Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
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16
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Sayyah-Melli M, Shokohi B, Yagoobi S, Adili A, Hosseini SS. Immature teratoma of the uterine cervix. J OBSTET GYNAECOL 2022; 42:1600-1601. [PMID: 35148248 DOI: 10.1080/01443615.2022.2026901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Manizheh Sayyah-Melli
- Department of Gynecologic Oncology, Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Behrouz Shokohi
- Department of Pathology, Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shabnam Yagoobi
- Department of Gynecologic Oncology, Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Adili
- Department of Radio-Oncology, Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyyedeh Sanaz Hosseini
- Department of Obstetrics and Gynecology, Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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17
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Takami H, Elzawahry A, Mamatjan Y, Fukushima S, Fukuoka K, Suzuki T, Yanagisawa T, Matsushita Y, Nakamura T, Satomi K, Tanaka S, Mukasa A, Saito N, Kanamori M, Kumabe T, Tominaga T, Kobayashi K, Nagane M, Iuchi T, Tamura K, Maehara T, Sugiyama K, Yoshimoto K, Sakai K, Nonaka M, Asai A, Yokogami K, Takeshima H, Narita Y, Shibui S, Nakazato Y, Hama N, Totoki Y, Kato M, Shibata T, Nishikawa R, Matsutani M, Ichimura K. Transcriptome and methylome analysis of CNS germ cell tumor finds its cell-of-origin in embryogenesis and reveals shared similarities with testicular counterparts. Neuro Oncol 2022; 24:1246-1258. [PMID: 35137206 PMCID: PMC9340652 DOI: 10.1093/neuonc/noac021] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND CNS germ cell tumors (GCTs) predominantly develop in pediatric and young adult patients with variable responses to surgery, radiation, and chemotherapy. This study aimed to examine the complex and largely unknown pathogenesis of CNS GCTs. METHODS We used a combined transcriptomic and methylomic approach in 84 cases and conducted an integrative analysis of the normal cells undergoing embryogenesis and testicular GCTs. RESULTS Genome-wide transcriptome analysis in CNS GCTs indicated that germinoma had a transcriptomic profile representative of primitive cells during early embryogenesis with high meiosis/mitosis potentials, while nongerminomatous GCTs (NGGCTs) had differentiated phenotypes oriented toward tissue formation and organogenesis. Co-analysis with the transcriptome of human embryonic cells revealed that germinomas had expression profiles similar to those of primordial germ cells, while the expression profiles of NGGCTs were similar to those of embryonic stem cells. Some germinoma cases were characterized by extensive immune-cell infiltration and high expression of cancer-testis antigens. NGGCTs had significantly higher immune-cell infiltration, characterized by immune-suppression phenotype. CNS and testicular GCTs (TGCTs) had similar mutational profiles; TGCTs showed enhanced copy number alterations. Methylation analysis clustered germinoma/seminoma and nongerminoma/nonseminoma separately. Germinoma and seminoma were co-categorized based on the degree of the tumor microenvironment balance. CONCLUSIONS These results suggested that the pathophysiology of GCTs was less dependent on their site of origin and more dependent on the state of differentiation as well as on the tumor microenvironment balance. This study revealed distinct biological properties of GCTs, which will hopefully lead to future treatment development.
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Affiliation(s)
- Hirokazu Takami
- Division of Brain Tumor Translational Research, National Cancer Center Research Institute, Tokyo, Japan,Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Asmaa Elzawahry
- Division of Cancer Genomics, National Cancer Center Research Institute, Tokyo, Japan
| | - Yasin Mamatjan
- MacFeeters Hamilton Centre for Neuro-Oncology Research, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada,Faculty of Science, Thompson Rivers University, Kamloops, British Columbia, Canada
| | - Shintaro Fukushima
- Division of Brain Tumor Translational Research, National Cancer Center Research Institute, Tokyo, Japan
| | - Kohei Fukuoka
- Division of Brain Tumor Translational Research, National Cancer Center Research Institute, Tokyo, Japan,Division of Pediatric Neuro-Oncology, Saitama Medical University International Medical Center, Saitama, Japan,Department of Pediatrics, Saitama Children’s Medical Center, Saitama, Japan
| | - Tomonari Suzuki
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Takaaki Yanagisawa
- Division of Pediatric Neuro-Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Yuko Matsushita
- Division of Brain Tumor Translational Research, National Cancer Center Research Institute, Tokyo, Japan,Department of Neurosurgery and Neuro-oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Taishi Nakamura
- Division of Brain Tumor Translational Research, National Cancer Center Research Institute, Tokyo, Japan,Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Kanagawa, Japan
| | - Kaishi Satomi
- Division of Brain Tumor Translational Research, National Cancer Center Research Institute, Tokyo, Japan,Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Shota Tanaka
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akitake Mukasa
- Department of Neurosurgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masayuki Kanamori
- Department of Neurosurgery, Tohoku University School of Medicine, Miyagi, Japan
| | - Toshihiro Kumabe
- Department of Neurosurgery, Tohoku University School of Medicine, Miyagi, Japan,Department of Neurosurgery, Kitasato University, Kanagawa, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University School of Medicine, Miyagi, Japan
| | - Keiichi Kobayashi
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Motoo Nagane
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Toshihiko Iuchi
- Department of Neurosurgery, Chiba Cancer Center, Chiba, Japan
| | - Kaoru Tamura
- Department of Neurosurgery, Tokyo Medical and Dental University, Graduate School of Medical and Dental Sciences, Tokyo, Japan
| | - Taketoshi Maehara
- Department of Neurosurgery, Tokyo Medical and Dental University, Graduate School of Medical and Dental Sciences, Tokyo, Japan
| | - Kazuhiko Sugiyama
- Department of Neurosurgery, Hiroshima University Faculty of Medicine, Hiroshima, Japan
| | - Koji Yoshimoto
- Department of Neurosurgery, Kyushu University Hospital, Fukuoka, Japan,Department of Neurosurgery, Kagoshima University Hospital, Kagoshima, Japan
| | - Keiichi Sakai
- Department of Neurosurgery, Shinshu Ueda Medical Center, Ueda, Japan
| | - Masahiro Nonaka
- Department of Neurosurgery, Kansai Medical University, Osaka, Japan
| | - Akio Asai
- Department of Neurosurgery, Kansai Medical University, Osaka, Japan
| | - Kiyotaka Yokogami
- Department of Neurosurgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan
| | - Hideo Takeshima
- Department of Neurosurgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan
| | - Yoshitaka Narita
- Department of Neurosurgery and Neuro-oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Soichiro Shibui
- Department of Neurosurgery and Neuro-oncology, National Cancer Center Hospital, Tokyo, Japan
| | | | - Natsuko Hama
- Division of Cancer Genomics, National Cancer Center Research Institute, Tokyo, Japan
| | - Yasushi Totoki
- Division of Cancer Genomics, National Cancer Center Research Institute, Tokyo, Japan
| | - Mamoru Kato
- Division of Cancer Genomics, National Cancer Center Research Institute, Tokyo, Japan
| | - Tatsuhiro Shibata
- Division of Cancer Genomics, National Cancer Center Research Institute, Tokyo, Japan
| | - Ryo Nishikawa
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Masao Matsutani
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Koichi Ichimura
- Corresponding Author: Department of Brain Disease Translational Research, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan ()
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18
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Piber N, Weichert W, Hörer J, Ono M. Life-Threatening Mediastinal Teratoma of Infant Requiring Emergency Surgical Removal. Thorac Cardiovasc Surg Rep 2022; 11:e7-e10. [PMID: 35036289 PMCID: PMC8758248 DOI: 10.1055/s-0041-1726350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 01/28/2021] [Indexed: 11/25/2022] Open
Abstract
Background
Teratoma is a tumor derived from fetal germ cells with aberrant differentiation.
Case Description
A 3-month-old infant with a mediastinal tumor was referred to our heart center. She presented with progressive dyspnea, cyanosis, and the need to be manually ventilated. The computed tomography scan displayed a huge tumor restricting the distal trachea including the bifurcation. An emergent operation was performed and the tumor was completely removed. Histological examination confirmed a mature teratoma.
Conclusion
In such life-threatening situation, the early detection and the immediate operation are very important for the management of rapidly-progressing mediastinal teratomas compressing the respiratory tract.
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Affiliation(s)
- Nicole Piber
- Deutsches Herzzentrum München des Freistaates Bayern, Munchen, Bayern, Germany
| | - Wilko Weichert
- Technical University of Munich Institute of Pathology and Pathological Anatomy, Munchen, Bayern, Germany
| | - Jürgen Hörer
- Deutsches Herzzentrum München des Freistaates Bayern, Munchen, Bayern, Germany
| | - Masamichi Ono
- Deutsches Herzzentrum München des Freistaates Bayern, Munchen, Bayern, Germany
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19
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Yang Y, Zhao M, Chen M, Tang H, Qin Z, Liu J, Wang H, Bao M, Chen J, Xia B. Mature cystic extragonadal teratoma in Douglas' pouch: Case report and literature review. Front Med (Lausanne) 2022; 9:985235. [PMID: 36910009 PMCID: PMC10000728 DOI: 10.3389/fmed.2022.985235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 10/27/2022] [Indexed: 03/14/2023] Open
Abstract
Teratomas often occur in the gonads, while Extragonadal mature cystic teratomas are reported occasionally, with the most common site being the omentum. Teratoma in the Douglas sac is extremely rare. we report a rare case of mature cystic Teratoma in the Douglas sac in a 71-year-old woman who underwent laparoscopic surgery. A cyst with a diameter of approximately 6 cm from Douglas was found during surgery, and the mass was separated from both ovaries. Microscopically, the cyst was a mature cystic teratoma that did not originate from the ovary.
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Affiliation(s)
- Yun Yang
- Dalian Medical University Graduate School, Dalian, China
| | - Mengru Zhao
- Dalian Medical University Graduate School, Dalian, China
| | - Mengyue Chen
- Dalian Medical University Graduate School, Dalian, China
| | - Huimin Tang
- Department of Gynecology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Zhenyue Qin
- Dalian Medical University Graduate School, Dalian, China
| | - Junling Liu
- Department of Gynecology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Huihui Wang
- Dalian Medical University Graduate School, Dalian, China
| | - Mingyue Bao
- Dalian Medical University Graduate School, Dalian, China
| | - Jiming Chen
- Department of Gynecology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Bairong Xia
- Division of Life Sciences and Medicine, Department of Gynecology, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
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20
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Menon P, Reddy M, Roy P, Solanki S, Gupta S, Samujh R, Trehan A. Abdominal wall yolk sac tumor in a child. J Indian Assoc Pediatr Surg 2022; 27:94-96. [PMID: 35261521 PMCID: PMC8853592 DOI: 10.4103/jiaps.jiaps_241_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/02/2020] [Accepted: 10/11/2020] [Indexed: 11/16/2022] Open
Abstract
Midline vascular abdominal wall lesions are likely to be mistaken for vascular malformations in young children. We report a case of large yolk sac tumor located in the anterior abdominal wall just below xiphisternum in a 20-month-old girl diagnosed by raised serum alpha fetoprotein levels and fine-needle aspiration cytology. Preoperative chemotherapy helped in reducing its size allowing wide resection and primary wound closure. This case is reported for the unusual location and role of chemotherapy in management.
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21
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Chen H, Ni M, Xu Y, Zhong LY. Pituitary Stalk Germ Cell Tumors: Retrospective Case Series and Literature Review. Int J Endocrinol 2022; 2022:9213220. [PMID: 35378836 PMCID: PMC8976628 DOI: 10.1155/2022/9213220] [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: 11/03/2021] [Revised: 01/11/2022] [Accepted: 02/17/2022] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE Intracranial germ cell tumors with isolated pituitary stalk involvement are rare. Early recognition and long-term monitoring deserve further exploration. METHODS A retrospective study reviewing eleven intracranial germ cell tumor patients with isolated pituitary stalk involvement was performed. RESULTS Seven boys and four girls who presented with a hyperintense pituitary stalk on postcontrast T1-weighted magnetic resonance imaging without a posterior pituitary signal were included. The average maximum width of the pituitary stalk was 5.2 ± 1.6 mm. Polydipsia and polyuria occurred in all patients, followed by growth retardation, fatigue, and amenorrhoea. Eight patients (72%) had concomitant partial anterior pituitary hormone deficiency. Seven patients initially had elevated human chorionic gonadotropin levels. After chemoradiotherapy, ten patients attended follow-up. Central diabetes insipidus remained in all survivors, and four (40%) of them had concomitant partial anterior pituitary hormone deficiency, primarily of growth hormone and insulin-like growth factor-1. The causes of the delayed diagnosis of previous studies were mainly negative tumor markers and the initial pathological diagnosis of autoimmune diseases. CONCLUSION Isolated pituitary stalk lesions could be a signal of intracranial germ cell tumors, especially coexisting with diabetes insipidus, hypopituitarism, and a worse response to glucocorticoid therapy. Negative results of tumor markers and pathology could not exclude the diagnosis. Chemoradiotherapy is an effective therapy, leaving mild-t-moderate hypothalamus-pituitary dysfunction. This rare neuroimaging feature may be used as a factor to predict long-term neuroendocrine outcomes.
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Affiliation(s)
- Han Chen
- Department of Endocrinology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Ming Ni
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Yun Xu
- Department of Obstetrics and Gynaecology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Li-Yong Zhong
- Department of Endocrinology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
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22
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Bhardwaj P, Thattaruparambil VP, Vellaisamy G, Mahadevaiah S, Hegde S. Gastric teratoma presenting as melena in the newborn: A case report. J Neonatal Perinatal Med 2022; 15:667-669. [PMID: 35694937 DOI: 10.3233/npm-210931] [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: 06/15/2023]
Abstract
Melena is reported in 1 of 350 to 400 new-borns. Significant upper gastrointestinal bleeding in a neonate with an antenatally diagnosed abdominal mass has not been reported before. This case highlights an unusual presentation of a gastric teratoma and proposes a probable embryological explanation for the site of occurrence.
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Affiliation(s)
- P Bhardwaj
- Department of Pediatric Surgery, St. John's Medical College Hospital, Bengaluru, India
| | - V P Thattaruparambil
- Department of Pediatric Surgery, St. John's Medical College Hospital, Bengaluru, India
| | - G Vellaisamy
- Department of Pathology, St. John's Medical College, Bengaluru, India
| | - S Mahadevaiah
- Department of Pediatric Surgery, St. John's Medical College Hospital, Bengaluru, India
| | - S Hegde
- Department of Pediatric Surgery, St. John's Medical College Hospital, Bengaluru, India
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23
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Fichtner A, Richter A, Filmar S, Kircher S, Rosenwald A, Küffer S, Nettersheim D, Oing C, Marx A, Ströbel P, Bremmer F. Primary mediastinal germ cell tumours: an immunohistochemical and molecular diagnostic approach. Histopathology 2021; 80:381-396. [PMID: 34506648 DOI: 10.1111/his.14560] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 08/24/2021] [Accepted: 09/06/2021] [Indexed: 11/30/2022]
Abstract
AIMS Primary mediastinal germ cell tumours (PMGCTs) are rare mediastinal neoplasms and their diagnosis can be challenging due to small biopsy samples. The aim of this study was to elaborate a diagnostic algorithm using immunohistochemical stainings with focus on novel markers and molecular analysis of isochromosome 12p [i(12p)]. METHODS AND RESULTS Paraffin-embedded tissues of 32 mediastinal tumours were analysed using immunohistochemical stainings for SALL4, LIN28, OCT3/4, D2-40, CD117, SOX17, SOX2, CD30, ß-hCG, GATA3, FOXA2, GPC3, AFP, TdT, NUT and pan-cytokeratin. Quantitative real-time polymerase chain reaction (qPCR) was performed to investigate i(12p) status. Fifteen seminomas, seven teratomas, one yolk sac tumour, one choriocarcinoma and seven mixed PMGCT were diagnosed. Each entity had different immunohistochemical staining patterns which helped to distinguish them: seminoma (OCT3/4, D2-40, CD117, TdT), embryonal carcinoma (OCT3/4, SOX2), yolk sac tumour (FOXA2, GPC3, AFP) and choriocarcinoma (ß-hCG, GATA3). Mature teratomas stained positive for pan-cytokeratin in epithelial components and focally for SALL4, SOX2, GATA3, D2-40 and FOXA2. Furthermore, a NUT carcinoma mimicking a PMGCT was diagnosed showing a strong nuclear SOX2 and speckled nuclear NUT staining. i(12p) was detected in 24 out of 27 PMGCTs [89%]. CONCLUSION A diagnostic algorithm is of great importance for a reliable diagnosis of PMGCTs in the usually small tissue biopsy samples. Therefore, a combination of three to four antibodies to identify the correct histological subtype is usually necessary in addition to morphological features. The i(12p) status serves as an additional option to underline germ cell origin in selected cases.
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Affiliation(s)
- A Fichtner
- University Medical Center Göttingen, Institute of Pathology, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - A Richter
- University Medical Center Göttingen, Institute of Pathology, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - S Filmar
- University Medical Center Göttingen, Institute of Pathology, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - S Kircher
- University of Würzburg, Institute of Pathology, Josef-Schneider-Straße 2, 97070, Würzburg, Germany
| | - A Rosenwald
- University of Würzburg, Institute of Pathology, Josef-Schneider-Straße 2, 97070, Würzburg, Germany
| | - S Küffer
- University Medical Center Göttingen, Institute of Pathology, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - D Nettersheim
- Heinrich-Heine-University, Medical Faculty and University Hospital Düsseldorf, Department of Urology, Urological Research Laboratory, Translational UroOncology, Universitätsstrasse 1, 40225, Düsseldorf, Germany
| | - C Oing
- University Medical Centre Hamburg-Eppendorf, Department of Oncology, Haematology and Bone Marrow Transplantation with Division of Pneumology & Mildred Scheel Cancer Career Centre HaTriCS4, Martinistrasse 52, 20246, Hamburg, Germany
| | - A Marx
- University Medical Centre Mannheim, Institute of Pathology, Theodor-Kutzer-Ufer 1-3, 68135, Mannheim, Germany
| | - P Ströbel
- University Medical Center Göttingen, Institute of Pathology, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - F Bremmer
- University Medical Center Göttingen, Institute of Pathology, Robert-Koch-Str. 40, 37075, Göttingen, Germany
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24
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Kafka M, Wöll E, Brunhuber T, Gruber L, Tulchiner G, Staudacher N, Horninger W, Pichler R. A presumed extragonadal germ cell tumor that turned out to be a gastric cancer-a case report. Transl Androl Urol 2021; 10:2528-2533. [PMID: 34295739 PMCID: PMC8261445 DOI: 10.21037/tau-21-150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/12/2021] [Indexed: 12/16/2022] Open
Abstract
A solely retroperitoneal mass in males in combination with elevated serum Alpha-Fetoprotein (AFP) and beta-human choriogonadotropin (β-HCG) levels is highly indicative of a metastatic testicular cancer. Although testicular cancers are rare, they represent the most common diagnosed cancer in males between 14 and 40 years. However, in cases without evidence of a primary testicular tumor, the rare diagnosis of a retroperitoneal extragonadal germ cell tumor (EGCT) must be assumed. Here, we describe the first published case of a 66-year-old man presenting with this typical clinical picture and the diagnosis of an AFP and β-HCG producing advanced gastric cancer with retroperitoneal lymph node metastases mimicking a primary retroperitoneal EGCT. The final diagnosis was only made by gastroscopy performed after a CT-guided retroperitoneal lymph node biopsy revealed an adenocarcinoma, suggesting an upper gastrointestinal tract primary origin. However, a specific initial anamnesis and also in the primary staging, including a full-body CT-scan there was no hint for another primary tumor. Only the slightly unusual extension of the retroperitoneal mass up to the ligamentum hepatoduodenale and the pylorus, as well as the atypical age made us question our initial diagnosis. This extraordinary case is of special clinical interest to all practising physicians and once again highlights the importance of keeping rare differential diagnosis such as AFP-producing gastrointestinal tumors in mind.
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Affiliation(s)
- Mona Kafka
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ewald Wöll
- Department of Internal Medicine, St. Vinzenz Hospital, Zams, Austria
| | - Thomas Brunhuber
- Laboratory of Pathology, Dr. Obrist and Dr. Brunhuber OG, Zams, Austria
| | - Leonhard Gruber
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Gennadi Tulchiner
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Nina Staudacher
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Wolfgang Horninger
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Renate Pichler
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
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25
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To Be or Not to Be a Germ Cell: The Extragonadal Germ Cell Tumor Paradigm. Int J Mol Sci 2021; 22:ijms22115982. [PMID: 34205983 PMCID: PMC8199495 DOI: 10.3390/ijms22115982] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 02/06/2023] Open
Abstract
In the human embryo, the genetic program that orchestrates germ cell specification involves the activation of epigenetic and transcriptional mechanisms that make the germline a unique cell population continuously poised between germness and pluripotency. Germ cell tumors, neoplasias originating from fetal or neonatal germ cells, maintain such dichotomy and can adopt either pluripotent features (embryonal carcinomas) or germness features (seminomas) with a wide range of phenotypes in between these histotypes. Here, we review the basic concepts of cell specification, migration and gonadal colonization of human primordial germ cells (hPGCs) highlighting the analogies of transcriptional/epigenetic programs between these two cell types.
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26
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Sugimoto A, Yamada Y, Fujimoto M, Minamiguchi S, Sato T, Akamatsu S, Marx A, Haga H. A multilocular thymic cyst associated with mediastinal seminoma: evidence for its medullary epithelial origin highlighted by POU2F3-positive thymic tuft cells and concomitant myoid cell proliferation. Virchows Arch 2021; 479:215-220. [PMID: 34028621 DOI: 10.1007/s00428-021-03125-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/13/2021] [Accepted: 05/16/2021] [Indexed: 01/07/2023]
Abstract
Multilocular thymic cyst (MTC) and germ cell tumors are common diseases that impact the mediastinum. Correctly diagnosing these diseases can be difficult because several other conditions can mimic them. We report a male patient with MTC associated with mediastinal seminoma. A needle biopsy of the mediastinal tumor revealed numerous epithelioid cell granulomas that mimicked sarcoidosis or mycobacterial infection. However, large atypical cells positive for Oct3/4 and KIT were noted between the granulomas; thus, we diagnosed the patient with mediastinal seminoma. The resected tumor, after chemotherapy, consisted of multiple cystic lesions, and a residual germ cell tumor was first considered. However, thymic medulla-specific elements, namely, POU2F3-positive thymic tuft cells and rhabdomyomatous myoid cells accompanying the epithelium, led to the correct diagnosis of MTC. Our case underscores the importance of recognizing the histological features associated with mediastinal seminoma and provides novel findings for MTC pathogenesis, namely, the presence of thymic tuft cells.
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Affiliation(s)
- Akihiko Sugimoto
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Yosuke Yamada
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan.
| | - Masakazu Fujimoto
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | | | - Takuma Sato
- Department of Urology, Kyoto University Hospital, Kyoto, Japan
| | | | - Alexander Marx
- Institute of Pathology, University Medical Centre Mannheim and Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Hironori Haga
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
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27
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Kanneganti A, Bhadiraju P, Tong PSY. Extragonadal teratomas in women and adolescent girls: A systematic review. Eur J Obstet Gynecol Reprod Biol 2021; 262:134-141. [PMID: 34022590 DOI: 10.1016/j.ejogrb.2021.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/10/2021] [Accepted: 05/02/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Extragonadal teratomas (EGTs) are rare and the commonest intra-abdominal subtype is omental. We present two cases: 1) a parasitic omental teratoma likely secondary to auto-amputation of an ovarian teratoma with subsequent omental reimplantation and 2) an omental immature teratoma likely due to parthenogenetic activation of displaced primordial germ cells. We subsequently conduct a systematic review to characterise EGTs. METHODS We sourced for English, peer-reviewed case reports of extragonadal teratomas in women and female adolescents aged 11 and above published from inception of each database through 31st June 2020 following PRISMA guidelines. Two authors reviewed each case for appropriateness and each case was graded for methodological quality utilising a modified Newcastle Ottawa Scale. PROSPERO Registration Number: CRD42020190131 RESULTS: Upon literature review between 1920-2020, from an initial screen of 818 articles, 67 articles were selected featuring 70 cases. One case featured an immature teratoma while the remaining were mature. Omental EGTs were the most common (56.5 %) followed by Pouch of Douglas and uterosacral ligament (23.2 %) and upper abdomen (14.5 %). There were statistically significant differences in EGT mean sizes between each location with the largest being in the upper abdomen (10.9 cm) and the smallest being in the adnexa or hernia (6.2 cm). Auto-amputation was deemed the commonest cause amongst omental EGTs (55.3 %) and Pouch of Douglas and uterosacral ligament EGTs (37.5 %) while 70 % of upper abdominal EGTs were likely due to displaced primordial germ cells. We characterise clinical features associated with each pathogenic mechanism and imaging characteristics of EGTs. Characterisation of EGT tumour marker profiles was limited as only 42.9 % of cases reported them but 19.2-25.0 % had raised tumour markers. The main risks are torsion, rupture, immature components and potential malignant change of the cell lines. Treatment is largely surgical. The mean size of EGTs approached laparoscopically and via laparotomy was 5.23 cm and 9.16 cm respectively. CONCLUSIONS While rare, EGTs should be considered when evaluating pelviabdominal masses with imaging characteristics consistent with teratomas. Confirmation is usually intraoperative and a laparoscopic approach is reasonable if there is good surgeon comfort and the size is about 5 cm.
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Affiliation(s)
- Abhiram Kanneganti
- Department of Obstetrics and Gynaecology, National University Hospital, 5 Lower Ridge Road, 119074, Singapore
| | - Poornima Bhadiraju
- Department of Obstetrics and Gynaecology, National University Hospital, 5 Lower Ridge Road, 119074, Singapore
| | - Pearl Shuang Ye Tong
- Department of Obstetrics and Gynaecology, National University Hospital, 5 Lower Ridge Road, 119074, Singapore.
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28
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Phi JH. Sacrococcygeal Teratoma : A Tumor at the Center of Embryogenesis. J Korean Neurosurg Soc 2021; 64:406-413. [PMID: 33906346 PMCID: PMC8128526 DOI: 10.3340/jkns.2021.0015] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 03/10/2021] [Indexed: 02/02/2023] Open
Abstract
Sacrococcygeal teratoma (SCT) is an extragonadal germ cell tumor (GCT) that develops in the fetal and neonatal periods. SCT is a type I GCT in which only teratoma and yolk sac tumors arise from extragonadal sites. SCT is the most common type I GCT and is believed to originate through epigenetic reprogramming of early primordial germ cells migrating from the yolk sac to the gonadal ridges. Fetal SCT diagnosed in utero presents many obstetrical problems. For high-risk fetuses, fetal interventions (devascularization and debulking) are under development. Most patients with SCT are operated on after birth. Complete surgical resection is the key for tumor control, and the anatomical location of the tumor determines the surgical approaches. Incomplete resection and malignant histology are risk factors for recurrence. Approximately 10-15% of patients have a tumor recurrence, which is frequently of malignant histology. Long-term surveillance with monitoring of serum alpha fetoprotein and magnetic resonance imaging is required. Survivors of SCT may suffer anorectal, urological, and sexual sequelae later in their life, and comprehensive evaluation and care are required.
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Affiliation(s)
- Ji Hoon Phi
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
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29
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Ozolek JA, Tekkesin MS. THE "-OMAS" and "-OPIAS": Targeted and Philosophical Considerations Regarding Hamartomas, Choristomas, Teratomas, Ectopias, and Heterotopias in Pediatric Otorhinolaryngologic Pathology. Head Neck Pathol 2021; 15:25-40. [PMID: 33723758 PMCID: PMC8010027 DOI: 10.1007/s12105-020-01251-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/12/2020] [Indexed: 12/17/2022]
Abstract
The spectrum of "developmental" lesions that occur in the head and neck predominantly congenital in origin and arising at birth and/or discovered in childhood is broad and fascinating. These have been grouped into categories such as "ectopias", "heterotopias", "hamartomas", and "choristomas". On a philosophical and consequently systematic level, these lesions, mostly benign tumors seem to lack a true understanding of the pathogenetic foundation on which to base a more unified taxonomic designation. In this review, we will consider some of these select tumors as they represent syndromic associations (nasal chondromesenchymal hamartoma and DICER1 syndrome), the lingual choristoma from the perspective of its nomenclature and classification, lesions with ectopic meningothelial elements, and teratomas and the enigmatic "hairy polyp" in reference to a broader discussion of pathogenesis and pluripotent cells in the head and neck. A consistent thread will be how these lesions are designated with some final thoughts on future directions regarding the investigation of their pathogenesis and taxonomic nomenclature.
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Affiliation(s)
- John A Ozolek
- Department of Pathology, Anatomy, and Laboratory Medicine, West Virginia University School of Medicine, Morgantown, WV, USA.
| | - Merva Soluk Tekkesin
- Department of Tumour Pathology, Institute of Oncology, Istanbul University, Istanbul, Capa-Istanbul, 34093, Turkey
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30
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Sugrue DD, Ryan J, Harris J, Cheema I. Visible haematuria-an unusual presentation of metastatic testicular mixed germ cell tumour. BMJ Case Rep 2021; 14:14/3/e241056. [PMID: 33692071 PMCID: PMC7949432 DOI: 10.1136/bcr-2020-241056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 29-year-old male patient presented to the emergency department with haematuria and flank pain. Ten months agopreviously, he had undergone orchidectomy and adjuvant chemotherapy for a testicular mixed germ cell tumour. Cystoscopy revealed a large bladder wall mass. The final diagnosis of yolk sac tumour was established after transurethral resection of the lesion. The patient was treated with salvage chemotherapy and placed on short-interval biochemical and radiological surveillance to assess treatment response.
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Affiliation(s)
| | - James Ryan
- Urology, Beaumont Hospital, Dublin, Ireland
| | | | - Ijaz Cheema
- Urology, Beaumont Hospital, Dublin, Ireland.,Urology, Connolly Hospital Blanchardstown, Dublin, Ireland
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Takami H, Perry A, Graffeo CS, Giannini C, Narita Y, Nakazato Y, Saito N, Nishikawa R, Matsutani M, Ichimura K, Daniels DJ. Comparison on epidemiology, tumor location, histology, and prognosis of intracranial germ cell tumors between Mayo Clinic and Japanese consortium cohorts. J Neurosurg 2021; 134:446-456. [PMID: 32005022 DOI: 10.3171/2019.11.jns191576] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 11/27/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Central nervous system (CNS) germ cell tumors (GCTs) are rare malignant neoplasms that arise predominantly in adolescents and young adults. CNS GCTs demonstrate characteristic trends in national associations, with implications for both tumor incidence and genetics. Although the incidence of CNS GCTs is markedly higher in East Asia than Western countries, direct comparative analyses between these CNS GCT populations are limited. METHODS In Japan, to facilitate the genomic analyses of CNS GCTs, the Intracranial Germ Cell Tumor Genome Analysis Consortium was established in 2011, and more than 200 cases of GCTs are available for both tumor tissue and clinical data, which is organized by the National Cancer Center (NCC) Japan. At the Mayo Clinic, there have been 98 cases of intracranial GCTs treated by the Department of Neurologic Surgery since 1988. In this paper, the authors compared the epidemiology, clinical presentation including location and histology, and prognosis between cases treated in the US and Japan. RESULTS There was no significant difference in age and sex distributions between the databases. However, there was a significant difference in the tumor locations; specifically, the frequency of basal ganglia was higher in the NCC database compared with the Mayo Clinic (8.4% vs 0%, p = 0.008), and bifocal location (neurohypophysis and pineal gland) was higher at the Mayo Clinic than at the NCC (18.8% vs 5.8%, p = 0.002). There was no difference in histological subdivisions between the databases. There was no difference in progression-free survival (PFS) and overall survival (OS) of germinoma cases and OS of nongerminomatous GCT (NGGCT) cases treated with chemotherapy and radiation therapy covering whole ventricles. However, PFS of NGGCTs differed significantly, and was better in the NCC cohorts (p = 0.04). CONCLUSIONS There appears to be a differential distribution of GCTs by neuroanatomical location between major geographic and national groups. Further study is warranted to better characterize any underlying genomic, epigenetic, or environmental factors that may be driving the phenotypic differences.
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Affiliation(s)
- Hirokazu Takami
- Departments of1Neurologic Surgery and
- 3Division of Brain Tumor Translational Research, National Cancer Center, Tokyo, Japan
- 4Department of Neurosurgery, Faculty of Medicine, University of Tokyo, Japan
| | | | | | - Caterina Giannini
- 2Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Yoshitaka Narita
- 5Department of Neurosurgery and Neuro-oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yoichi Nakazato
- 6Department of Pathology, Hidaka Hospital, Gunma, Japan; and
| | - Nobuhito Saito
- 4Department of Neurosurgery, Faculty of Medicine, University of Tokyo, Japan
| | - Ryo Nishikawa
- 7Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Masao Matsutani
- 7Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Koichi Ichimura
- 3Division of Brain Tumor Translational Research, National Cancer Center, Tokyo, Japan
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Takami H, Graffeo CS, Perry A, Giannini C, Daniels DJ. Epidemiology, natural history, and optimal management of neurohypophyseal germ cell tumors. J Neurosurg 2021; 134:437-445. [PMID: 32032947 DOI: 10.3171/2019.10.jns191136] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 10/14/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Intracranial germ cell tumors (iGCTs) often arise at the neurohypophysis, their second most common origination, following the pineal region. Neurohypophyseal iGCTs present with stereotypical symptoms, including pituitary dysfunction and visual field deficit, due to their suprasellar location. The goal of this study was to present a large, longitudinal single-institution experience with neurohypophyseal iGCTs to better understand their natural history and identify opportunities for further improvement in treatment outcomes. METHODS This is a retrospective, single-institution cohort study of neurohypophyseal iGCTs treated between 1988 and 2017, with a focus on the epidemiology, presentation, natural history, and treatment. RESULTS Thirty-five neurosurgically managed patients met inclusion criteria; the median age was 18 years (3 months to 49 years), and 74% of patients were male (n = 26). Thirty-one tumors were germinomas, and 4 were nongerminomatous iGCTs. Presenting symptoms included pituitary insufficiency in 76% (n = 25), visual deficit in 45% (n = 15), and diabetes insipidus (DI) in 61% (n = 20) of patients. Index symptoms included isolated DI in 10 (36%), isolated hormone deficiency in 14 (50%), and concomitant DI and hormone deficiency symptoms in 4 (14%). Radiographic diagnostic latency was common, occurring at a median of 363 days (range 9-2626 days) after onset of the first symptoms and was significantly associated with both DI and hormone deficiency as the index symptoms (no DI vs DI: 360 vs 1083 days, p = 0.009; no hormone deficiency vs hormone deficiency: 245 vs 953 days, p = 0.004). Biochemical abnormalities were heterogeneous; each pituitary axis was dysfunctional in at least 1 patient, with most patients demonstrating at least 2 abnormalities, and pretreatment dysfunction demonstrating a nonsignificant trend toward association with long-term posttreatment hormone supplementation. Among germinomas, whole-brain or whole-ventricle radiotherapy demonstrated significantly improved progression-free and overall survival compared with local therapy (p = 0.009 and p = 0.004, respectively). CONCLUSIONS Neurohypophyseal iGCTs are insidious tumors that may pose a diagnostic dilemma, as evidenced by the prolonged latency before radiographic confirmation. Serial imaging and close endocrine follow-up are recommended in patients with a characteristic clinical syndrome and negative imaging, due to the propensity for radiographic latency. Pretreatment biochemical abnormalities may indicate higher risk of posttreatment pituitary insufficiency, and all patients should receive careful endocrine follow-up. Local radiotherapy is prone to treatment failure, while whole-ventricle treatment is associated with improved survival in germinomas.
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Affiliation(s)
| | | | | | - Caterina Giannini
- 2Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
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33
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Ramonfaur D, Josephs M, Shmorhun D, Hasbani K. A teenager with recurrent supraventricular tachycardia and a giant mediastinal mass. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2020.101750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Rao YF, Cheng DN, Qiu K, Song Y, Zhao Y, Gu D, Ren J. Sinonasal teratocarcinosarcoma: a case report and literature review. J Int Med Res 2020; 48:300060520971488. [PMID: 33342340 PMCID: PMC7754799 DOI: 10.1177/0300060520971488] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/13/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Sinonasal teratocarcinosarcoma (SNTCS) is a highly invasive malignant tumor most frequently found in the nasal cavity and paranasal sinuses. As a result, it can be confused with other sinonasal tumors. In addition, SNTCS progresses rapidly and often infiltrates other tissues or organs in the early phase, resulting in poor patient prognosis. The objective of this article was to report the case of a patient with SNTCS and discuss the management strategy. Furthermore, we conducted a literature review for SNTCS and summarized the findings from 107 cases.Case presentation: Here, we report a 47-year-old man diagnosed with SNTCS and treated with radiochemotherapy after an initial operation. After follow-up for 5 years, no tumor recurrence was observed. CONCLUSIONS As SNTCS progresses rapidly, early diagnosis and surgical treatment combined with radiochemotherapy can improve patient survival.
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Affiliation(s)
| | | | - Ke Qiu
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Yao Song
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Yu Zhao
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Deying Gu
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Jianjun Ren
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
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Bonouvrie K, van der Werff Ten Bosch J, van den Akker M. Klinefelter syndrome and germ cell tumors: review of the literature. INTERNATIONAL JOURNAL OF PEDIATRIC ENDOCRINOLOGY 2020; 2020:18. [PMID: 33005196 PMCID: PMC7526209 DOI: 10.1186/s13633-020-00088-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/27/2020] [Indexed: 11/10/2022]
Abstract
Objective The most common presentation of Klinefelter syndrome (KS) is infertility and features of hypogonadism. Currently no consensus exists on the risk of malignancy in this syndrome. Several case reports show an incidence of extragonadal germ cells tumors (eGCT) of 1.5 per 1000 KS patients (OR 50 against healthy population). Malignant germ cell tumors are rare in children. They account for 3% of all children cancers. Young patients with a germ cell tumor are not routinely tested for Klinefelter syndrome. This can therefore result in underdiagnosing. Literature data suggest a correlation between eGCT and KS. To the best of our knowledge there is no precise description of the primary locations of germ cell tumors in KS patients. The purpose of this study is to evaluate age groups and primary locations of extragonadal germ cell tumors in Klinefelter patients. With this data we investigate whether it is necessary to perform a cytogenetic analysis for KS in every eGCT patient. Study design This study is based on case report publications in PubMed/Medline published until march 2020 that described "Klinefelter Syndrome (MeSH) AND/OR extragonadal germ cell tumors". Publications were included when patients age, location and histology of the germ cell tumor was known. Two double blinded reviewers selected the studies.Results: 141 KS patients with eGCTs were identified. Mean age at presentation was 17.3 years (StDev + - 10.2). In contrast to the extragonadal germ cell tumors in adults, most eGCT in children were mediastinal or in the central nervous system (respectively 90/141; 64% and 23/141; 16% of all tumors). Distribution of histologic subtypes showed that the largest fraction represented a teratoma, mixed-type-non-seminomateus GCT and germinoma, respectively 34/141; 24%, 26/141; 18% and 20/141; 14% of all tumors. Conclusion These data suggest a correlation between primary extragonadal germ cell tumors and Klinefelter syndrome. There appears to be an indication for screening on KS in young patients with an eGCT in the mediastinum. A low threshold for radiologic examinations should be considered to discover eGCT. We emphasize the need for genetic analysis in all cases of a male with a mediastinal germ cell tumor for the underdiagnosed Klinefelter syndrome.
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Affiliation(s)
- Kimberley Bonouvrie
- Department of Pediatrics, Maxima Medisch Centrum, Veldhoven, The Netherlands.,Department of Pediatrics, ZNA Queen Paola Children's Hospital, Lindendreef 1, 2020 Antwerp, Belgium
| | - Jutte van der Werff Ten Bosch
- Department of Pediatrics, ZNA Queen Paola Children's Hospital, Lindendreef 1, 2020 Antwerp, Belgium.,Department of Pediatric Hematology and Oncology, University Hospital Brussel, Brussels, Belgium
| | - Machiel van den Akker
- Department of Pediatrics, ZNA Queen Paola Children's Hospital, Lindendreef 1, 2020 Antwerp, Belgium.,Department of Pediatric Hematology and Oncology, University Hospital Brussel, Brussels, Belgium
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36
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Ovarian and non-ovarian teratomas: a wide spectrum of features. Jpn J Radiol 2020; 39:143-158. [PMID: 32875471 DOI: 10.1007/s11604-020-01035-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/20/2020] [Indexed: 01/01/2023]
Abstract
Teratoma is a germ cell tumor (GCT) derived from stem cells of the early embryo and the germ line. Teratoma is the most common neoplasm of the ovaries and is usually diagnosed easily using imagings by detecting fat components. However, there are various histopathological types and the imaging findings differ according to the type. Teratoma usually occurs in the gonads or in the midline due to migration of primordial germ cells during development. The clinical course of teratomas depends on the age of the patient, histological type, and anatomical site. Sometimes teratomas show unusual manifestations, such as mature teratoma without demonstrable fat components, torsion, rupture, growing teratoma syndrome, anti-N-methyl-D-aspartate receptor encephalitis, and autoimmune hemolytic anemia. For all of these reasons, teratomas demonstrate a wide spectrum of imaging features and radiologists should be familiar with these variabilities. The present article aims to introduce a model encompassing types of GCTs based on their developmental potential, and to review several histopathological types in various anatomical sites and unusual manifestations of teratomas, with representative imaging findings.
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37
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Hayden J, Murray MJ, Bartels U, Ajithkumar T, Muthusamy B, Penn A, Calaminus G, Nicholson J. Symptom interval and treatment burden for patients with malignant central nervous system germ cell tumours. Arch Dis Child 2020; 105:247-252. [PMID: 31594777 DOI: 10.1136/archdischild-2019-317245] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 09/02/2019] [Accepted: 09/23/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Patients with central nervous system germ cell tumours (CNS-GCTs) commonly initially present to primary care or general paediatricians. Prolonged symptom intervals (SI) are frequently seen in CNS-GCTs and have been associated with inferior outcomes in other brain tumours. This study reviewed the clinical presentation of CNS-GCTs and examined the effect of prolonged SI. DESIGN/SETTING/PATIENTS/OUTCOMES International multicentre 10-year retrospective study (2002-2011 inclusive), across six international paediatric oncology treatment centres. All newly diagnosed patients with CNS-GCT were included. Main outcome measure was time interval from first symptom to diagnosis. RESULTS The study cohort included 86 (58 males:28 female) patients (59 'germinoma' and 27 'non-germinomatous' GCTs), with tumours being pineal (n=33), suprasellar (n=25), bifocal (pineal+suprasellar; n=24) and 'other' site (n=4), of which 16 (19%) were metastatic. Median age at diagnosis was 14 years (0-23 years). The time to diagnosis from first symptom (SI) was 0-69 months (median 3 months, mean 9 months). A prolonged SI (>6 months) was observed in 28/86 patients (33%) and significantly associated with metastatic disease (11/28 (39%) vs 5/58 (9%); p=0.002)) at diagnosis, but not overall survival. With prolonged SI, endocrine symptoms, particularly diabetes insipidus, were more common (21/28 (75%) vs 14/58 (24%) patients; p<0.002), but raised intracranial pressure (RICP) was less frequent (4/28 (14%) vs 43/58 (74%) patients; p<0.001)) at first symptom. CONCLUSIONS One-third of patients with CNS-GCT have >6 months of symptoms prior to diagnosis. Delayed diagnosis is associated with metastatic disease. Early symptom recognition, particularly related to visual and hormonal disturbances in the absence of RICP, may improve timely diagnosis, reduce metastatic disease frequency and consequently reduce treatment burden and late effects.
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Affiliation(s)
- James Hayden
- Department of Paediatric Haematology and Oncology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.,Department of Paediatric Haematology and Oncology, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Matthew J Murray
- Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ute Bartels
- Department of Paediatric Haematology and Oncology, Paediatric Brain Tumour Program, SickKids, Toronto, Ontario, Canada
| | - Thankamma Ajithkumar
- Department of Radiation Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, UK
| | - Brinda Muthusamy
- Department of Paediatric Neuro-Ophthalmology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Anthony Penn
- Children's Brain Tumour Research Network (CBTRN), Royal Manchester Children's Hospital, Manchester, UK.,Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Gabriele Calaminus
- Department of Paediatric Haematology and Oncology, University Hospital Bonn, Bonn, Germany
| | - James Nicholson
- Paediatric Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Manojlovic-Gacic E, Rostami E, Karavitaki N, Casar-Borota O. Histopathology of Parasellar Neoplasms. Neuroendocrinology 2020; 110:740-752. [PMID: 32155632 PMCID: PMC7490502 DOI: 10.1159/000507084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 03/09/2020] [Indexed: 01/28/2023]
Abstract
The anatomical and histological complexity of the parasellar region as well as the presence of embryonic remnants determine the huge diversity of parasellar neoplasms. Some of them are only located in the parasellar region, whereas others can occur elsewhere, within or outside the central nervous system. Their spectrum ranges from histologically benign and low-grade malignant to high-grade malignant tumours. Although rare, metastases can pose differential diagnostic dilemmas. The severity of the clinical picture, the challenges of surgery and the risk of adverse sequelae related to surgery or radiotherapy make parasellar tumours interesting entities for the clinicians irrespective of their histological malignancy grade. Due to the different cell origins of parasellar tumours, the World Health Organization classification system does not categorise them as a distinct group. Detailed criteria for classification and malignancy grading are presented in the classification systems covering central nervous system tumours, haematological malignancies and tumours of the soft tissue and bone. In the last few years, molecular genetic features have been integrated into the diagnosis of several types of the parasellar tumours enhancing diagnostic accuracy and providing information of the value for targeting therapies. In this review, we will present histopathological and molecular genetic features, updated classification criteria and recent advances in the diagnostics and rationale for novel pharmacological therapies of selected types of parasellar neoplasms.
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Affiliation(s)
| | - Elham Rostami
- Section of Neurosurgery, Department of Neuroscience, Uppsala University, Uppsala, Sweden
- Department of Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Niki Karavitaki
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, United Kingdom
- Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Olivera Casar-Borota
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden,
- Department of Clinical Pathology, Uppsala University Hospital, Uppsala, Sweden,
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Dell'Aversana S, Coppola M, Romeo V, Ugga L, Piccin L, Sirignano C, D'Amico A, Soscia E, Matano E, D'Armiento FP, Del Basso De Caro M, Camera L, Maurea S. Germ cell tumors in male patients without gonadal involvement: computed tomography/magnetic resonance imaging findings and diagnostic workflow. Quant Imaging Med Surg 2019; 9:2000-2007. [PMID: 31929974 DOI: 10.21037/qims.2019.11.01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Serena Dell'Aversana
- Department of Advanced Biomedical Sciences, Oncology Division, University of Naples Federico II, Naples, Italy
| | - Milena Coppola
- Department of Advanced Biomedical Sciences, Oncology Division, University of Naples Federico II, Naples, Italy
| | - Valeria Romeo
- Department of Advanced Biomedical Sciences, Oncology Division, University of Naples Federico II, Naples, Italy
| | - Lorenzo Ugga
- Department of Advanced Biomedical Sciences, Oncology Division, University of Naples Federico II, Naples, Italy
| | - Luisa Piccin
- Department of Clinical Medicine and Surgery, Oncology Division, University of Naples Federico II, Naples, Italy
| | - Cesare Sirignano
- Institute of Biostructures and Bioimaging of the National Research Council (CNR), Naples, Italy
| | - Alessandra D'Amico
- Department of Advanced Biomedical Sciences, Oncology Division, University of Naples Federico II, Naples, Italy
| | - Ernesto Soscia
- Institute of Biostructures and Bioimaging of the National Research Council (CNR), Naples, Italy
| | - Elide Matano
- Department of Clinical Medicine and Surgery, Oncology Division, University of Naples Federico II, Naples, Italy
| | - Francesco Paolo D'Armiento
- Department of Advanced Biomedical Sciences, Oncology Division, University of Naples Federico II, Naples, Italy
| | | | - Luigi Camera
- Department of Advanced Biomedical Sciences, Oncology Division, University of Naples Federico II, Naples, Italy
| | - Simone Maurea
- Department of Advanced Biomedical Sciences, Oncology Division, University of Naples Federico II, Naples, Italy
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Tamura D, Maeda D, Sato T, Sugawara T, Shirasawa H, Shimizu D, Sato N, Goto A, Terada Y. An extragonadal yolk sac tumor presumed to be of postmeiotic germ cell origin by genetic zygosity analysis via single nucleotide polymorphism array. Genes Chromosomes Cancer 2019; 59:209-213. [DOI: 10.1002/gcc.22817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/15/2019] [Indexed: 01/19/2023] Open
Affiliation(s)
- Daisuke Tamura
- Department of Obstetrics and Gynecology, Graduate School of MedicineAkita University Akita Japan
- Department of GynecologyAkita Red Cross Hospital Akita Japan
| | - Daichi Maeda
- Department of Clinical Genomics, Graduate School of MedicineOsaka University Osaka Japan
| | - Toshiharu Sato
- Department of Obstetrics and Gynecology, Graduate School of MedicineAkita University Akita Japan
| | - Tae Sugawara
- Department of Obstetrics and Gynecology, Graduate School of MedicineAkita University Akita Japan
| | - Hiromitsu Shirasawa
- Department of Obstetrics and Gynecology, Graduate School of MedicineAkita University Akita Japan
| | - Dai Shimizu
- Department of Obstetrics and Gynecology, Graduate School of MedicineAkita University Akita Japan
| | - Naoki Sato
- Department of Obstetrics and Gynecology, Graduate School of MedicineAkita University Akita Japan
| | - Akiteru Goto
- Department of Cellular and Organ Pathology, Graduate School of MedicineAkita University Akita Japan
| | - Yukihiro Terada
- Department of Obstetrics and Gynecology, Graduate School of MedicineAkita University Akita Japan
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Ito K, Yano M, Ogasawara A, Miwa M, Kozawa E, Yasuda M. A unique uterine cervical "teratocarcinosarcoma": a case report. Diagn Pathol 2019; 14:122. [PMID: 31684979 PMCID: PMC6827231 DOI: 10.1186/s13000-019-0890-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 09/12/2019] [Indexed: 12/02/2022] Open
Abstract
Background Teratocarcinosarcoma (TCS) is a rare aggressive tumor of the nasal cavity and paranasal sinuses and has both epithelial and two or more mesenchymal components. In other organs, 5 cases of ovarian tumors closely resembling TCS have been reported; however, there has been no published case of cervical TCS. Herein, we describe a unique case of cervical tumor that had carcinosarcomatous and teratomatous features, resembling a sinonasal TCS. Case presentation A 45-year-old woman presented to our hospital for evaluation of a cervical lesion. The gynecologist found a large polypoid mass, whose biopsy showed glandular components of probable germ cell origin based on the immunohistochemical features. The patient underwent total hysterectomy with bilateral salpingo-oophorectomy. The cervical polypoid mass was found to consist of both epithelial and mesenchymal tissues, including immature glandular structure resembling fetal enteric tubules, neuroepithelial cells, hyaline cartilage, and rhabdomyosarcoma cells. This tumor was diagnosed as TCS of the uterine cervix. Following the surgery, the patient received radiotherapy and has been free of disease for 13 months. Conclusion This is the first case report of cervical TCS. The tumor is thought to be histogenetically less associated with HPV infection, and its teratomatous components with an absence of cytogenetic abnormalities (including isochromosome 12p (i(12p)) suggest a analogous histogenesis compared to pure mature or immature teratoma.
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Affiliation(s)
- Kozue Ito
- Department of Pathology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-City, Saitama, 350-1298, Japan
| | - Mitsutake Yano
- Department of Pathology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-City, Saitama, 350-1298, Japan.,Department of Obstetrics and Gynecology, Oita University Faculty of Medicine, Yufu-shi, Oita, 879-5593, Japan
| | - Aiko Ogasawara
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-City, Saitama, 350-1298, Japan
| | - Maiko Miwa
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-City, Saitama, 350-1298, Japan
| | - Eito Kozawa
- Department of Diagnostic Radiology, Saitama Medical University Hospital, Moroyama, Saitama, 350-0495, Japan
| | - Masanori Yasuda
- Department of Pathology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-City, Saitama, 350-1298, Japan.
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Hay D, Biswas B, Dasgupta J. Fimbrial dermoid cyst with elevated CA19-9 levels: A case report. Case Rep Womens Health 2019; 24:e00156. [PMID: 31871902 PMCID: PMC6909036 DOI: 10.1016/j.crwh.2019.e00156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 10/09/2019] [Accepted: 10/11/2019] [Indexed: 11/20/2022] Open
Abstract
Dermoid cysts in aberrant locations are usually reported at Caesarean section or during laparoscopic sterilisation and thus a pre-operative CA19-9 level is rarely available. That and the rarity of these 'ectopic dermoids' make it very hard to give further support to a causative association with the high tumour marker levels. We report the case of a 39-year-old woman who presented in an acute setting with pelvic pain and was found to have a large dermoid cyst located at the fimbrial end of the left fallopian tube with no apparent connection to either ovary. It has been suggested that auto-amputation of a dermoid cyst or part thereof and subsequent reimplantation could give rise to this phenomenon, and this is what we postulated as the cause in our case.
We report the case of a 39-year-old woman who presented in an acute setting with pelvic pain, an adnexal mass on imaging and a high CA19-9 level. She was taken for surgery, where a large dermoid cyst was found at the fimbrial end of a fallopian tube at the time of laparoscopy, with no apparent connection to either ovary and absence of ovarian necrosis. This was corroborated on final histology. Dermoid cysts in aberrant locations are usually reported at Caesarean section or during laparoscopic sterilisation and thus, understandably, a pre-operative CA19-9 level is rarely available. That and the rarity of these 'ectopic dermoids' make it hard to give further support for a causative association with the high tumour marker levels. Some authors suggest that auto-amputation of a dermoid cyst or part thereof and subsequent reimplantation may give rise to this phenomenon, and thus the term 'wandering dermoid' has been applied to similar situations. This is what we postulated as the cause in our case. It is likely that a full understanding of the aetiology of wandering dermoid cysts will remain elusive, given the paucity of cases.
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Affiliation(s)
- Dan Hay
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, United Kingdom
| | - Bivas Biswas
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, United Kingdom
| | - Jaydip Dasgupta
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, United Kingdom
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43
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Fox L, Hanley CS, Padilla LR, Duncan M. Bladder teratoma in a maned wolf (Chrysocyon brachyurus). Open Vet J 2019; 9:259-262. [PMID: 31998620 PMCID: PMC6794395 DOI: 10.4314/ovj.v9i3.11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 08/08/2019] [Indexed: 01/22/2023] Open
Abstract
Background Teratomas are germ cell tumors, comprised of a mixture of tissue types and with tissue foreign to their site of origin. Case Description A 5.5-year-old intact female maned wolf (Chrysocyon brachyurus) was treated for recurrent stranguria and suspected cystitis. Due to lack of resolution, the wolf was anesthetized for further evaluation. The urinary bladder was firm on palpation, with a markedly thickened wall and no observable lumen on ultrasound. Neoplastic infiltration was suspected on double contrast cystogram and confirmed via surgical exploration. The lesion was inoperable and the wolf was euthanized. Gross necropsy revealed two poorly distinguished masses infiltrating the urinary bladder dorsally and caudoventrally, with minimal remaining lumen. Histopathologic examination of the bladder and associated masses revealed a neoplasm comprised of multiple tissue types. Vascular invasion was noted. Conclusion The neoplasm was diagnosed as an extragonadal teratoma. Few extragonadal teratomas have been described and this is the first report of a teratoma originating in the urinary bladder of a non-human species.
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Affiliation(s)
- Lana Fox
- Texas A&M Veterinary Medical Teaching Hospital, Department of Zoological Medicine, 408 Raymond Stotzer Parkway, College Station, TX 77845, USA
| | - Christopher S Hanley
- Department of Animal Health, Saint Louis Zoo, One Government Drive, Saint Louis, MO 63110, USA
| | - Luis R Padilla
- Department of Animal Health, Saint Louis Zoo, One Government Drive, Saint Louis, MO 63110, USA
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Ronchi A, Cozzolino I, Montella M, Panarese I, Zito Marino F, Rossetti S, Chieffi P, Accardo M, Facchini G, Franco R. Extragonadal germ cell tumors: Not just a matter of location. A review about clinical, molecular and pathological features. Cancer Med 2019; 8:6832-6840. [PMID: 31568647 PMCID: PMC6853824 DOI: 10.1002/cam4.2195] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 03/25/2019] [Accepted: 04/10/2019] [Indexed: 12/25/2022] Open
Abstract
Extragonadal germ cell tumors (EGGCTs) are uncommon neoplasms, which arise in anatomical locations other than gonads. The pathogenesis of these neoplasms is still poorly understood and it is a matter of debate if they really represent extragondal primary neoplasms or rather extragondal metastasis from occult gonadal neoplasms. The actual observations suggest that EGGCTs represent a unique entity, so their biology and behavior are substantially different from gonadal counterparts. The diagnosis of EGGCTs is often challenging, and differential diagnosis is particularly wide. Nevertheless, a correct diagnosis is essential for the correct management of the patient. We summarize the state of art about EGGCTs, with particular emphasis on diagnosis and prognosis.
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Affiliation(s)
- Andrea Ronchi
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Immacolata Cozzolino
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Marco Montella
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Iacopo Panarese
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Federica Zito Marino
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Sabrina Rossetti
- Uro-Andrologic Oncology Unit, Department of Uro-Gynaecological Oncology, Istituto Nazionale Tumori "Fondazione G. Pascale"-IRCCS, Naples, Italy
| | - Paolo Chieffi
- Department of Psychology, University of Campania "L. Vanvitelli", Caserta, Italy
| | - Marina Accardo
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Gaetano Facchini
- Uro-Andrologic Oncology Unit, Department of Uro-Gynaecological Oncology, Istituto Nazionale Tumori "Fondazione G. Pascale"-IRCCS, Naples, Italy
| | - Renato Franco
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "L. Vanvitelli", Naples, Italy
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45
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Singh R, Fazal Z, Freemantle SJ, Spinella MJ. Mechanisms of cisplatin sensitivity and resistance in testicular germ cell tumors. CANCER DRUG RESISTANCE (ALHAMBRA, CALIF.) 2019; 2:580-594. [PMID: 31538140 PMCID: PMC6752046 DOI: 10.20517/cdr.2019.19] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Testicular germ cell tumors (TGCTs) are a cancer pharmacology success story with a majority of patients cured even in the highly advanced and metastatic setting. Successful treatment of TGCTs is primarily due to the exquisite responsiveness of this solid tumor to cisplatin-based therapy. However, a significant percentage of patients are, or become, refractory to cisplatin and die from progressive disease. Mechanisms for both clinical hypersensitivity and resistance have largely remained a mystery despite the promise of applying lessons to the majority of solid tumors that are not curable in the metastatic setting. Recently, this promise has been heightened by the realization that distinct (and perhaps pharmacologically replicable) epigenetic states, rather than fixed genetic alterations, may play dominant roles in not only TGCT etiology and progression but also their curability with conventional chemotherapies. In this review, it discusses potential mechanisms of TGCT cisplatin sensitivity and resistance to conventional chemotherapeutics.
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Affiliation(s)
- Ratnakar Singh
- Department of Comparative Biosciences, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Zeeshan Fazal
- Department of Comparative Biosciences, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Sarah J Freemantle
- Department of Comparative Biosciences, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Michael J Spinella
- Department of Comparative Biosciences, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA.,The Carle Illinois College of Medicine , University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA.,The Cancer Center of Illinois, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
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Abstract
Human germ cell tumours (GCTs) are derived from stem cells of the early embryo and the germ line. They occur in the gonads (ovaries and testes) and also in extragonadal sites, where migrating primordial germ cells are located during embryogenesis. This group of heterogeneous neoplasms is unique in that their developmental potential is in effect determined by the latent potency state of their cells of origin, which are reprogrammed to omnipotent, totipotent or pluripotent stem cells. Seven GCT types, defined according to their developmental potential, have been identified, each with distinct epidemiological and (epi)genomic features. Heritable predisposition factors affecting the cells of origin and their niches likely explain bilateral, multiple and familial occurrences of the different types of GCTs. Unlike most other tumour types, GCTs are rarely caused by somatic driver mutations, but arise through failure to control the latent developmental potential of their cells of origin, resulting in their reprogramming. Consistent with their non-mutational origin, even the malignant tumours of the group are characterized by wild-type TP53 and high sensitivity for DNA damage. However, tumour progression and the rare occurrence of treatment resistance are driven by embryonic epigenetic state, specific (sub)chromosomal imbalances and somatic mutations. Thus, recent progress in understanding GCT biology supports a comprehensive developmental pathogenetic model for the origin of all GCTs, and provides new biomarkers, as well as potential targets for treatment of resistant disease.
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Affiliation(s)
- J Wolter Oosterhuis
- Laboratory for Experimental Patho-Oncology, Department of Pathology, Erasmus MC Cancer Institute, Rotterdam, Netherlands.
| | - Leendert H J Looijenga
- Laboratory for Experimental Patho-Oncology, Department of Pathology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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Abstract
Mature cystic teratoma is one of the more common ovarian neoplasms; however, teratoma in the pouch of Douglas is extremely rare, and the exact etiology is unknown. Here, we report a rare case of mature cystic teratoma of Douglas’ pouch in a 40-year-old woman who had undergone laparotomy. A 15 cm x 15 cm x 10 cm cyst was noted arising from the pouch of Douglas, and the mass was seen separated from both ovaries. Microscopically, the cyst was a mature cystic teratoma not arising from the ovaries.
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Affiliation(s)
- Pruthwiraj Sethi
- Obstetrics and Gynecology, All India Institute of Medical Sciences, Bhubaneswar, IND
| | - Suvendu Purkait
- Pathology, All India Institute of Medical Sciences, Bhubaneswar, IND
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Huang Q, Liu C, Tang R, Li J, Li W, Zhu L, Guo Y, Zhang L, Qu T, Yang L, Li L, Wang Y, Sun B, Meng B, Yan J, Xu W, Zhang H, Cao D, Cao W. Multidisciplinary team for the diagnosis and treatment of 2 cases of primary intestinal yolk sac tumor. Cancer Biol Med 2019; 15:461-467. [PMID: 30766756 PMCID: PMC6372916 DOI: 10.20892/j.issn.2095-3941.2018.0054] [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] [Indexed: 11/30/2022] Open
Abstract
Extragonadal primary yolk sac tumor of the intestinal tract origin is exceedingly rare. Through a multiple disciplinary team, the diagnosis and treatment of primary intestinal yolk sac tumor were further defined. We report 2 such cases with detailed histologic and immunohistochemical analysis. The two patients were a 7-year-old girl and a 29-year-old woman. Both of them preoperatively had an elevated serum alpha fetoprotein (AFP) level (≥ 1,210 ng/mL). The tumors are located in the intestine and imaging examination indicated the rectum as the primary site. Grossly the mass was grey-white and crisp texture. Microscopic examination featured reticular, microcystic, macrocystic, papillary, solid, and some glandular patterns. Immunohistochemically, tumor cells of both cases were positive for SALL4, AFP, pan-cytokeratin (AE1/AE3), and glypican-3. Simultaneously, a stain for EMA, OCT4, CD30, HCG, vimentin and CK20 were negative in all 2 neoplasms. The features of morphology, immunohistochemistry, laboratory examinations and imaging studies consist of the diagnosis of primary yolk sac tumor of the intestine.
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Affiliation(s)
- Qiujuan Huang
- Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin Medical University, Ministry of Education, Tianjin 300060, China
| | - Changxu Liu
- Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin Medical University, Ministry of Education, Tianjin 300060, China
| | - Ruijun Tang
- Department of Pathology, Guilin TCM Hospital of China, Guilin 541002, China
| | - Jie Li
- Department of Pediatric Oncology
| | | | - Lei Zhu
- Department of Molecular Image and Nuclear Medicine, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Yuhong Guo
- Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin Medical University, Ministry of Education, Tianjin 300060, China
| | - Lin Zhang
- Department of Pathology, Tianjin Central Hospital of Gynecology Obstetrics, Tianjin 300110, China
| | - Tongyuan Qu
- Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin Medical University, Ministry of Education, Tianjin 300060, China
| | - Lingyi Yang
- Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin Medical University, Ministry of Education, Tianjin 300060, China
| | - Lingmei Li
- Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin Medical University, Ministry of Education, Tianjin 300060, China
| | - Yalei Wang
- Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin Medical University, Ministry of Education, Tianjin 300060, China
| | - Baocun Sun
- Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin Medical University, Ministry of Education, Tianjin 300060, China
| | - Bin Meng
- Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin Medical University, Ministry of Education, Tianjin 300060, China
| | - Jie Yan
- Department of Pediatric Oncology
| | - Wengui Xu
- Department of Molecular Image and Nuclear Medicine, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | | | - Dengfeng Cao
- The Lauren V Ackerman Laboratory of Surgical Pathology, Division of Anatomic and Molecular Pathology, Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, MO 63110, USA
| | - Wenfeng Cao
- Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin Medical University, Ministry of Education, Tianjin 300060, China
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Yazawa H, Takiguchi K, Kato A, Imaizumi K. An Unusual Presentation of Ovarian Fibroma Originating from an Autoamputated Ovary. Gynecol Minim Invasive Ther 2019; 8:40-43. [PMID: 30783589 PMCID: PMC6367919 DOI: 10.4103/gmit.gmit_63_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 10/26/2018] [Accepted: 10/29/2018] [Indexed: 11/04/2022] Open
Abstract
We describe an extremely rare case of an unusually presented ovarian fibroma adherent to the sigmoid colon originating from an autoamputated ovary. A 64-year-old woman was referred to our hospital with an abnormal shadow that was approximately 4 cm in diameter in the pelvic cavity detected on abdominal X-ray imaging. Computed tomography demonstrated an irregularly shaped tumor with calcification in the pelvic cavity. Laparoscopy revealed that the tumor was adherent to the surface of the sigmoid colon with a discontinuous shell and empty cavity. The left ovary was lacking, although the left salpinx and right adnexa were in their normal locations. The tumor was carefully resected with cutting of the serosa of the sigmoid colon. The serosal defect was repaired with sutures. Postoperative histopathological diagnosis was old fibroma with calcification. To the best of our knowledge, this is the first reported case of extragonadal ovarian tumor originating from an autoamputated ovarian fibroma.
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Affiliation(s)
- Hiroyuki Yazawa
- Department of Obstetrics and Gynecology, Fukushima Red Cross Hospital, Fukushima, Japan
| | - Kaoru Takiguchi
- Department of Obstetrics and Gynecology, Ohta Nishinouchi Hospital, Koriyama, Japan
| | - Asami Kato
- Department of Obstetrics and Gynecology, Fukushima Red Cross Hospital, Fukushima, Japan
| | - Karin Imaizumi
- Department of Obstetrics and Gynecology, Fukushima Red Cross Hospital, Fukushima, Japan
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50
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Hen G, Sela-Donenfeld D. "A narrow bridge home": The dorsal mesentery in primordial germ cell migration. Semin Cell Dev Biol 2018; 92:97-104. [PMID: 30153479 DOI: 10.1016/j.semcdb.2018.08.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 08/23/2018] [Accepted: 08/23/2018] [Indexed: 01/08/2023]
Abstract
Specification of primordial germ cells (PGCs) in all vertebrates takes place in extragonadal sites. This requires migration of PGCs through embryonic tissues towards the genital ridges by both passive and active types of migration. Commonly, colonization in the genital ridges follows migration of the PGCs along the thin tissue of the dorsal mesentery. Here we review the anatomy of the dorsal mesentery, the role it plays in migration of PGCs, and the interactions of PGCs with different cell types, extracellular matrix and signaling pathways that are all essential for attraction and orientation of PGCs along the dorsal mesentery towards the gonad anlage.
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Affiliation(s)
- Gideon Hen
- Koret School of Veterinary Medicine, The Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Dalit Sela-Donenfeld
- Koret School of Veterinary Medicine, The Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot, Israel.
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