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Goyal LD, Kaur B, Goyal G, Rajora P. Unusual Cases of Pure Malignant Germ Cell Tumors of the Ovary: A Case Series on 10 Years Experience at a Tertiary Care Center. J Reprod Infertil 2022; 22:267-273. [PMID: 34987988 PMCID: PMC8669411 DOI: 10.18502/jri.v22i4.7652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 11/24/2020] [Indexed: 11/24/2022] Open
Abstract
Background Malignant ovarian germ cell tumors (MOGCTs) are rare female cancers, constituting up to 10% of ovarian cancers. Dysgerminoma is the most common histological variant. Surgical removal of the tumor with optimal debulking is the treatment of choice. Multidrug chemotherapy following surgery offers high remission rates. Considering the prevalence of these tumors in adolescent and young females, fertility-sparing treatment is of paramount importance. Methods The data of all patients with ovarian malignancy admitted at a tertiary-care-teaching hospital from September 2009-March 2019 were analyzed. Ten patients of MOGCTs were treated in this period. The clinical features, radiological and biochemical findings, and management and treatment outcome were evaluated. Results The median age of patients was 23 years. Histological subtypes included immature teratoma (n=3), endodermal sinus tumor (n=4), and dysgerminoma (n=3). Tumor markers namely AFP, βHCG, and LDH increased in all except the patients with immature teratoma. Two patients with dysgerminoma were in the second trimester of pregnancy. All patients except one underwent surgery followed by BEP chemotherapy. Two patients had developed metastasis within six months of treatment and died. In seven patients, no evidence of disease was reported till date. Conclusion Management of antenatal patients with dysgerminoma by surgery followed by BEP chemotherapy has favorable prognosis. Fertility-sparing surgery with adjuvant chemotherapy offers great advantage in young girls. However, risk stratification based on prognostic factors should be implemented in order to individualize the treatment for achieving higher survival rates. The option for oocyte-cryopreservation prior to surgery must be discussed with patients desiring future fertlity.
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Affiliation(s)
- Lajya Devi Goyal
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Punjab, India
| | - Balpreet Kaur
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Punjab, India
| | - Gitanjali Goyal
- Department of Biochemistry, Guru Gobind Singh Medical College and Hospital, Punjab, India
| | - Parveen Rajora
- Department of Obstetrics and Gynaecology, Guru Gobind Singh Medical College and Hospital, Punjab, India
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Parcesepe P, Coppola L, Remo A, D’Andrea MR, Coppola G, Simbolo M, Manfrin E, Scarpa A, De Santis E, Giordano G. Molecular and Clinical Insights in Malignant Brenner Tumor of the Testis With Liver Metastases:A Case Report. Front Oncol 2021; 11:663489. [PMID: 33912469 PMCID: PMC8072450 DOI: 10.3389/fonc.2021.663489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/25/2021] [Indexed: 02/05/2023] Open
Abstract
Malignant Brenner Tumor (mBT) is extremely rare. Although BT are almost exclusive ovarian neoplasms, they may constitute a highly unusual tumor of the testis; in fact, only seven fully documented cases have been reported to date. Because of their rarity, the pathogenesis of these tumors has not been clarified and there is no standard therapeutic approach. We report the first case of epididymal mBT with synchronous, multiple, liver metastases and a very dramatic clinical course. Both primary tumor and metastasis were subjected to mutational analysis of 20 cancer associated genes. Primary tumor showed FGFR3 Tyr375Cys and PIK3CA His1047Arg missense mutations. Both mutations are reported as pathogenic in ClinVar database. The same FGFR3 mutation was present in liver metastasis. Based on these results we believe that the FGFR pathway could be an ideal candidate for personalized treatment, offering hope to a subset of patients with mBT. Personalized approach, including mutational analysis and molecular testing should be required in patients with rare tumors in order to clarify diagnosis and improve therapeutic strategies.
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Affiliation(s)
- Pietro Parcesepe
- Section of Pathology, Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Verona, Italy
- *Correspondence: Pietro Parcesepe, ; Guido Giordano,
| | - Luigi Coppola
- Unità Operativa Complessa (UOC) Anatomia ed Istologia Patologica e Citologia Diagnostica, Dipartimento dei Servizi Diagnostici e della Farmaceutica, Ospedale Sandro Pertini, Roma, Italy
| | - Andrea Remo
- Pathology Unit, “Mater Salutis” Hospital, Legnago, Italy
| | - Mario Rosario D’Andrea
- Unità Operativa Semplice a valenza Dipartimentale (UOSD) Oncologia, Ospedale S. Paolo, Civitavecchia, Italy
| | - Giulia Coppola
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Michele Simbolo
- Section of Pathology, Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Verona, Italy
- ARC-Net Centre for Applied Research on Cancer, University and Hospital Trust of Verona, Verona, Italy
| | - Erminia Manfrin
- Section of Pathology, Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Verona, Italy
| | - Aldo Scarpa
- Section of Pathology, Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Verona, Italy
- ARC-Net Centre for Applied Research on Cancer, University and Hospital Trust of Verona, Verona, Italy
| | - Elena De Santis
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Guido Giordano
- Unit of Medical Oncology and Biomolecular Therapy, Polilinico Riuniti, Foggia, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
- *Correspondence: Pietro Parcesepe, ; Guido Giordano,
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Wang N, Li C, Yang Y, Guan Y, Wang F, Wang Y, Zhao W. The Use of Platelet/Lymphocyte Ratio and Cancer Antigen 125 Combined with Magnetic Resonance Diffusion-Weighted Imaging in Diagnosis of Recurrent Ovarian Cancer and Neuropathic Pain. World Neurosurg 2020; 149:502-510. [PMID: 33326856 DOI: 10.1016/j.wneu.2020.11.117] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/19/2020] [Accepted: 11/20/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This work aimed to analyze the value of serum platelet/lymphocyte ratio (PLR), carbohydrate antigen 125 (CA125), and diffusion-weighted imaging (DWI) in the diagnosis of recurrent ovarian cancer. METHODS Forty-three patients with suspected recurrence of ovarian cancer were deemed as research objects, and 5 healthy people were set as controls. PLR, DWI, and CA125 level before surgery were analyzed. Pearson correlation analysis was implemented to explore the correlation between CA125 and lymphocyte count, platelet count, and PLR. Neuropathic Pain Scale was adopted to analyze the analgesic effect of patients with recurrent ovarian cancer before treatment and 7 days after treatment. Moreover, the quality of life scores of patients with recurrent ovarian cancer were evaluated before treatment and 30 days after treatment. RESULTS The platelet and PLR values of patients with recurrent ovarian cancer were significantly higher relative to healthy people (P < 0.001), while the lymphocyte count was relatively lower (P = 0.002). There were considerable differences in PLR and CA125 levels in patients with recurrent ovarian cancer before and after treatment (P < 0.001). The single detection of CA125 was significantly better than that of DWI and PLR (P = 0.034). The sensitivity and specificity of CA125 detection alone was 77.3% and 81.8%, respectively, while those of the joint detection of DWI + PLR + CA125 was 92.4% and 79.9%, respectively. PLR was proved to be positively correlated with CA125 before and after treatment (r = 0.687, P < 0.001). Pain scores in all aspects of patients with recurrence of ovarian cancer after treatment were lower than that before treatment (P < 0.001), and the quality of life score was significantly higher than that before treatment (P < 0.001). CONCLUSIONS CA125 and PLR combined with DWI had the best diagnostic effect for patients with recurrent ovarian cancer. After treatment, the levels of PLR and CA125 were reduced and the quality of life of patients was improved.
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Affiliation(s)
- Na Wang
- Department of Obstetrics and Gynecology, Qiqihar Medical University, Qiqihar City, China
| | - Cuiping Li
- Department of Obstetrics and Gynecology, Qiqihar Medical University, Qiqihar City, China
| | - Yujie Yang
- Department of Obstetrics and Gynecology, Qiqihar Medical University, Qiqihar City, China
| | - Yu Guan
- Department of Obstetrics and Gynecology, Qiqihar Medical University, Qiqihar City, China
| | - Fengjiao Wang
- Department of Obstetrics and Gynecology, Qiqihar Medical University, Qiqihar City, China
| | - Yan Wang
- Department of Obstetrics and Gynecology, Qiqihar Medical University, Qiqihar City, China
| | - Wei Zhao
- Department of Obstetrics and Gynecology, Qiqihar Medical University, Qiqihar City, China.
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The role of preoperative serum cancer antigen 125 in malignant ovarian germ cell tumors. Taiwan J Obstet Gynecol 2018; 57:236-240. [DOI: 10.1016/j.tjog.2018.02.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2017] [Indexed: 12/22/2022] Open
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Malignant Brenner tumor of the ovary: Review and case report. Gynecol Oncol Rep 2017; 22:26-31. [PMID: 28971141 PMCID: PMC5608552 DOI: 10.1016/j.gore.2017.07.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 06/20/2017] [Accepted: 07/02/2017] [Indexed: 11/20/2022] Open
Abstract
Ovarian neoplasms are a heterogeneous group of tumors with varying incidence in the general population. The most common are the surface epithelial tumors which include transitional cell tumors. Transitional cell tumors include both transitional cell carcinoma and Brenner tumor. The vast majority of Brenner tumors are benign, often incidental findings; however, malignant Brenner tumors (MBT) do occasionally occur. MBT present similarly to other ovarian neoplasms with abdominal pain and bulk symptoms. On imaging, these tumors demonstrate nonspecific findings. Microscopically, they demonstrate areas of conventional benign Brenner tumor juxtaposed with regions of frank malignancy showing marked cytologic atypia and infiltration. There is no consistent tumor marker for these tumors, but CA-125, CA 72-4 and SCC have been reported in singular instances. Tumors express several immunohistochemical markers of urothelial differentiation including uroplakin III, thrombomodulin, GATA3, p63, as well as cytokeratin 7. The primary treatment modality is surgical excision. Due to their rarity, the precise role and regimen of adjuvant chemo-radiation therapy for MBT has not been established. We herein review a case of MBT with emphasis on primary treatment and treatment of recurrent disease, including the use of adjuvant pelvic radiation, discuss the current state of the literature and standards of practice regarding this malignancy. Histologic differentiation of MBT from TCC is critical for diagnosis. Surgical staging should be performed for all cases of MBT. The role of adjuvant strategies for MBT is poorly defined.
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Kempf E, Desamericq G, Vieites B, Diaz-Padilla I, Calvo E, Estevez P, Garcia-Arreza A, Martinez-Maestre MA, Duran I. Clinical and pathologic features of patients with non-epithelial ovarian cancer: retrospective analysis of a single institution 15-year experience. Clin Transl Oncol 2016; 19:173-179. [PMID: 27193130 DOI: 10.1007/s12094-016-1517-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 04/30/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE Non-epithelial ovarian cancers (NEOCs) are rare diseases. Despite their overall good prognosis, the best management and current prognostic factors remain unclear. The objective of our study was to assess the clinical and pathological features of NEOC patients treated in our institution in the last 15 years and to explore risk factors for relapse and survival. METHODS/PATIENTS All patients with a pathological diagnosis of NEOC referred to the medical oncology department at Hospital Universitario Virgen del Rocio between 1999 and 2014 were included. Demographics, tumor characteristics, treatment procedures, and clinical follow-up were retrospectively collected. Risk factors for disease-free survival (DFS) and overall survival (OS) were assessed. RESULTS Fifty-seven patients were included, 33 (58 %) had a sex cord-stromal tumor (SCST) and 24 (42 %) had a germ-cell tumor (GCT). Median age, non-conservative surgery rates and DFS were lower in the GCT cohort; however, salvage chemotherapy led to a high proportion of complete responses in this group translating into a 90 % 3-year OS rate in both NEOC subtypes. The only identified risk factors statistically significant were stage and tumour relapse that associated, respectively, with DFS (HR = 8.84; 95 % CI 1.85-42) and OS (HR = 11.02; 95 % CI 1.76-68.7). CONCLUSIONS Despite their rarity, NEOCs remain a highly curable group of neoplasm. In our series, a more conservative treatment approach in ovarian GCTs revealed comparable OS outcomes to SCST. No new risk factors that would help in patient stratification were identified.
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Affiliation(s)
- E Kempf
- Medical Oncology Department, Hospital Universitario Virgen del Rocio, Seville, Spain.,Medical Oncology Department, AP-HP, H. Mondor-A. Chenevier Hospital, Créteil, France
| | - G Desamericq
- Centre de Référence Maladie de Huntington, AP-HP, Hôpital H. Mondor-A. Chenevier, Créteil, France.,Inserm, U955, Equipe 01, Créteil, France.,Faculté de Médecine, Université Paris Est, Créteil, France.,Département d'Etudes Cognitives, Ecole Normale Supérieure, Paris, France
| | - B Vieites
- Department of Pathology, Hospital Universitario Virgen del Rocio, Seville, Spain
| | - I Diaz-Padilla
- Deanery of Doctorate Studies, School of Medicine, University of Seville, Seville, Spain
| | - E Calvo
- Medical Oncology Department, Hospital Universitario Virgen del Rocio, Seville, Spain
| | - P Estevez
- Medical Oncology Department, Hospital Universitario Virgen del Rocio, Seville, Spain
| | - A Garcia-Arreza
- Gynecology Department, Hospital Universitario Virgen del Rocio, Seville, Spain
| | | | - I Duran
- Medical Oncology Department, Hospital Universitario Virgen del Rocio, Seville, Spain. .,Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain.
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Tang QL, Jiang XF, Yuan XP, Liu Y, Zhang L, Tang XF, Zhou JJ, Li HG, Fang JP, Xue L. Prognosis of Eight Chinese Cases of Primary Vaginal Yolk Sac Tumor with a Review of the Literature. Asian Pac J Cancer Prev 2014; 15:9395-404. [DOI: 10.7314/apjcp.2014.15.21.9395] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Yesilyurt H, Tokmak A, Guzel AI, Simsek HS, Terzioglu SG, Erkaya S, Gungor T. Parameters for Predicting Granulosa Cell Tumor of the Ovary: A Single Center Retrospective Comparative Study. Asian Pac J Cancer Prev 2014; 15:8447-50. [DOI: 10.7314/apjcp.2014.15.19.8447] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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9
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Neeyalavira V, Suprasert P. Outcomes of malignant ovarian germ-cell tumors treated in Chiang Mai University Hospital over a nine year period. Asian Pac J Cancer Prev 2014; 15:4909-13. [PMID: 24998562 DOI: 10.7314/apjcp.2014.15.12.4909] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Malignant ovarian germ cell tumors (MOGCT) are rare neoplasms that most frequently occur in women at a young reproductive age. There have been limited data regarding this disease from Southeast Asian countries. We therefore conducted a retrospective study to analyze the clinical characteristics and the treatment outcomes of MOGCT treated at our institute between January, 2003 and December, 2012. Seventy-six patients were recruited from this period with the mean age of 21.6 years and 11.8% were pre-puberty. The two most common symptoms were pelvic mass and pelvic pain. Two-thirds of the studied patients presented at an early stage. The most common histology was immature teratoma (34.2%) followed by endodermal sinus tumor (28.9%), dysgerminoma (25%), mixed type (10.5%) and choriocarcinoma (1.3%). Over 80% of these patients received fertility sparing surgery and about 70% received adjuvant chemotherapy with the complete response rate at 73.3% and partial response at 11.1%. The most frequent chemotherapy was BEP regimen (bleomycin, etoposide, cisplatin). With the mean follow up time at 56.0 months, 12 patients (15.8%) developed recurrence and only an advanced stage was the independent prognostic factor. The ten year progression free survival (PFS) and overall survival rate of our study were 81.9% and 86.2%, respectively. In conclusion, MOGCT often occurs at a young age. Treatment with fertility sparing operations and adjuvant chemotherapy with a BEP regimen showed a good outcome. An advanced stage is a significant prognostic factor for recurrence.
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Affiliation(s)
- Vithida Neeyalavira
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand E-mail :
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Lin L, Yang J, Ding Y, Wang J, Ting L. Genetic Polymorphisms of TCF7L2 Lack Influence on Risk of the Polycystic Ovary Syndrome - a Systemic Analysis. Asian Pac J Cancer Prev 2014; 15:3331-3. [DOI: 10.7314/apjcp.2014.15.7.3331] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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