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Weil BR, Rich BS, Madenci AL, Stambough KC, Schmoke N, Peace A, Bruny JL, Rescorla FJ, Dicken BJ, Dietrich JE, Billmire DF. Critical elements in the operative management of pediatric malignant ovarian germ cell tumors. Semin Pediatr Surg 2023; 32:151342. [PMID: 38039829 DOI: 10.1016/j.sempedsurg.2023.151342] [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: 12/03/2023]
Abstract
Performance of the appropriate operation is highly important to ensure that any patient with a suspected ovarian germ cell tumor receives optimal therapy that prioritizes cure while simultaneoulsy minimizing risk of short and long-term toxicities of treatment. The following critical elements of any operative procedure performed for a suspected pediatric or adolescent ovarian germ cell tumor are reviewed: 1. Complete resection of the tumor via ipsilateral oophorectomy while avoiding tumor rupture and spillage, and 2. Performance of complete intraperitoneal staging at the time of initial tumor resection.
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Affiliation(s)
- Brent R Weil
- Department of Pediatric Surgery, Boston Children's Hospital, Harvard University, Boston, United State; Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard University, Boston, United States.
| | - Barrie S Rich
- Division of Pediatric Surgery, Cohen Children's Medical Center, Zucker School of Medicine at Northwell/Hofstra, NY, United States
| | - Arin L Madenci
- Department of Pediatric Surgery, Boston Children's Hospital, Harvard University, Boston, United State
| | - Kathryn C Stambough
- Division of Pediatric and Adolescent Gynecology, Arkansas Children's Hospital, University of Arkansas School for Medical Sciences, Little Rock, United States
| | - Nicholas Schmoke
- Division of Pediatric Surgery, Children's Hospital of Colorado, University of Colorado Anschutz Medical Center, Denver, United States
| | - Alyssa Peace
- Division of Pediatric Surgery, Children's Hospital of Colorado, University of Colorado Anschutz Medical Center, Denver, United States
| | - Jennifer L Bruny
- Division of Pediatric Surgery, Children's Hospital of Colorado, University of Colorado Anschutz Medical Center, Denver, United States
| | - Frederick J Rescorla
- Division of Pediatric Surgery, Riley Children's Hospital, Indiana University School of Medicine, Indianapolis, United States
| | - Bryan J Dicken
- Division of Pediatric Surgery, Stollery Children's Hospital, University of Alberta, Edmonton, Canada
| | - Jennifer E Dietrich
- Division of Pediatric and Adolescent Gynecology, Texas Children's Hospital, Baylor College of Medicine, United States
| | - Deborah F Billmire
- Division of Pediatric Surgery, Riley Children's Hospital, Indiana University School of Medicine, Indianapolis, United States
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Moraru L, Mitranovici MI, Chiorean DM, Coroș M, Moraru R, Oală IE, Turdean SG. Immature Teratoma: Diagnosis and Management-A Review of the Literature. Diagnostics (Basel) 2023; 13:diagnostics13091516. [PMID: 37174909 PMCID: PMC10177811 DOI: 10.3390/diagnostics13091516] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/05/2023] [Accepted: 04/18/2023] [Indexed: 05/15/2023] Open
Abstract
An immature teratoma is a germinal malignant tumor composed of three germ cell layers, occurring more frequently in young women. It is the second most frequent among the malignant germinal tumors after dysgerminoma, and it is the only neoplasm with germ cells that are histologically graded. Even if we do not have a consensus regarding its therapeutical management, it has a good prognosis, with an excellent overall survival rate and good fertility preservation. More studies are needed regarding the necessity of adjuvant chemotherapy in pediatric oncology, and because of chemotherapy's long-term adverse effects, surveillance or a targeted treatment is preferred, but the main therapy is fertility-sparing surgery. Special attention should be given to the genetic mapping of the histological pieces for patient risk stratification due to its value in prognosis and future treatment.
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Affiliation(s)
- Liviu Moraru
- Department of Anatomy, "George Emil Palade" University of Medicine, Pharmacy, Sciences and Technology, 540142 Targu Mures, Romania
| | | | - Diana Maria Chiorean
- Department of Pathology, County Clinical Hospital of Targu Mures, 540072 Targu Mures, Romania
| | - Marius Coroș
- Department of Surgery, "George Emil Palade" University of Medicine, Pharmacy, Sciences and Technology, 540142 Targu Mures, Romania
| | - Raluca Moraru
- Faculty of Medicine, "George Emil Palade" University of Medicine, Pharmacy, Sciences and Technology, 540142 Targu Mures, Romania
| | - Ioan Emilian Oală
- Department of Obstetrics and Gynecology, Emergency County Hospital Hunedoara, 331057 Hunedoara, Romania
| | - Sabin Gligore Turdean
- Department of Pathology, County Clinical Hospital of Targu Mures, 540072 Targu Mures, Romania
- Department of Pathology, "George Emil Palade" University of Medicine, Pharmacy, Sciences and Technology, 540142 Targu Mures, Romania
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Hao J, Sun Z, Song G. Laparoscopy for Ovary-Sparing Tumorectomy in Children with Ovarian Tumors: A Clinical Retrospective Analysis. J Laparoendosc Adv Surg Tech A 2023; 33:296-302. [PMID: 36716193 DOI: 10.1089/lap.2022.0372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Objective: The aim of this study is to analyze the characteristics of pediatric ovarian tumors (OTs) and evaluate treatment strategies for ovary-sparing tumorectomy (OST). Materials and Methods: Medical records of children from October 2011 to December 2021 were reviewed. Data regarding clinical characteristics, pathological type, and management of OST were analyzed. Results: In total, 61 patients with OTs were screened. The median age was 14.8 ± 3.0 years. The median length and volume of borderline and malignant OTs were larger than those of benign OTs (P < .001 and P = .05, respectively). There was a significant difference in the median OT volume between torsion and nontorsion OTs (P = .04). The overall OST rate was 91.8% (67/73). A total of 53.4% (39/73) lesions were treated with laparoscopic OST. The OT volume was smaller in patients who underwent laparoscopy than in those who underwent laparotomy (P = .04). The probability of intraoperative tumor rupture or spillage was higher during laparoscopy than during laparotomy (P = .02). No significant differences were observed in OT recurrence. Seven patients had borderline and malignant tumors, 3 of whom had stage IA tumors and underwent OST. None of the patients experienced relapse. Conclusions: OT size is a useful reference factor for differential diagnosis and choosing laparoscopic surgery. Intraoperative tumor rupture and spillage of benign tumors during laparoscopy and laparotomy did not seem to be associated with recurrence, and laparoscopic OST was considered safe. Further prospective studies are required to confirm these conclusions.
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Affiliation(s)
- Jing Hao
- Department of Gynaecology, Weihai Municipal Hospital, Shandong, China
| | - Zhihuan Sun
- Department of Pediatric Surgery, Weihai Municipal Hospital, Shandong, China
| | - Guoxin Song
- Department of Pediatric Surgery, Weihai Municipal Hospital, Shandong, China
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Wu X, Shi M, Lian Y, Zhang H. Exosomal circRNAs as promising liquid biopsy biomarkers for glioma. Front Immunol 2023; 14:1039084. [PMID: 37122733 PMCID: PMC10140329 DOI: 10.3389/fimmu.2023.1039084] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 03/30/2023] [Indexed: 05/02/2023] Open
Abstract
Liquid biopsy strategies enable the noninvasive detection of changes in the levels of circulating biomarkers in body fluid samples, providing an opportunity to diagnose, dynamically monitor, and treat a range of diseases, including cancers. Glioma is among the most common forms of intracranial malignancy, and affected patients exhibit poor prognostic outcomes. As such, diagnosing and treating this disease in its early stages is critical for optimal patient outcomes. Exosomal circular RNAs (circRNAs) are involved in both the onset and progression of glioma. Both the roles of exosomes and methods for their detection have received much attention in recent years and the detection of exosomal circRNAs by liquid biopsy has significant potential for monitoring dynamic changes in glioma. The present review provides an overview of the circulating liquid biopsy biomarkers associated with this cancer type and the potential application of exosomal circRNAs as tools to guide the diagnosis, treatment, and prognostic evaluation of glioma patients during disease progression.
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Affiliation(s)
- Xiaoke Wu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Mengmeng Shi
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yajun Lian
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- *Correspondence: Haifeng Zhang, ; Yajun Lian,
| | - Haifeng Zhang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- *Correspondence: Haifeng Zhang, ; Yajun Lian,
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Pereira PN, Yoshida A, Sarian LO, Barros RHDO, Jales RM, Derchain S. Assessment of the performance of the O-RADS MRI score for the evaluation of adnexal masses, with technical notes. Radiol Bras 2022; 55:137-144. [PMID: 35795605 PMCID: PMC9254700 DOI: 10.1590/0100-3984.2021.0050] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 08/05/2021] [Indexed: 01/18/2023] Open
Abstract
Objective To assess the performance of the Ovarian-Adnexal Reporting and Data System Magnetic Resonance Imaging (O-RADS MRI) score in the evaluation of adnexal masses and to provide technical notes about its current MRI parameters and concepts. Materials and Methods This was a prospective study of 226 patients with 287 adnexal masses (190 submitted to surgery or biopsy and 97 followed for at least one year). We calculated the sensitivity, specificity, positive predictive value, and negative predictive value for the O-RADS MRI score, using ≥ 4 as the cutoff for malignancy. We performed a technical analysis of the main updates to the score, announced in September 2020 by the American College of Radiology, in comparison with the original (2013) version. Results We found that an O-RADS MRI score of 4 or 5 was associated with malignancy of an adnexal mass, with a sensitivity of 91.11% (95% CI: 83.23-96.08), specificity of 94.92% (95% CI: 90.86-97.54), positive predictive value of 89.13% (95% CI: 81.71-93.77), negative predictive value of 95.90% (95% CI: 92.34-97.84), and overall accuracy of 93.73% (95% CI: 90.27-96.24). Conclusion Our findings support the use of the O-RADS MRI score for evaluating adnexal masses, especially those considered indeterminate on ultrasound. The updates made recently to the O-RADS MRI score facilitate its interpretation and will allow its more widespread use, with no loss of diagnostic accuracy.
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Affiliation(s)
- Patrick Nunes Pereira
- Department of Obstetrics and Gynecology, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM-Unicamp), Campinas, SP, Brazil
| | - Adriana Yoshida
- Department of Obstetrics and Gynecology, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM-Unicamp), Campinas, SP, Brazil
| | - Luís Otavio Sarian
- Department of Obstetrics and Gynecology, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM-Unicamp), Campinas, SP, Brazil
| | - Ricardo Hoelz de Oliveira Barros
- Department of Radiology, Hospital das Clínicas da Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM-Unicamp), Campinas, SP, Brazil
| | - Rodrigo Menezes Jales
- Department of Obstetrics and Gynecology, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM-Unicamp), Campinas, SP, Brazil
| | - Sophie Derchain
- Department of Obstetrics and Gynecology, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM-Unicamp), Campinas, SP, Brazil
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Mburu AW, Itsura PM, Orang'o EO, Tonui PK, Odongo EB, Shaffi AF, Muliro HN, Achia TN, Covens AL, Rosen BP. Epidemiological profile and clinico-pathological features of pediatric gynecological cancers at Moi Teaching & Referral Hospital, Kenya. Gynecol Oncol Rep 2022; 40:100956. [PMID: 35300053 PMCID: PMC8920865 DOI: 10.1016/j.gore.2022.100956] [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: 01/13/2022] [Revised: 02/28/2022] [Accepted: 03/06/2022] [Indexed: 11/12/2022] Open
Abstract
Fertility-sparing surgery for pediatric gynecological cancers should be the primary management. Dysgerminomas are the commonest ovarian germ cell tumors. Neo-adjuvant chemotherapy is feasible in advanced germ cell tumors. Pediatric gynecological cancers can have excellent prognosis. Early diagnosis and treatment can improve prognosis for germ cell tumors in LMICs.
Background The main pediatric (0–18 years) gynecologic cancers include stromal carcinomas (juvenile granulosa cell tumors and Sertoli-Leydig cell tumors), genital rhabdomyosarcomas and ovarian germ cell. Outcomes depend on time of diagnosis, stage, tumor type and treatment which can have long-term effects on the reproductive career of these patients. This study seeks to analyze the trends in clinical-pathologic presentation, treatment and outcomes in the cases seen at our facility. This is the first paper identifying these cancers published from sub-Saharan Africa. Method Retrospective review of clinico-pathologic profiles and treatment outcomes of pediatric gynecologic oncology patients managed at MTRH between 2010 and 2020. Data was abstracted from gynecologic oncology database and medical charts. Results Records of 40 patients were analyzed. Most, (92.5%, 37/40) of the patients were between 10 and 18 years. Ovarian germ cell tumors were the leading histological diagnosis in 72.5% (29/40) of the patients; with dysgerminomas being the commonest subtype seen in 12 of the 37 patients (32.4%). The patients received platinum-based chemotherapy in 70% of cases (28/40). There were 14 deaths among the 40 patients (35%) Conclusion Surgery remains the main stay of treatment and fertility-sparing surgery with or without adjuvant platinum-based chemotherapy are the standard of care with excellent prognosis following early detection and treatment initiation. LMICs face several challenges in access to quality care and that affects survival of these patients. Due to its commonality, ovarian germ cell cancers warrant a high index of suspicion amongst primary care providers attending to adnexal masses in this age group.
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Wang D, Zhu S, Jia C, Cao D, Yang J, Xiang Y. Oncological and Reproductive Outcomes of Cystectomy Compared with Unilateral Salpingo-Oophorectomy as Fertility-Sparing Surgery in Patients with Apparent Early Stage Pure Immature Ovarian Teratomas. Ann Surg Oncol 2021; 28:6684-6693. [PMID: 33772392 DOI: 10.1245/s10434-021-09719-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 01/28/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE To compare the oncological and reproductive outcomes of patients with apparent early stage pure ovarian immature teratomas (IMTs) treated with unilateral salpingo-oophorectomy (USO) or cystectomy. PATIENTS AND METHODS We retrospectively reviewed the medical records of patients with apparent early stage pure ovarian IMTs who received fertility-sparing surgery (FSS) between 1984 and 2019. FSS was defined as preservation of the uterus and at least one adnexa. Recurrence rates were compared between patients receiving USO and cystectomy. Reproductive outcomes and menstrual histories were assessed by telephone interview. RESULTS A total of 124 patients were included, of whom 83 underwent USO and 41 underwent cystectomy. After a median follow-up of 70.6 months (range: 6.2-410.6 months), eight patients suffered recurrences (5 in the USO group and 3 in the cystectomy group). The median times to recurrence were 5.0 and 5.1 months in the USO and cystectomy groups, respectively (P = 0.764). All patients with recurrence were successfully salvaged by surgery, except for one death. Univariate analysis showed no difference in disease-free survival and overall survival between the groups (P = 0.781, 0.155). Of the 111 patients contacted by telephone, 97 resumed menstruation following the surgery. Of the 31 patients desiring pregnancy, 26 achieved 28 pregnancies. USO (83.3%), like cystectomy (85.7%), resulted in excellent pregnancy rates. CONCLUSIONS A USO is the standard treatment for women with early stage pure IMTs who want to preserve fertility. However, a cystectomy with adjuvant chemotherapy may be a suitable fertility-sparing therapy when a cystectomy is the only surgical option.
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Affiliation(s)
- Dan Wang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
| | - Shan Zhu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
| | - Congwei Jia
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
| | - Dongyan Cao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
| | - Jiaxin Yang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
| | - Yang Xiang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China.
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Łuczak J, Bagłaj M, Dryjański P. What recent primary studies tell us about ovarian teratomas in children: a scoping review. Cancer Metastasis Rev 2020; 39:321-329. [PMID: 32006216 PMCID: PMC7098956 DOI: 10.1007/s10555-020-09844-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Our knowledge of ovarian teratomas in children is still far from complete, and much remains to be discovered. Here, we conduct a scoping review of the primary research related to ovarian teratomas in pediatric age. To our knowledge, there is no published synthesis of the literature surrounding ovarian teratomas in children using scoping review methodology. We identified 24 studies from 11 countries; 18 studies were retrospective, 3 were prospective, and 3 were experimental. There were 6 studies concerning mature teratomas, 5 concerning immature teratomas, and 13 that included both tumor types. Overall, 9 out of all the studies concerned more than 50 patients. We revealed 7 major branches of research within the topic of ovarian teratoma in pediatric population: recurrence rate/relapse and follow-up strategy, malignant potential, prognostic factors, use of sparing surgery, differences between the use of laparoscopy and laparotomy, use of chemotherapy, and additional examinations to test the character of the lesion (immature vs. mature). This scoping review has revealed a number of knowledge gaps in the evidence base for pediatric ovarian teratomas. Overall, this topic has not been extensively explored, and more research dedicated exclusively to this tumor and patient population is required.
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Affiliation(s)
- Justyna Łuczak
- Pediatric Surgery and Urology Department, Wroclaw Medical University, Wroclaw, Poland.
| | - Maciej Bagłaj
- Pediatric Surgery and Urology Department, Wroclaw Medical University, Wroclaw, Poland
| | - Piotr Dryjański
- Pediatric Surgery and Urology Department, Wroclaw Medical University, Wroclaw, Poland
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