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Marino G, Grassi T, De Ponti E, Negri S, Testa F, Giuliani D, Delle Marchette M, Dell’Oro C, Fumagalli D, Donatiello G, Besana G, Marchetta L, Bonazzi CM, Lissoni AA, Landoni F, Fruscio R. Outcome of patients with stage I immature teratoma after surveillance or adjuvant chemotherapy. Front Oncol 2024; 14:1330481. [PMID: 38371620 PMCID: PMC10869612 DOI: 10.3389/fonc.2024.1330481] [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: 10/30/2023] [Accepted: 01/19/2024] [Indexed: 02/20/2024] Open
Abstract
Objective Immature teratomas are rare malignant ovarian germ cell tumours, typically diagnosed in young women, where fertility-sparing surgery is the treatment of choice. The role of adjuvant chemotherapy in stage I disease remains controversial. We evaluated the impact of surveillance versus chemotherapy on the recurrence rate in stage I immature teratomas. Methods We collected a single centre retrospective series of patients with stage I immature teratomas treated with fertility-sparing surgery at San Gerardo Hospital, Monza, Italy, between 1980 and 2019. Potential risk factors for recurrence were investigated by multivariate logistic regression. Results Of the 74 patients included, 12% (9/74) received chemotherapy, while 88% (65/74) underwent surveillance. Median follow-up was 188 months. No difference in recurrence was found in stage IA/IB and IC immature teratomas [10% (6/60) vs. 28.6% (4/14) (P=0.087)], grade 1, grade 2, and grade 3 [7.1% (2/28) vs. 14.3% (4/28) vs. 22.2% (4/18) (p=0.39)], and surveillance versus chemotherapy groups [13.9% (9/65) vs. 11.1% (1/9)) (p = 1.00)]. In univariate analysis, the postoperative approach had no impact on recurrence. The 5-year disease-free survival was 87% and 90% in the surveillance and chemotherapy groups, respectively; the overall survival was 100% in both cohorts. Conclusions Our results support the feasibility of surveillance in stage I immature teratomas. Adjuvant chemotherapy may be reserved for relapses. However, the potential benefit of chemotherapy should be discussed, especially for high-risk tumours. Prospective series are warranted to confirm our findings. What is already known on this topic To date, no consensus has been reached regarding the role of adjuvant chemotherapy in stage I immature teratomas of the ovary. Some studies suggest that only surveillance is an acceptable choice. However, guidelines are not conclusive on this topic. What this study adds No difference in terms of recurrence was observed between the surveillance and the adjuvant chemotherapy group. All patients who relapsed were successfully cured with no disease-related deaths. How this study might affect research practice or policy Adjuvant chemotherapy should be appropriately discussed with patients. However, it may be reserved for relapse according to our data.
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Affiliation(s)
- Giuseppe Marino
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Tommaso Grassi
- Unit of Gynecology, Woman and Child Department, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) San Gerardo, Monza, Italy
| | - Elena De Ponti
- Unit of Gynecology, Woman and Child Department, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) San Gerardo, Monza, Italy
| | - Serena Negri
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Filippo Testa
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Daniela Giuliani
- Unit of Gynecology, Woman and Child Department, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) San Gerardo, Monza, Italy
| | | | - Cristina Dell’Oro
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Diletta Fumagalli
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Gianluca Donatiello
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Giulia Besana
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Liliana Marchetta
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Cristina Maria Bonazzi
- Unit of Gynecology, Woman and Child Department, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) San Gerardo, Monza, Italy
| | - Andrea Alberto Lissoni
- Unit of Gynecology, Woman and Child Department, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) San Gerardo, Monza, Italy
| | - Fabio Landoni
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
- Unit of Gynecology, Woman and Child Department, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) San Gerardo, Monza, Italy
| | - Robert Fruscio
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
- Unit of Gynecology, Woman and Child Department, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) San Gerardo, Monza, Italy
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2
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Errami L, Douzi A, Lamzouri O, Taheri H, Saadi H, Mimouni A. Immature ovarian teratoma in a 20-year-old woman: A case report. J Int Med Res 2024; 52:3000605241232568. [PMID: 38410854 PMCID: PMC10898317 DOI: 10.1177/03000605241232568] [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] [Received: 10/14/2023] [Accepted: 01/26/2024] [Indexed: 02/28/2024] Open
Abstract
Immature ovarian teratomas are a rare subtype of germ cell tumours characterized by the presence of embryonic elements, particularly primitive neuroepithelium, and they typically affect young women. We report the case of a 20-year-old woman who presented with a growing abdominal mass that turned out to be a grade II immature teratoma after adnexectomy. This article reviews the clinical presentation, imaging features, and some of the main problems that arise in the management of immature ovarian teratomas.
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Affiliation(s)
- L. Errami
- Gynecology and Obstetrics Department, Mohammed VI University Hospital, Mohammed First University Oujda, Morocco
| | - A. Douzi
- Gynecology and Obstetrics Department, Mohammed VI University Hospital, Mohammed First University Oujda, Morocco
| | - O. Lamzouri
- Gynecology and Obstetrics Department, Mohammed VI University Hospital, Mohammed First University Oujda, Morocco
| | - H. Taheri
- Gynecology and Obstetrics Department, Mohammed VI University Hospital, Mohammed First University Oujda, Morocco
| | - H. Saadi
- Gynecology and Obstetrics Department, Mohammed VI University Hospital, Mohammed First University Oujda, Morocco
| | - A. Mimouni
- Gynecology and Obstetrics Department, Mohammed VI University Hospital, Mohammed First University Oujda, Morocco
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3
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Trozzi R, Rosati A, Panico C, Perisiano C, Santoro A, Fagotti A. Extra-cranial meningioma associated with relapse of immature ovarian teratoma. Int J Gynecol Cancer 2023; 33:1649-1654. [PMID: 37783480 DOI: 10.1136/ijgc-2023-004718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023] Open
Affiliation(s)
- Rita Trozzi
- Dipartimento di Scienze della salute della donna, del bambino e di sanità pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Universita Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Rosati
- Dipartimento di Scienze della salute della donna, del bambino e di sanità pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Universita Cattolica del Sacro Cuore, Rome, Italy
| | - Camilla Panico
- U.O.C. Radiologia Addomino-pelvica. Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carlo Perisiano
- UOC Ortopedia e Traumatologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Angela Santoro
- Unità di Ginecopatologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Anna Fagotti
- Dipartimento di Scienze della salute della donna, del bambino e di sanità pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Universita Cattolica del Sacro Cuore, Rome, Italy
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4
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Vaidya SA, Rai S, Jha A. Immature Teratoma in Pregnancy: A Case Report. JNMA J Nepal Med Assoc 2023; 61:727-730. [PMID: 38289795 PMCID: PMC10579741 DOI: 10.31729/jnma.8267] [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] [Received: 08/17/2023] [Indexed: 02/01/2024] Open
Abstract
Immature teratoma is one of the rare malignant germ cell tumours presented in pregnancy. Here, we present 26-year-old pregnant women who had an incidental finding of left adnexal mass in an anomaly scan at 19 weeks of pregnancy. Laparotomy with peritoneal fluid cytology, left salpingo-oophorectomy and omental biopsy at 20 weeks of pregnancy revealed immature teratoma stage 1A, grade 2 in the histopathology report. However, she followed up with the metastatic mass in the pouch of Douglas at 30 weeks of pregnancy in magnetic resonance imaging despite being counselled for possible chemotherapy and surveillance. A baby with a good Apgar score and grade 3 immature teratoma in the metastatic mass was revealed following the exploratory laparotomy and cesarean section at 36 weeks of pregnancy. Fertility-sparing surgery with chemotherapy during pregnancy for high-grade tumours may result in a good prognosis. Keywords case reports; chemotherapy; immature teratoma; pregnancy; surgery.
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Affiliation(s)
- Sapana Amatya Vaidya
- Department of Obstetrics and Gynecology, Paropakar Maternity and Women's Hospital, Thapathali, Kathmandu, Nepal
| | - Snigdha Rai
- Department of Obstetrics and Gynecology, Paropakar Maternity and Women's Hospital, Thapathali, Kathmandu, Nepal
| | - Anushree Jha
- Kathmandu Cancer Center, Changunarayan, Bhaktapur, Nepal
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5
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Saani I, Raj N, Sood R, Ansari S, Mandviwala HA, Sanchez E, Boussios S. Clinical Challenges in the Management of Malignant Ovarian Germ Cell Tumours. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6089. [PMID: 37372675 DOI: 10.3390/ijerph20126089] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/22/2023] [Accepted: 04/25/2023] [Indexed: 06/29/2023]
Abstract
Nonepithelial ovarian cancers (NEOC) are a group of rare malignancies, including germ cell tumours (GCT) and sex cord-stromal tumours (SCST), along with small-cell carcinomas and sarcomas. GCTs represent 2-5% of ovarian cancers, with a yearly incidence of 4:100,000, and they usually affect young women and adolescents. Precursory germ cells of the ovary form the basis of GCT. They are histologically classified into primitive GCT, teratomas, and monodermal and somatic-type tumours associated with dermoid cysts. A primitive GCT can be either a yolk sac tumour (YST), dysgerminoma, or mixed germ cell neoplasm. Teratomas are either mature (benign) or immature (malignant). Given that malignant GCTs occur rarely compared to epithelial ovarian tumours (EOC), greater focus is required in their diagnosis and treatment. In this article, we review the epidemiology, clinical manifestations, diagnosis, and molecular biology, along with the management and therapeutic challenges.
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Affiliation(s)
- Iqra Saani
- Department of Medicine, Medway NHS Foundation Trust, Windmill Road, Gillingham ME7 5NY, UK
| | - Nitish Raj
- Department of Radiology, University Hospitals Plymouth NHS Trust, Plymouth PL6 8DH, UK
| | - Raja Sood
- Department of Clinical Medical Education, Epsom and St Helier University Hospitals NHS Trust, Epsom KT18 7EG, UK
| | - Shahbaz Ansari
- Department of Medicine, Glan Clwyd Hospital, NHS Wales, Denbighshire LL18 5UJ, UK
| | - Haider Abbas Mandviwala
- Department of Internal Medicine, School of Medicine, Faculty of Health Sciences, Ziauddin Medical University, Karachi 75000, Sindh, Pakistan
| | - Elisabet Sanchez
- Department of Medical Oncology, Medway NHS Foundation Trust, Windmill Road, Gillingham ME7 5NY, UK
| | - Stergios Boussios
- Department of Medical Oncology, Medway NHS Foundation Trust, Windmill Road, Gillingham ME7 5NY, UK
- Faculty of Life Sciences & Medicine, School of Cancer & Pharmaceutical Sciences, King's College London, London SE1 9RT, UK
- Kent Medway Medical School, University of Kent, Canterbury CT2 7LX, UK
- AELIA Organization, 9th Km Thessaloniki-Thermi, 57001 Thessaloniki, Greece
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6
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Pinto MT, Eiras Martins G, Vieira AGS, Galvão JMS, de Pádua Souza C, Macedo CRPD, Lopes LF. Molecular Biology of Pediatric and Adult Ovarian Germ Cell Tumors: A Review. Cancers (Basel) 2023; 15:cancers15112990. [PMID: 37296950 DOI: 10.3390/cancers15112990] [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: 02/22/2023] [Revised: 03/14/2023] [Accepted: 03/20/2023] [Indexed: 06/12/2023] Open
Abstract
Ovarian germ cell tumors (OGCTs) are rare in adults; indeed, they occur predominantly in children, adolescents, and young adults, and they account for approximately 11% of cancer diagnoses in these groups. Because OGCTs are rare tumors, our current understanding of them is sparse; this is because few studies have investigated the molecular basis of pediatric and adult cancers. Here, we review the etiopathogenesis of OGCTs in children and adults, and we address the molecular landscape of these tumors, including integrated genomic analysis, microRNAs, DNA methylation, the molecular implications of treatment resistance, and the development of in vitro and in vivo models. An elucidation of potential molecular alterations may provide a novel field for understanding the pathogenesis, tumorigenesis, diagnostic markers, and genetic peculiarity of the rarity and complexity of OGCTs.
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Affiliation(s)
| | - Gisele Eiras Martins
- Brazilian Childhood Germ Cell Tumor Study Group, The Brazilian Pediatric Oncology Society (SOBOPE), Barretos 14784400, Brazil
- Children's Cancer Hospital from Hospital de Amor, Barretos 14784400, Brazil
| | - Ana Glenda Santarosa Vieira
- Brazilian Childhood Germ Cell Tumor Study Group, The Brazilian Pediatric Oncology Society (SOBOPE), Barretos 14784400, Brazil
- Children's Cancer Hospital from Hospital de Amor, Barretos 14784400, Brazil
| | | | | | - Carla Renata Pacheco Donato Macedo
- Brazilian Childhood Germ Cell Tumor Study Group, The Brazilian Pediatric Oncology Society (SOBOPE), Barretos 14784400, Brazil
- Pediatric Oncology Department, IOP/GRAACC/Federal University of Sao Paulo, Sao Paulo 04038001, Brazil
| | - Luiz Fernando Lopes
- Brazilian Childhood Germ Cell Tumor Study Group, The Brazilian Pediatric Oncology Society (SOBOPE), Barretos 14784400, Brazil
- Children's Cancer Hospital from Hospital de Amor, Barretos 14784400, Brazil
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7
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Role of Adjuvant Chemotherapy in Stage I Pure Ovarian Immature Teratoma: A Systematic Review and Meta-Analysis. Cancers (Basel) 2023; 15:cancers15061741. [PMID: 36980627 PMCID: PMC10046473 DOI: 10.3390/cancers15061741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 03/15/2023] Open
Abstract
To determine the role of adjuvant chemotherapy in stage IA G2-3 and stage IB-IC pure ovarian immature teratoma (POIT), we performed a systematic review and meta-analysis by searching PubMed, Embase, Cochrane library, Web of Science, and ClinicalTrials.gov. Randomized controlled trials or cohort studies on stage IA G2-G3 or stage IB-IC POIT between 1 January 1970 and 15 December 2022 were enrolled. The recurrence rate and mortality rate were the primary outcomes, and subgroup analysis based on the tumor stage and grade was also conducted. In total, 15 studies with 707 patients were included. Compared with surveillance, adjuvant chemotherapy significantly decreased the mortality rate (RR 0.31, 95% CI 0.11–0.88, p = 0.03), but not recurrence (RR 0.74, 95% CI 0.39–1.42, p = 0.37), in the overall population. Subgroup analysis showed no statistical difference in the recurrence rate and mortality rate between patients who received adjuvant chemotherapy and surveillance in pediatric POIT, stage IA G2-3 POIT, stage IB-IC POIT, and stage IA-IC G3 POIT (all with p > 0.05). However, patients who underwent adjuvant chemotherapy appeared to have a lower risk of both recurrence (RR 0.17, 95% CI 0.03–0.83, p = 0.03) and death (RR 0.04, 95% CI 0.00–1.00, p = 0.05) in adult POIT. Adjuvant chemotherapy significantly decreased the mortality rate in patients with stage I POIT and lowered the risk of recurrence in the adult subgroup. Surveillance administered in stage I POIT over IA G1 should be cautious, especially in adult patients.
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8
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Pashankar F, Hanley K, Lockley M, Stoneham S, Nucci MR, Reyes-Múgica M, Elishaev E, Vang R, Veneris J, Rytting H, Olson T, Hazard K, Covens A, Arora R, Billmire D, Al-Ibraheemi A, Ulbright TM, Frazier L, Hirsch MS. Addressing the diagnostic and therapeutic dilemmas of ovarian immature teratoma: Report from a clinicopathologic consensus conference. Eur J Cancer 2022; 173:59-70. [PMID: 35863107 DOI: 10.1016/j.ejca.2022.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 06/03/2022] [Accepted: 06/06/2022] [Indexed: 11/24/2022]
Abstract
Ovarian immature teratoma is a rare subtype of germ cell tumour that can be pure or associated with non-teratomatous germ cell tumour elements and is graded based on extent of the immature neuroectodermal component. Immature teratoma (IT) can also be associated with somatic differentiation in the form of sarcoma, carcinoma, or extensive immature neuroectodermal elements and may produce low levels of serum alpha-fetoprotein. Variable interpretation of these issues underlies diagnostic and management dilemmas, resulting in substantial practice differences between paediatric and adult women with IT. The Malignant Germ Cell International Consortium (MaGIC) convened oncologists, surgeons, and pathologists to address the following crucial clinicopathologic issues related to IT: (1) grading of IT, (2) definition and significance of 'microscopic' yolk sac tumour, (3) transformation to a somatic malignancy, and (4) interpretation of serum tumour biomarkers. This review highlights the discussion, conclusions, and suggested next steps from this clinicopathologic conference.
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Affiliation(s)
- Farzana Pashankar
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Krisztina Hanley
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Michelle Lockley
- Department of Medical Oncology, University College Hospital, University College London Hospital, NHS Foundation Trust, London, UK; Centre for Cancer Genomics and Computational Biology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Sara Stoneham
- Department of Pediatrics University College Hospital, University College London Hospital, NHS Foundation Trust, London, UK
| | - Marisa R Nucci
- Department of Pathology, Women's and Perinatal Division, Brigham and Women's Hospital; Harvard Medical School, Boston, MA, USA
| | - Miguel Reyes-Múgica
- Department of Pathology, University of Pittsburg Medical Center, Pittsburg, PA, USA
| | - Esther Elishaev
- Department of Pathology, University of Pittsburg Medical Center, Pittsburg, PA, USA
| | - Russell Vang
- Department of Pathology, Johns Hopkins Hospital, Baltimore, MD, USA
| | | | - Heather Rytting
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Thomas Olson
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Atlanta, GA, USA
| | - Kim Hazard
- Department of Pathology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Al Covens
- Division of Gyneacologic Oncology, University of Toronto, Sunnybrook Health Science Centre, Toronto, ON
| | - Rupali Arora
- Department of Gyneacology, University College Hospital, University College London Hospital, NHS Foundation Trust, London, UK
| | - Deborah Billmire
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Alyaa Al-Ibraheemi
- Harvard Medical School, Boston, MA, USA; Department of Pathology, Boston Children's Hospital, Boston, MA, USA
| | - Thomas M Ulbright
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Lindsay Frazier
- Harvard Medical School, Boston, MA, USA; Dana Farber/Boston Children's Cancer and Blood Center, Boston, MA, USA
| | - Michelle S Hirsch
- Department of Pathology, Women's and Perinatal Division, Brigham and Women's Hospital; Harvard Medical School, Boston, MA, USA.
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9
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Zhang X, Yang J, Wang J, Zhang Y, Yang J. Early Stage Ovarian Immature Teratoma, Surveillance or Chemotherapy After Surgery? a Propensity Score Matched Analysis. Gynecol Oncol Rep 2022; 40:100976. [PMID: 35434235 PMCID: PMC9011035 DOI: 10.1016/j.gore.2022.100976] [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: 01/28/2022] [Revised: 03/29/2022] [Accepted: 03/31/2022] [Indexed: 11/25/2022] Open
Abstract
Active surveillance after conservative surgery may be safe for early stage ITs. Complete resection of tumor is probably the key for successful surveillance. The survival outcomes of patients after recurrence were relatively satisfactory.
Objective Methods Results Conclusion
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10
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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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11
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Surveillance Only for High-risk FIGO Stage IA/IB Malignant Ovarian Germ Cell Tumors: Results From a National Cancer Database. Am J Clin Oncol 2021; 44:195-199. [PMID: 33710136 DOI: 10.1097/coc.0000000000000805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Investigate the use and outcomes of a surveillance only strategy for patients with high-risk stage I malignant ovarian germ cell tumors. METHODS Patients with International Federation of Gynecology and Obstetrics stage IA/IB grade 2 or 3 immature teratoma, yolk sac, or mixed germ cell tumor diagnosed between 2004 and 2014 who had at least 1 month of follow-up were drawn from the National Cancer Database. Overall survival (OS) was evaluated for each histologic subtype using Kaplan-Meier curves, and compared with the log-rank test. RESULTS A total of 497 patients were identified; 115 (23.1%) with grade 2 immature teratoma, 157 (31.6%) with grade 3 immature teratoma, 101 (20.3%) with yolk sac tumor, 124 (25%) with mixed germ cell tumor. Rate of adjuvant chemotherapy was 68.2% (655 patients), while rate of lymph node biopsy/dissection was 55.2%. A total of 19 (3.8%) deaths were observed at a median of 29.8 months. There was no difference in OS between patients who did and did not receive adjuvant chemotherapy with grade 2 (P=0.35) and grade 3 immature teratoma (P=0.47) or mixed germ cell tumors (P=0.55). Patients with yolk sac tumors those who received chemotherapy had better OS compared with those who did not, P=0.019; 5-year OS rates were 92.7% and 79.6%, respectively. CONCLUSIONS A surveillance only strategy for patients with stage I malignant ovarian germ cell tumors is associated with excellent survival outcomes for patients with grade 2 or 3 immature teratoma or mixed germ cell tumors.
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12
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Bergamini A, Sarwar N, Ferrandina G, Scarfone G, Short D, Aguiar X, Camnasio C, Kaur B, Savage PM, Cormio G, Lim A, Pignata S, Mangili G, Seckl MJ. Response to letter entitled: Re: Can we replace adjuvant chemotherapy with surveillance for stage IA-C immature ovarian teratomas of any grade? An international multicenter analysis. Eur J Cancer 2021; 152:257-258. [PMID: 34112565 DOI: 10.1016/j.ejca.2021.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 05/04/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Alice Bergamini
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Milan, Italy; Università Vita Salute San Raffaele, Milan, Italy.
| | - Naveed Sarwar
- Department of Medical Oncology, Charing Cross Hospital Campus of Imperial College London, London, UK
| | - Gabriella Ferrandina
- Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore, Istituto di Ginecologia e Ostetricia, Roma, Italy
| | - Giovanna Scarfone
- Department of Obstetrics, Gynecology and Neonatology, University of Milan, Ospedale Maggiore Policlinico, Milan, Italy
| | - Dee Short
- Department of Medical Oncology, Charing Cross Hospital Campus of Imperial College London, London, UK
| | - Xianne Aguiar
- Department of Medical Oncology, Charing Cross Hospital Campus of Imperial College London, London, UK
| | - Cristina Camnasio
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo, Pavia, Italy
| | - Baljeet Kaur
- Department of Medical Oncology, Charing Cross Hospital Campus of Imperial College London, London, UK
| | - Philip M Savage
- Sussex Cancer Centre, Brighton and Sussex University Hospitals NHS Trust, UK
| | - Gennaro Cormio
- Gynecologic Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II" Bari & Department of Biomedical Sciences and Human Oncology, University of Bari, UK
| | - Adrian Lim
- Department of Imaging, Charing Charing Cross Hospital Campus of Imperial College London, London, UK
| | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, 80138 Naples, Italy
| | - Giorgia Mangili
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Michael J Seckl
- Department of Medical Oncology, Charing Cross Hospital Campus of Imperial College London, London, UK.
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13
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Lockley M, Stoneham S, Shamash J, Pashankar F, Frazier L. Re: 'Can we replace adjuvant chemotherapy with surveillance for stage IA-C immature ovarian teratomas of any grade? An international multicenter analysis'. Eur J Cancer 2021; 152:255-256. [PMID: 34099362 DOI: 10.1016/j.ejca.2021.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 05/04/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Michelle Lockley
- Centre for Cancer Cell and Molecular Biology, Barts Cancer Institute, Queen Mary University of London, UK; Department of Gynaecological Oncology, Cancer Services, University College London Hospital, London, UK.
| | - Sara Stoneham
- Children's and Young Persons Cancer Services, University College London Hospital Trusts, London, United Kingdom, UK
| | | | | | - Lindsay Frazier
- Dana Farber/Boston Childrens Cancer and Blood Disorders Center, Boston, MA, USA
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14
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Moro F, Castellano LM, Franchi D, Epstein E, Fischerova D, Froyman W, Timmerman D, Zannoni GF, Scambia G, Valentin L, Testa AC, Mascilini F. Imaging in gynecological disease (22): clinical and ultrasound characteristics of ovarian embryonal carcinomas, non-gestational choriocarcinomas and malignant mixed germ cell tumors. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:987-994. [PMID: 33142349 DOI: 10.1002/uog.23529] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/08/2020] [Accepted: 10/21/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To describe the clinical and ultrasound characteristics of three types of rare malignant ovarian germ cell tumor: embryonal carcinoma, non-gestational choriocarcinoma and malignant mixed germ cell tumor. METHODS This was a retrospective multicenter study. From the International Ovarian Tumor Analysis (IOTA) database, we identified patients with a histological diagnosis of ovarian embryonal carcinoma, non-gestational choriocarcinoma or malignant mixed germ cell tumor, who had undergone preoperative ultrasound examination by an experienced ultrasound examiner between 2000 and 2020. Additional patients with the same histology were identified from the databases of the departments of gynecological oncology in the participating centers. All tumors were described using IOTA terminology. Three examiners reviewed all available ultrasound images and described them using pattern recognition. RESULTS One patient with embryonal carcinoma, five patients with non-gestational ovarian choriocarcinoma and seven patients with ovarian malignant mixed germ cell tumor (six primary tumors and one recurrence) were identified. Seven patients were included in the IOTA studies and six patients were examined outside of the IOTA studies. The median age at diagnosis was 26 (range, 14-77) years. Beta-human chorionic gonadotropin levels were highest in non-gestational choriocarcinomas and alpha-fetoprotein levels were highest in malignant mixed germ cell tumors. Most tumors were International Federation of Gynecology and Obstetrics (FIGO) Stage I (9/12 (75.0%)). All tumors were unilateral, and the median largest diameter was 129 (range, 38-216) mm. Of the tumors, 11/13 (84.6%) were solid and 2/13 (15.4%) were multilocular-solid; 9/13 (69.2%) manifested abundant vascularization on color Doppler examination. Using pattern recognition, the typical ultrasound appearance was a large solid tumor with inhomogeneous echogenicity of the solid tissue and often dispersed cysts which, in most cases, were small and irregular. Some tumors had smooth contours while others had irregular contours. CONCLUSIONS A unilateral, large solid tumor with inhomogeneous echogenicity of the solid tissue and with dispersed small cystic areas in a young woman should raise the suspicion of a rare malignant germ cell tumor. This suspicion can guide the clinician to test tumor markers specific for malignant germ cell tumors. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- F Moro
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - L M Castellano
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - D Franchi
- Preventive Gynecology Unit, Division of Gynecology, European Institute of Oncology, IRCCS, Milan, Italy
| | - E Epstein
- Department of Clinical Science and Education, Karolinska Institutet and Department of Obstetrics and Gynecology, Sodersjukhuset, Stockholm, Sweden
| | - D Fischerova
- Gynecological Oncology Center, Department of Obstetrics and Gynecology, Charles University, Prague, Czech Republic
| | - W Froyman
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - D Timmerman
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - G F Zannoni
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
- Dipartimento Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Scambia
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
- Dipartimento Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - L Valentin
- Skåne University Hospital Malmö, Malmö, Sweden
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - A C Testa
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
- Dipartimento Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - F Mascilini
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
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15
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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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16
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Agarwal R, Rajanbabu A, Keechilattu P, Nair IR, Vijaykumar DK, Unnikrishnan UG. A retrospective analysis of the pattern of care and survival in patients with malignant ovarian germ cell tumors. South Asian J Cancer 2020; 8:35-40. [PMID: 30766850 PMCID: PMC6348783 DOI: 10.4103/sajc.sajc_6_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective: The objective of this study is to evaluate the pattern of care and survival outcome in patients with malignant ovarian germ cell tumors (MOGCTs). Materials and Methods: Between January 2004 and August 2017, 50 patients with MOGCT were identified at Amrita Institute of Medical Sciences and 48 included in analyses. Histologic subtypes were as follows: dysgerminoma 11; immature teratoma 16; yolk sac tumor 3; and mixed germ cell tumor 18. 31 (64.6% patients belonged to Stage I and 17 (35.4%) patients were advanced stage (Stage II-IV). Results: Median follow-up period was 34 months (range: 1–241 months). The 5- and 10-year disease-free survival (DFS) and overall survival (OS) for the entire cohort were 87.5% and 94.4%, respectively. DFS and OS of incomplete surgery Stage I patients 28.6% and 68.6%, respectively, were significantly lower than completely staged patients 100%. Out of 8 incomplete surgery patients, 5 recurred of which 2 died of disease within 4 and 9 months of recurrence. There was no survival difference with comprehensive surgical staging (CSS) and pediatric surgical staging (PSS) in Stage I MOGCT (DFS and OS 100%). Stage I dysgerminoma kept on active surveillance after PSS had equivalent survival of 100%. There was no survival difference in advanced stage MOGCT treated with primary debulking surgery and neoadjuvant chemotherapy (NAC) followed by fertility-sparing surgery (DFS and OS 100%). Conclusion: Incomplete surgery in Stage I MOGCT was associated with poor survival. There was no survival difference with CSS and PSS. NAC followed by surgery could be a reasonable option for patients of advanced stage MOGCT.
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Affiliation(s)
- Reshu Agarwal
- Department of Gynecologic Oncology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
| | - Anupama Rajanbabu
- Department of Gynecologic Oncology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
| | - Pavithran Keechilattu
- Department of Medical Oncology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
| | - Indu R Nair
- Department of Pathology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
| | - D K Vijaykumar
- Department of Surgical Oncology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
| | - U G Unnikrishnan
- Department of Biostatistics, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
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Yüksel D, Ayhan S, Korkmaz V, Çakır C, Kılıç Ç, Akgor U, Özgül N, Kılıç F, Ersak B, Esen S, Kuru O, Uncu D, Gökcü M, Özdal B, Gültekin M, Salman MC, Boran N, Toptaş T, Üreyen I, Taşcı T, Kimyon Cömert G, Türkmen O, Moraloğlu Tekin Ö, Engin Üstün Y, Turan T. Retrospective Analysis of Pure Ovarian Immature Teratoma in Patients Aged 15-39 Years: A Turkish Multicenter Study. J Adolesc Young Adult Oncol 2020; 10:697-702. [PMID: 33296263 DOI: 10.1089/jayao.2020.0155] [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: 12/12/2022] Open
Abstract
Purpose: To evaluate the clinicopathological characteristics and surgical outcomes in patients with pure ovarian immature teratomas (POITs). Materials and Methods: In this multicenter study, a retrospective review was made of the databases of six Gynecology Oncology Departments in Turkey to identify patients with POITs who had undergone surgery between 1993 and 2019. Results: Evaluation was made of 48 patients with a median age at diagnosis of 22.5 years (range, 15-37 years). In 40 (83%) patients, stage I was determined and in eight patients, an advanced stage (IIIB, IIIC, and IVB) was determined. Tumors were found to be grade I in 17 (35.4%) cases, grade II in 12 (25%), and grade III in 19 (39.6%). Fertility-sparing surgery was applied to 42 (87.5%) patients and radical surgery to 6 (12.5%). The median follow-up was 60 months (range, 3-246 months). Recurrence was seen in seven patients, all with grade III tumors. In the final pathological examination of recurrent tumors, mature teratoma was reported in five patients, and immature teratoma in one patient. Salvage surgery was not performed in one patient as the tumor was unresectable and so a regimen of bleomycin, etoposide, and cisplatin (BEP) was administered. Conclusion: POITs are rare tumors seen at a young age, and benign or malignant relapse can be seen in these tumors. In this cohort, the malignant recurrence rate was 4.1%, and the benign recurrence rate was 10.4%. All the recurrences were in grade III tumors. Benign recurrences can be treated with surgery alone and the malignant group should be treated with surgery followed by chemotherapy.
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Affiliation(s)
- Dilek Yüksel
- Division of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Sevgi Ayhan
- Division of Gynecologic Oncology, Ankara City Hospital, Ankara, Turkey
| | - Vakkas Korkmaz
- Division of Gynecologic Oncology, Ankara City Hospital, Ankara, Turkey
| | - Caner Çakır
- Division of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Çiğdem Kılıç
- Division of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Utku Akgor
- Division of Gynecologic Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Nejat Özgül
- Division of Gynecologic Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Fatih Kılıç
- Division of Gynecologic Oncology, Ankara City Hospital, Ankara, Turkey
| | - Burak Ersak
- Division of Gynecologic Oncology, Ankara City Hospital, Ankara, Turkey
| | - Selin Esen
- Division of Medical Oncology, Ankara City Hospital, Ankara, Turkey
| | - Oğuzhan Kuru
- Division of Gynecologic Oncology, University of Health Sciences Tepecik Education and Research Hospital, İzmir, Turkey
| | - Doğan Uncu
- Division of Medical Oncology, Ankara City Hospital, Ankara, Turkey
| | - Mehmet Gökcü
- Division of Gynecologic Oncology, University of Health Sciences Tepecik Education and Research Hospital, İzmir, Turkey
| | - Bülent Özdal
- Division of Gynecologic Oncology, Ankara City Hospital, Ankara, Turkey
| | - Murat Gültekin
- Division of Gynecologic Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mehmet Coşkun Salman
- Division of Gynecologic Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Nurettin Boran
- Division of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Tayfun Toptaş
- Antalya Education and Research Hospital Faculty of Medicine, University of Health Sciences, Antalya, Turkey
| | - Işın Üreyen
- Antalya Education and Research Hospital Faculty of Medicine, University of Health Sciences, Antalya, Turkey
| | - Tolga Taşcı
- Division of Gynecologic Oncology, Faculty of Medicine Bahçeşehir University, Istanbul, Turkey
| | - Günsu Kimyon Cömert
- Division of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Osman Türkmen
- Division of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey
| | | | - Yaprak Engin Üstün
- Division of Obstetrics and Gynecology, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Taner Turan
- Division of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey
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18
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Bergamini A, Sarwar N, Ferrandina G, Scarfone G, Short D, Aguiar X, Camnasio C, Kaur B, Savage PM, Cormio G, Lim A, Pignata S, Mangili G, Seckl MJ. Can we replace adjuvant chemotherapy with surveillance for stage IA-C immature ovarian teratomas of any grade? an international multicenter analysis. Eur J Cancer 2020; 137:136-143. [PMID: 32763784 DOI: 10.1016/j.ejca.2020.06.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/29/2020] [Accepted: 06/26/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The role of surveillance after surgery for stage IA-C grade 2 (G2) or grade 3 (G3) immature teratomas (ITs) is controversial with many guidelines advocating adjuvant chemotherapy. Here, we investigate the safety of surveillance in stage IA-C G1-3 ITs. METHODS Clinicopathological data were analysed on postpubertal patients with stage I pure ITs in Multicenter Italian Trials in Ovarian Cancer centres and at Charing Cross Hospital, UK, between January 1985 and January 2018. RESULTS Of 108 stage I patients, 66 (61.1%), 3 (2.8%) and 39 (36.1%) were International Federation of Gynecology and Obstetrics IA, IB, IC, respectively, with 31 (28.7%), 41 (38%) and 36 (33.3%) having grade 1 (G1), 2 and 3 disease, respectively. After surgery, 27 patients (25%) had adjuvant chemotherapy and 81 (75%) surveillance. There was no significant increase in the risk of malignant (G2-3 IT) relapse (9/81 vs 2/27; p = 0.72) or in disease-free survival (DFS) or overall survival in the surveillance vs chemotherapy groups. The median time to relapse was 17.8 months (range: 3-47) with no significant difference between surveillance or chemotherapy groups. The median follow-up was 64.3 months (Interquartile range (IQR) 22.2-101.7). Chemotherapy induced cures in all except for one patient who did not follow the surveillance protocol due to pregnancy and died of disease. Univariate and multivariate analyses revealed that only tumour grade (hazard ratio [HR] = 3.11; p = 0.02) and complete surgical staging (HR = 0.2; p = 0.01) were independent prognostic factors for decreased DFS. CONCLUSION The present study suggests that in the adult setting careful surveillance appears to be an acceptable alternative to adjuvant chemotherapy for stage IA-C ITs of any grade, properly staged and with negative postoperative tumour markers.
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Affiliation(s)
- Alice Bergamini
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Milan, Italy; Università Vita Salute San Raffaele, Milan, Italy.
| | - Naveed Sarwar
- Department of Medical Oncology, Charing Cross Hospital Campus of Imperial College London, London, UK
| | - Gabriella Ferrandina
- Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore, Istituto di Ginecologia e Ostetricia, Roma, Italy
| | - Giovanna Scarfone
- Department of Obstetrics, Gynecology, and Neonatology, University of Milan, Ospedale Maggiore Policlinico, Milan, Italy
| | - Dee Short
- Department of Medical Oncology, Charing Cross Hospital Campus of Imperial College London, London, UK
| | - Xianne Aguiar
- Department of Medical Oncology, Charing Cross Hospital Campus of Imperial College London, London, UK
| | - Cristina Camnasio
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo, Pavia, Italy
| | - Baljeet Kaur
- Department of Medical Oncology, Charing Cross Hospital Campus of Imperial College London, London, UK
| | - Philip M Savage
- Sussex Cancer Centre, Brighton and Sussex University Hospitals NHS Trust, UK
| | - Gennaro Cormio
- Gynecologic Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II" Bari & Department of Biomedical Sciences and Human Oncology, University of Bari, Italy
| | - Adrian Lim
- Department of Imaging, Charing Charing Cross Hospital Campus of Imperial College London, London, UK
| | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, 80138, Naples, Italy
| | - Giorgia Mangili
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Michael J Seckl
- Department of Medical Oncology, Charing Cross Hospital Campus of Imperial College London, London, UK.
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19
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Morrison A, Nasioudis D. Reproductive outcomes following fertility-sparing surgery for malignant ovarian germ cell tumors: A systematic review of the literature. Gynecol Oncol 2020; 158:476-483. [PMID: 32513565 DOI: 10.1016/j.ygyno.2020.05.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 05/19/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Investigate the reproductive outcomes of patients diagnosed with malignant ovarian germ cell tumors (MOGCTs) following fertility-sparing surgery (FSS). METHODS A systematic review of the Pubmed/Medline, EMBASE and Web-of-Science databases between January 1st 1990 and February 28th 2020 was performed. Full articles reporting on at least 10 patients with MOGCT who underwent FSS and provided data on fertility or pregnancy outcomes were included. RESULTS A total of 47 studies that included 2189 patients with MOGCT who underwent FSS were included. Rate of chemotherapy use was 79.9% while cumulative relapse rate was 8.7%. Based on 1110 patient from 27 studies rate of premature ovarian failure was 3.7%. Fecundity rate was 24.6% (n = 1980, from 42 studies), while 80.6% of patients attempting pregnancy had at least one pregnancy (n = 474, from 27 studies). Based on 294 live births, the rate of preterm delivery was 3% while among 261 live infants, only 3 (1.2%) malformations were reported. CONCLUSIONS The majority of patients with MOGCTs have normal menstrual and reproductive function following FSS. Fecundity and pregnancy outcomes are comparable to the general population.
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Affiliation(s)
- Aimee Morrison
- Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Dimitrios Nasioudis
- Division of Gynecologic Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
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20
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Wang J, Zhuo X, Yang J, Cao D, Shen K, Huang H, Wu M, Pan L, Xiang Y, Guo L. Outcomes and prognostic factors of patients with recurrent and persistent malignant ovarian germ cell tumors. Arch Gynecol Obstet 2020; 301:1021-1026. [PMID: 32198624 DOI: 10.1007/s00404-020-05452-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 01/23/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Due to the rarity of recurrent and persistent malignant ovarian germ cell tumors (MOGCTs), there is no standardized protocol for salvage therapy. This study aimed to investigate the outcomes and prognostic factors of patients with recurrent and persistent MOGCTs. METHODS Clinical data for 59 patients with recurrent and persistent MOGCTs admitted to Peking Union Medical College Hospital from January 1, 2000, to April 30, 2018, were retrospectively analyzed. RESULTS Twenty-one cases (35.6%) were recurrent, and 38 (64.4%) were persistent. Patient age ranged from 1 to 39 years, and disease stage was as follows: 33 stage I, 4 stage II, 21 stage III, and 1 stage IV. There were 19 immature teratomas, 26 yolk sac tumors, 1 dysgerminoma, and 13 mixed germ cell tumors. Regarding the primary surgery, fertility was preserved in 49 patients and not preserved in 10 patients. Among the patients who underwent fertility-preserving primary surgery, 40 had fertility preserved in the second operation, and 9 did not. In the mean follow-up of 52.6 months (range 2-279 months) after recurrence, 19 patients (32.2%) experienced a second relapse, and 16 (27.1%) died. The 5-year survival and progression-free survival rates after relapse were 70.0% and 67.0%, respectively. The optimal salvage surgery and chemotherapy regimen after relapse were independent prognostic factors (P < 0.05). CONCLUSIONS The prognosis of recurrent and persistent MOGCTs was good after salvage therapy. The optimal salvage surgery and adjuvant standardized chemotherapy significantly impact patient prognosis. For young nulliparous patients, secondary fertility-sparing salvage therapy can be considered.
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Affiliation(s)
- Jinhui Wang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Xiuping Zhuo
- Department of Gynecology and Obstetrics, Beijing Youan Hospital of Capital Medical University, Beijing, China
| | - Jiaxin Yang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China.
| | - Dongyan Cao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Keng Shen
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Huifang Huang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Ming Wu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Lingya Pan
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Yang Xiang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Lina Guo
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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Re: A multicentre retrospective cohort study of ovarian germ cell tumours: Evidence for chemotherapy de-escalation and alignment of paediatric and adult practice. Eur J Cancer 2020; 130:265-266. [PMID: 32178968 DOI: 10.1016/j.ejca.2020.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 01/12/2020] [Indexed: 11/22/2022]
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Wang D, Zhu S, Jia C, Cao D, Wu M, Shen K, Yang J, Xiang Y. Role of staging surgery and adjuvant chemotherapy in adult patients with apparent stage I pure immature ovarian teratoma after fertility-sparing surgery. Int J Gynecol Cancer 2020; 30:664-669. [PMID: 32179695 DOI: 10.1136/ijgc-2019-001116] [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: 12/03/2019] [Revised: 01/26/2020] [Accepted: 01/29/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE The standard treatment for young patients with stage I malignant ovarian germ cell tumors, except stage I dysgerminoma and stage IA G1 immature teratoma, is unilateral salpingo-oophorectomy with complete staging surgery followed by platinum-based chemotherapy. However, the role of complete staging surgery and adjuvant chemotherapy remains controversial. The aim of this study was to investigate the role of complete staging surgery and adjuvant chemotherapy in patients with early-stage pure immature teratoma after fertility-sparing surgery. METHODS Patients with stage I pure immature teratoma who underwent fertility-sparing surgery between January 1986 and June 2018 were reviewed retrospectively. Fertility-sparing surgery was defined as preservation of the uterus and at least one adnexa. The inclusion criteria were age >18 years, stage I disease (confined to one ovary), and diagnosis of pure immature teratoma. Patients with distant metastasis or mixed ovarian germ cell tumor were excluded. Complete staging surgery was defined as peritoneal cytology examination, peritoneal biopsy, omentectomy, or omental biopsy with or without lymph node dissection. Patients designated with stage I disease without complete staging surgery were categorized as stage X. Disease-free survival was defined as the interval from the date of surgery to the date of recurrence or censoring. Disease-free survival curves were calculated using the Kaplan-Meier method and compared using the log-rank test. RESULTS A total of 75 patients were included in the analysis, with a median age of 26 years (range 18-40): 26 (34.7%) patients had received complete staging surgery; 51 (68%) patients received postoperative adjuvant chemotherapy while 24 (32%) underwent surgery alone; and 4 patients (5.3%) had recurrent disease during a median follow-up time of 80.2 months (range 13.7-261). The recurrence rates in the chemotherapy group and surveillance groups were 3.9% and 8.3%, respectively (p=0.46). All patients were successfully salvaged, except for one death. Tumor relapse occurred in patients with all grades of immature teratoma (G1: 1/35; G2: 2/25; G3: 1/15). Univariate analysis revealed that complete staging surgery, adjuvant chemotherapy, and tumor grade were not associated with 5 year disease-free survival (p=0.69, p=0.46, p=0.7, respectively). The 5 year disease-free survival rate was 94.6% and the overall survival rate was 98.7%. CONCLUSION Adult patients with stage I pure immature teratoma had 98.7% overall survival and recurrence rates were low after fertility-sparing surgery.
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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, China
| | - Shan Zhu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Congwei Jia
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Dongyan Cao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Ming Wu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Keng Shen
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Jiaxin Yang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yang Xiang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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Sun H, Ding H, Wang J, Zhang E, Fang Y, Li Z, Yu X, Wang C, Zhao Y, Chen K, Wen S, Li L, Shan S, Hong L, Chen F, Su P. The differences between gonadal and extra-gonadal malignant teratomas in both genders and the effects of chemotherapy. BMC Cancer 2019; 19:408. [PMID: 31039746 PMCID: PMC6492338 DOI: 10.1186/s12885-019-5598-0] [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: 09/03/2018] [Accepted: 04/11/2019] [Indexed: 11/21/2022] Open
Abstract
Background A tumor comprising of different types of tissues (such as hair, muscle, bone, etc.) is known as a teratoma. It is a type of germ cell (cells that make sperm or eggs) tumor. When these germ cells have rapid cancerous growth, then such a teratoma is called a malignant teratoma. We have studied the differences between gonadal and extra-gonadal malignant teratomas and the effects of chemotherapy in both genders. Methods The samples of 3799 male and 1832 female patients with malignant teratoma samples, between the ages of 1 and 85+ years, were selected from the years 1973 to 2014. Trends in incidence, estimated prevalence, incidence rates, and frequency were calculated in gonadal and extra-gonadal tumors with age adjustment. The five-year observed, expected, and relative survival rates were analyzed to study the prognosis. Results The gonadal took over a majority percentage of malignant teratomas compared with the extra-gonadal (90% vs. 10% in male; 83% vs. 17% in female). For the male, the total of the gonadal and the extra-gonadal were all significantly decreased from 1973 to 2014 (p < 0.05). For the female, there were no significant trends. As for prevalence, incidence, and frequency, there were two separate peaks of malignant teratomas. One peak was at under 1 year old, which was composed of the extra-gonadal tumor; the other peak was at 20–24 for male and 10–34 for female, which was composed of the gonadal tumor. This separation of the gonadal and extra-gonadal showed a significant difference (p < 0.05). As for the prognosis, the extra-gonadal tumor showed significantly lower survival rates than the gonadal (p < 0.05). In the short term, the survival rate of the chemotherapy group was higher than the supportive care group. However, in the long term, the survival rate of the chemotherapy group was lower than the supportive care group. Conclusion The gonadal and extra-gonadal malignant teratomas show lots of differences. Chemotherapy might not help improve survival rates. Electronic supplementary material The online version of this article (10.1186/s12885-019-5598-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hang Sun
- Department of Endocrinology, Shanghai Tenth Peoples' Hospital, Tongji University, No.301 Middle Yanchang Road, Shanghai, 200072, China.
| | - Hongxin Ding
- Hospital of Yantai University, Yantai University, Yantai, China
| | - Jianjun Wang
- Tongji Hospital, Tongji University, Shanghai, China
| | - Emma Zhang
- Mannjo Informatics Studio, Shanghai, China
| | - Yihua Fang
- The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zhenhua Li
- Yantai Yuhuangding Hospital, Qingdao University School of Medicine, Yantai, China
| | - Xiao Yu
- Huangshan First Peoples' Hospital, Huangshan, China
| | - Chongren Wang
- Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yifan Zhao
- Department of Endocrinology, Shanghai Tenth Peoples' Hospital, Tongji University, No.301 Middle Yanchang Road, Shanghai, 200072, China
| | - Kan Chen
- Department of Endocrinology, Shanghai Tenth Peoples' Hospital, Tongji University, No.301 Middle Yanchang Road, Shanghai, 200072, China
| | - Siwan Wen
- Tongji Hospital, Tongji University, Shanghai, China
| | - Liang Li
- Tongji Hospital, Tongji University, Shanghai, China
| | - Shan Shan
- Shanghai Sixth Peoples' Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Liu Hong
- Sam M. Walton College of Business, University of Arkansas, Fayetteville, AR, USA
| | - Face Chen
- Department of Informatics, Discovery & Analytical Solutions, PerkinElmer, Shanghai, No.1670, Zhang Heng Road, Zhangjiang Hi-Tech Park, Shanghai, 201203, China
| | - Pu Su
- Department of Informatics, Discovery & Analytical Solutions, PerkinElmer, Shanghai, No.1670, Zhang Heng Road, Zhangjiang Hi-Tech Park, Shanghai, 201203, China.
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Qin B, Xu W, Li Y. Are omentectomy and lymphadenectomy necessary in patients with apparently early-stage malignant ovarian germ cell tumors? Int J Gynecol Cancer 2019; 29:398-403. [DOI: 10.1136/ijgc-2018-000078] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/11/2018] [Accepted: 10/17/2018] [Indexed: 12/12/2022] Open
Abstract
ObjectiveTo evaluate the role of omentectomy and lymphadenectomy in the treatment of clinically apparent early-stage malignant ovarian germ cell tumors.MethodsWe retrospectively reviewed 245 patients with malignant ovarian germ cell tumors (yolk sac tumor, dysgerminoma, and immature teratoma) and with clinically early-stage disease, who were treated at Sun Yat-sen University Cancer Center between January 1, 1970 and December 31, 2017. The survival of patients who underwent either omentectomy or lymphadenectomy, or both (omentectomy/lymphadenectomy group) was compared with that of patients who did not undergo omentectomy or lymphadenectomy (non-omentectomy/lymphadenectomy group).ResultsSixty patients were diagnosed with yolk sac tumor, 74 with dysgerminoma, and 111 with immature teratoma. Of these 245 patients, 216 patients had stage I disease, 28 patients had stage II, and 1 patient had stage IIIA. There were 190 patients who underwent omentectomy and/or lymphadenectomy and 55 patients in the non-omentectomy/lymphadenectomy group, respectively. In the omentectomy/lymphadenectomy group, 112 patients underwent both omentectomy and lymphadenectomy, 71 underwent omentectomy only, and 7 underwent lymphadenectomy only. Two hundred and fourteen of 245 patients (87.3%) received post-operative chemotherapy. Median follow-up was 73 months (range 1–388). The 10-year overall survival rates in the omentectomy/lymphadenectomy group and non-omentectomy/lymphadenectomy groups were 96.8% and 100%, respectively (p=0.340). Multivariate analysis evaluating all potential prognostic factors showed that omentectomy and lymphadenectomy are not prognostic factors for survival.ConclusionsOmentectomy and lymphadenectomy do not appear to improve survival and may be omitted in patients with clinically apparent early-stage malignant ovarian germ cell tumors.
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Thomakos N, Malakasis A, Machairiotis N, Zarogoulidis P, Rodolakis A. Fertility Sparing Management in Non-Epithelial Ovarian Cancer. Which Patients, What Procedure and What Outcome? J Cancer 2018; 9:4659-4664. [PMID: 30588250 PMCID: PMC6299391 DOI: 10.7150/jca.26674] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 09/15/2018] [Indexed: 12/18/2022] Open
Abstract
Non epithelial ovarian tumors represent a small group of rare gynecological cancers but they have a high incidence in young childbearing women. The recent years fertility preservation surgeries have become a common practice in specific ovarian malignancies when the patients wish to maintain their fertility. Specific types of non-epithelial ovarian tumors can be managed with fertility sparing operations with a similar outcome to more radical intervention but due to the rarity of these tumors the extent of the operation remains in some cases controversial. Moreover, the reproductive outcome of the women that had these conservative operations seems to be very promising. In our review we try to summarize the data regarding the fertility sparing management of all types of non-epithelial ovarian cancers and what procedure should be performed in each case. Finally we have accumulated the data concerning the reproductive outcome of patients that had undergone this type of surgery.
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Affiliation(s)
- Nikolaos Thomakos
- First Department of Obstetrics and Gynecology, Alexandra Hospital, Gynecologic Oncology Unit, University of Athens, Athens, Greece
| | - Anastasios Malakasis
- First Department of Obstetrics and Gynecology, Alexandra Hospital, Gynecologic Oncology Unit, University of Athens, Athens, Greece
| | - Nikolaos Machairiotis
- First Department of Obstetrics and Gynecology, Alexandra Hospital, Gynecologic Oncology Unit, University of Athens, Athens, Greece
| | - Paul Zarogoulidis
- 3rd Department of Surgery, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - Alexandros Rodolakis
- First Department of Obstetrics and Gynecology, Alexandra Hospital, Gynecologic Oncology Unit, University of Athens, Athens, Greece
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Ohara T, Yamanoi K, Inayama Y, Ogura J, Sakai M, Suzuki H, Hirayama T, Yasumoto K, Suginami K. Gliomatosis peritonei with 18F-fluorodeoxyglucose accumulation and contrast enhancement secondary to immature teratoma: A case report. Mol Clin Oncol 2018; 9:40-43. [DOI: 10.3892/mco.2018.1618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 04/27/2018] [Indexed: 12/22/2022] Open
Affiliation(s)
- Tsutomu Ohara
- Department of Obstetrics and Gynecology, Toyooka Public Hospital, Toyooka, Hyogo 668-8501, Japan
| | - Koji Yamanoi
- Department of Obstetrics and Gynecology, Toyooka Public Hospital, Toyooka, Hyogo 668-8501, Japan
| | - Yoshihide Inayama
- Department of Obstetrics and Gynecology, Toyooka Public Hospital, Toyooka, Hyogo 668-8501, Japan
| | - Jumpei Ogura
- Department of Obstetrics and Gynecology, Toyooka Public Hospital, Toyooka, Hyogo 668-8501, Japan
| | - Mie Sakai
- Department of Obstetrics and Gynecology, Toyooka Public Hospital, Toyooka, Hyogo 668-8501, Japan
| | - Haruka Suzuki
- Department of Obstetrics and Gynecology, Toyooka Public Hospital, Toyooka, Hyogo 668-8501, Japan
| | - Takahiro Hirayama
- Department of Obstetrics and Gynecology, Toyooka Public Hospital, Toyooka, Hyogo 668-8501, Japan
| | - Koji Yasumoto
- Department of Obstetrics and Gynecology, Toyooka Public Hospital, Toyooka, Hyogo 668-8501, Japan
| | - Ko Suginami
- Department of Obstetrics and Gynecology, Toyooka Public Hospital, Toyooka, Hyogo 668-8501, Japan
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Mangili G, Sigismondi C, Lorusso D, Cormio G, Candiani M, Scarfone G, Mascilini F, Gadducci A, Mosconi AM, Scollo P, Cassani C, Pignata S, Ferrandina G. The role of staging and adjuvant chemotherapy in stage I malignant ovarian germ cell tumors (MOGTs): the MITO-9 study. Ann Oncol 2017; 28:333-338. [PMID: 27803008 DOI: 10.1093/annonc/mdw563] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Surgery followed by platinum-based chemotherapy is the standard of care for MOGCTs, except for stage IA dysgerminoma and stage IA grade 1 immature teratoma where surveillance only is recommended. The role of adjuvant chemotherapy and surgical staging is debated. Patients and methods Data from 144 patients with stage I MOGTs were collected among MITO centers (Multicenter Italian Trials in Ovarian Cancer) and analyzed. Results Fifty-five (38.2%) patients were affected by dysgerminomas, 49 (34%) by immature teratomas, 26 (18.1%) by yolk sac tumors and 14 (9.7%) by mixed tumors. Seventy-three (50.7%) patients receive surgery plus chemotherapy, while 71 (49.3%) patients underwent surgery alone. The latter group included 32 dysgerminomas (14 IA-13 Ix, 3 IB, and 2 IC), 34 immature teratomas (20 1A-13 IA grade 1, 6 Ix, 1 IB, and 7 IC), 4 mixed tumors and 1 yolk sac tumor. Forty-four patients did not received chemotherapy, even if it would have been indicated by recommended approach. 94 (65.3%) patients received peritoneal surgical staging. Twenty-three (15.9%) developed a recurrence. Incomplete surgical staging was associated with recurrence (P < 0.05; OR 2.37) at Cox regression analysis. Seven patients died. Four patients were affected by yolk sac tumors, two by mixed tumors and one by immature teratoma. Five patients died for disease, one for acute leukemia and one for suicide. Prognostic parameter analyses showed that yolk sac component is a predictor for survival (P < 0.05). Five-years OS rates were 96.8% and 88.7% in the surgically staged and the incomplete staged group, respectively, while 93.8% and 94.1% in the standard treatment and in the surveillance group, respectively. Conclusions This study shows that surveillance seems not to affect survival; chemotherapy should be reserved for relapse resulting in high cure rate. Incomplete peritoneal surgical staging is associated with recurrence. Yolk sac histology worsens the prognosis.
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Affiliation(s)
- G Mangili
- Department of Gynecology and Obstetrics, I.R.C.C.S. San Raffaele Hospital, Milan
| | - C Sigismondi
- Department of Gynecology and Obstetrics, I.R.C.C.S. San Raffaele Hospital, Milan
| | - D Lorusso
- Department of Gynecologic Oncology, IRCCS Foundation National Cancer Institute, Milan
| | - G Cormio
- Department of Biomedical Science and Human Oncology, University of Bari, Bari I, Bari
| | - M Candiani
- Department of Gynecology and Obstetrics, I.R.C.C.S. San Raffaele Hospital, Milan
| | - G Scarfone
- Department of Obstetrics, Gynecology and Neonatology, IRCCS Fondazione Cà Granda, Ospedale Maggiore Policlinico, Milan
| | - F Mascilini
- Gynecology Oncology Unit, Foundation "PoliclinicoUniversitario A. Gemelli", Rome
| | - A Gadducci
- Division of Gynecology and Obstetrics, Department of Experimental and Clinical Medicine, University of Pisa, Pisa
| | - A M Mosconi
- Azienda Ospedaliera Universitaria Perugia, Perugia
| | - P Scollo
- Department of Obstetrics and Gynecology, Cannizzaro Hospital, Catania
| | - C Cassani
- Department of Obstetrics and Gynaecology Fondazione IRCCS Policlinico San Matteo-University of Pavia, Pavia
| | - S Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori "Fondazione G. Pascale" IRCCS, Naples
| | - G Ferrandina
- Department of Medicine and Health Science, University of Molise, Campobasso/Foundation, PoliclinicoUniversitario A. Gemelli, Rome, Italy
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Wang M, Jiang S, Zhang Y, Jiang C, Xia F, Lyu W, Ma X. The application of 18F-FDG PET/CT in ovarian immature teratomas when pathological examination results contradict clinical observations: a case report. Medicine (Baltimore) 2017; 96:e9171. [PMID: 29390326 PMCID: PMC5815738 DOI: 10.1097/md.0000000000009171] [Citation(s) in RCA: 7] [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] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) could reveal potential lymph node involvement and assisted locating sample sites for pathological examinations. PATIENT CONCERNS Help choose the right treatment strategies for patients. To better stage immature ovarian teratomas with 18F-FDG PET/CT when lymphatic metastasis is suspected while lymph node biopsy results are negative. DIAGNOSES The ultimate pathological diagnosis was left ovarian cancer, an immature teratoma (IMT) Grade 1. INTERVENTIONS Surgery was the initial treatment option. Chemotherapy (BEP scheme: Bleomycin 30 mg d1, 7 + Etoposide 100mg d1-6 + Cisplatin 50mg d1-3) was then administered. OUTCOMES The post-operational pathological examination additionally showed a small number of tumor cells in para-aortic lymph nodes. The end-of-treatment disclosed no recurrent tumors and serum levels of AFP (2.9 ng/mL), hCG (0.12 mIU/L), and CA-125 (11.4 IU/mL) were normal. LESSONS 18F-FDG PET/CT successfully detected lymphatic metastasis when lymph node biopsy results were negative, which would be of great significance in detecting metastasis and monitoring reoccurrence of ovarian immature teratomas.
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Affiliation(s)
- Manni Wang
- Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center
| | | | - Yiwen Zhang
- Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center
| | - Chong Jiang
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Fan Xia
- Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center
| | | | - Xuelei Ma
- Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center
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Outcomes of Surgery Alone and Surveillance Strategy in Young Women With Stage I Malignant Ovarian Germ Cell Tumors. Int J Gynecol Cancer 2017; 26:859-64. [PMID: 27101582 DOI: 10.1097/igc.0000000000000702] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES This study aimed to evaluate the safety of surgery alone followed by surveillance in young women with stage I malignant ovarian germ cell tumor (MOGCT). METHODS A retrospective review was performed on 31 patients with stage I MOGCT who were treated by surgery alone with follow-up. RESULTS The median patient age was 22 years (range, 6-45 years). The histological type was dysgerminoma in 17, immature teratoma in 11, yolk sac tumor in 1, and mixed MOGCT in 2 cases. Seventeen patients were stage IA, 1 was IB, and 13 were IC. All patients underwent fertility-sparing surgery, which involved either unilateral salpingo-oophorectomy or oophorectomy. Additionally, 12 (38.7%) patients underwent cystectomy of the contralateral ovary, but only 1 patient had MOGCT in the contralateral ovary. Twenty (65%) patients underwent a complete staging operation that included peritoneal exploration, biopsy, cytology, and/or omentectomy or omental biopsy; 7 (22.6%) patients who underwent pelvic and para-aortic lymphadenectomy. After a median follow-up time of 137 months (range, 24-268 months), 7 (22.6%) patients had recurrent disease, and underwent secondary surgery followed by chemotherapy with bleomycin, etoposide, and cisplatin (BEP). Six (86%) patients were successfully salvaged, but 1 died of disease progression. The 10-year disease-free survival rate was 77%, but the 10-year overall survival rate was 97%. CONCLUSIONS Fertility-sparing surgery alone with surveillance could be a safe treatment strategy. Most recurrence can be successfully salvaged by surgery and BEP chemotherapy and the overall survival is not compromised. Using this strategy, 77.4% of patients may avoid unnecessary BEP chemotherapy.
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Abstract
The question of giving or not adjuvant chemotherapy in pure ovarian immature teratomas (ITs) remains unsolved to date and illustrates differences in management between pediatric and adults oncologists. Because of the rarity of these tumors, this question has never been addressed through randomized trials. Standard of care for adult women with ovarian ITs is postoperative platinum based chemotherapy for all patients except FIGO stage IA, grade 1 tumors, whereas pediatric series concluded that surgery alone is curative for completely resected ovarian ITs, regardless of grade. Moreover the role of chemotherapy in incompletely resected tumors and its impact on the rate of malignant relapses needs to be better assessed. This emphasizes the urgent need for cooperation between adult and pediatric teams.
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Leary AF, Quinn M, Fujiwara K, Coleman RL, Kohn E, Sugiyama T, Glasspool R, Ray-Coquard I, Colombo N, Bacon M, Zeimet A, Westermann A, Gomez-Garcia E, Provencher D, Welch S, Small W, Millan D, Okamoto A, Stuart G, Ochiai K. Fifth Ovarian Cancer Consensus Conference of the Gynecologic Cancer InterGroup (GCIG): clinical trial design for rare ovarian tumours. Ann Oncol 2017; 28:718-726. [PMID: 27993794 PMCID: PMC6246130 DOI: 10.1093/annonc/mdw662] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
This manuscript reports the consensus statements on designing clinical trials in rare ovarian tumours reached at the fifth Ovarian Cancer Consensus Conference (OCCC) held in Tokyo, November 2015. Three important questions were identified concerning rare ovarian tumours (rare epithelial ovarian cancers (eOC), sex-cord stromal tumours (SCST) and germ cell tumours (GCT)): (i) What are the research and trial issues that are unique to rare ovarian tumours? There is a lack of randomised phase III data defining standards of care which makes it difficult to define control arms, but identifies unmet needs that merit investigation. Internationally agreed upon diagnostic criteria, expert pathological review and translational research are crucial. (ii) What should be investigated in rare eOC, GCT and SCST? Trials dedicated to each rare ovarian tumour should be encouraged. Nonetheless, where the question is relevant, rare eOC can be included in eOC trials but with rigorous stratification. Although there is emerging evidence suggesting that rare eOC have different molecular profiles, trials are needed to define new type-specific standards for each rare eOC (clear cell, low grade serous and mucinous). For GCTs, a priority is reducing toxicities from treatment while maintaining cure rates. Both a robust prognostic scoring system and more effective treatments for de novo poor prognosis and relapsed GCTs are needed. For SCSTs, validated prognostic markers as well as alternatives to the current standard of bleomycin/etoposide/cisplatin (BEP) should be identified. (iii) Are randomised trials feasible? Randomised controlled trials (RCT) should be feasible in any of the rare tumours through international collaboration. Ongoing trials have already demonstrated the feasibility of RCT in rare eOC and SCST. Mucinous OC may be considered for inclusion, stratified, into RCTs of non-gynaecological mucinous tumours, while RCTs in high risk or relapsed GCT may be carried out as a subset of male and/or paediatric germ cell studies.
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Affiliation(s)
- A F Leary
- INSERM U981 Gynaecological Tumours, Gustave Roussy Cancer Center, Villejuif, France
| | - M Quinn
- ANZGOG Coordinating Centre, NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | | | | | - E Kohn
- National Cancer Institute, Bethesda, MD, USA
| | | | | | - I Ray-Coquard
- INSERM U981 Gynaecological Tumours, Gustave Roussy Cancer Center, Villejuif, France
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Zhao T, Liu Y, Wang X, Zhang H, Lu Y. Ovarian cystectomy in the treatment of apparent early-stage immature teratoma. J Int Med Res 2017; 45:771-780. [PMID: 28415950 PMCID: PMC5536676 DOI: 10.1177/0300060517692149] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objective To investigate the role of ovarian cystectomy in patients with early-stage immature teratoma. Methods A retrospective review was undertaken on patients diagnosed pathologically with immature teratoma and with malignant lesions confined to the ovary. Patients were included if they had been treated between January 1997 and December 2015 at the Obstetrics and Gynaecology Hospital of Fudan University, Shanghai, China. Relevant demographic and clinical data were retrieved from the medical records. Results Forty-three patients were included in the study; 14 underwent ovarian cystectomy (group 1) and 29 underwent unilateral salpingo-oophorectomy (USO; group 2). Three of the patients who underwent USO relapsed and required a second surgical intervention. The 5-year disease-free survival rates were 100% and 88%for groups 1 and 2, respectively. There were no significant differences between the two groups in terms of survival or postoperative fertility outcomes. Univariate and multivariate analysis further revealed that ovarian cystectomy was not a poor prognostic indicator for disease-free survival. Conclusion These current data suggest that ovarian cystectomy can be considered for patients with apparent early-stage immature teratoma as it preserves fertility as much as possible without adversely impacting upon survival.
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Affiliation(s)
- Ting Zhao
- 1 Department of Gynaecology, Obstetrics and Gynaecology Hospital of Fudan University, Shanghai, China
| | - Yan Liu
- 1 Department of Gynaecology, Obstetrics and Gynaecology Hospital of Fudan University, Shanghai, China
| | - Xiao Wang
- 1 Department of Gynaecology, Obstetrics and Gynaecology Hospital of Fudan University, Shanghai, China
| | - Hao Zhang
- 2 Department of Pathology, Obstetrics and Gynaecology Hospital of Fudan University, Shanghai, China
| | - Yuan Lu
- 1 Department of Gynaecology, Obstetrics and Gynaecology Hospital of Fudan University, Shanghai, China
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Mandilaras V, Karakasis K, Clarke B, Oza A, Lheureux S. Rare tumors in gynaecological cancers and the lack of therapeutic options and clinical trials. Expert Opin Orphan Drugs 2016. [DOI: 10.1080/21678707.2017.1264300] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Victoria Mandilaras
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Katherine Karakasis
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Blaise Clarke
- Department of Pathology and Laboratory Medicine, University Health Network, Toronto, Canada
| | - Amit Oza
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Stephanie Lheureux
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
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Conundrums in the management of malignant ovarian germ cell tumors: Toward lessening acute morbidity and late effects of treatment. Gynecol Oncol 2016; 143:428-432. [PMID: 27569583 DOI: 10.1016/j.ygyno.2016.08.329] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 08/17/2016] [Accepted: 08/22/2016] [Indexed: 11/20/2022]
Abstract
One of the most extraordinary stories in the chronicles of gynecologic cancers has been that of malignant ovarian germ cell tumors. Prior to the mid-1960s, most patients died of disease. Fifty years later, most survive. Precisely because high cure rates are achievable, the concentration over the past decade has been on minimizing toxicity and late effects. The present review focuses on five areas of interest related to the management of malignant ovarian germ cell tumors that highlight the different therapeutic strategies practiced by pediatric and gynecologic oncologists: 1) primary surgery, 2) surgery alone (surveillance) for patients with FIGO stage IA disease, 3) postoperative management of FIGO stage IC-III disease, 4) postoperative management of pure immature teratoma, and 5) postoperative management of metastatic pure dysgerminoma. All of these topics share a common overarching theme: Lessening acute morbidity and late effects of treatment.
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Pure Immature Teratoma of the Ovary in Adults: Thirty-Year Experience of a Single Tertiary Care Center. Int J Gynecol Cancer 2016; 25:1616-22. [PMID: 26332392 PMCID: PMC4623850 DOI: 10.1097/igc.0000000000000541] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The aim of this study was to evaluate clinicopathologic characteristics, treatment outcome, and reproductive function in women diagnosed with ovarian immature teratoma (IT). Our standard chemotherapy regime is currently etoposide/cisplatin (EP), creating a unique opportunity to evaluate this protocol in ovarian ITs.
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The influence of age and other prognostic factors associated with survival of ovarian immature teratoma - A study of 1307 patients. Gynecol Oncol 2016; 142:446-51. [PMID: 27423379 DOI: 10.1016/j.ygyno.2016.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 06/25/2016] [Accepted: 07/01/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine impact of age and other prognostic factors on the survival of ovarian immature teratoma (IT) patients. METHODS Data obtained from the SEER database between 1973 and 2012. Kaplan-Meier methods and multivariate Cox regression models were used for statistical analyses. RESULTS Of 1307 patients (median: 24years; range: 0-93), 78%, 5%, 13%, 4% were stages I, II, III and IV, respectively. 25%, 35%, and 40% had grades 1, 2, and 3. Whites were less likely to be diagnosed, and Asians had a nearly 3-fold higher proportion of IT compared to the proportion of Asians in the U.S. census. The 5-year disease-specific survival (DSS) was 91.2%. Those with stages I, II, III and IV disease had survivals of 99.7%, 95%, 81%, and 71.8% (p<0.001) and grades 1, 2, and 3 had DSS of 98.7%, 95.8%, and 91% (p<0.001), respectively. Of those who underwent fertility-preserving surgery, the DSS was 98.8%. Over time from 1973 to 1986, to 1987-1999, to 2000-2012, the survivals were 76.4%, 92.8%, and 94.7% (p<0.001). Of stage I patients, no patient <18years (n=214, used as adult cutoff) and 2 of 283 patients >18years died of cancer, with corresponding 5years DSS of 100% vs. 99.6% (p>0.05). Older age (by year, HR: 1.05; 95% CI: 1.04-1.06; p<0.0001) and higher stage (HR: 11.52; 95% CI: 4.08-32.48; p<0.0001) were independent factors indicating poorer survival. CONCLUSION The outcome of patients with stage I disease was excellent at 99.7%, with children and adults having corresponding survivals of 100% and 99.6%.
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Feichtinger M, Rodriguez-Wallberg KA. Fertility preservation in women with cervical, endometrial or ovarian cancers. GYNECOLOGIC ONCOLOGY RESEARCH AND PRACTICE 2016; 3:8. [PMID: 27468354 PMCID: PMC4962474 DOI: 10.1186/s40661-016-0029-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 07/06/2016] [Indexed: 12/19/2022]
Abstract
Background Although cancer in general affects an aged population, a significant number of women develop cancer at childbearing age. Long-term survival rates after gynecological cancer, especially in young patients are increasing and all quality-of-life aspects, including preservation of fertility have become of major relevance. Outcomes Surgical techniques aimed at sparing reproductive organs and preserving fertility have been developed for women presenting with gynecological cancer found at early stages. Indications for fertility-sparing surgery are in general restricted to women presenting with a well-differentiated low-grade tumor in its early stages or with low malignant potential. Up to now, use of fertility-sparing techniques in well-selected patients has not been shown to affect overall survival negatively and fertility outcomes reported have been favorable. Still larger amounts of data and longer follow-up periods are needed. Several current fertility-sparing cancer treatments may result in sub-fertility and in those cases assisted reproductive techniques are indicated. Overall quality of life has been satisfactory in cancer patients after fertility-sparing surgery. Conclusions Fertility-sparing surgery is a viable tool to enable gynecological cancer patients of young age to fulfill their family building without impairment of oncological outcome. Cancer patients of reproductive age should undergo fertility counseling to analyze this sensitive subject. Further studies are needed to investigate the role of fertility-sparing treatment and combined adjuvant therapy in higher-grade cancers.
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Affiliation(s)
- Michael Feichtinger
- Department of Obstetrics and Gynecology, Division of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna, Austria ; Wunschbaby Institut Feichtinger, Vienna, Austria ; Department of Obstetrics and Gynecology, Section of Reproductive Medicine, Karolinska University Hospital, Novumhuset Plan 4, SE-141 86 Stockholm, Sweden
| | - Kenny A Rodriguez-Wallberg
- Department of Oncology - Pathology, Karolinska Institutet, Stockholm, Sweden ; Department of Obstetrics and Gynecology, Section of Reproductive Medicine, Karolinska University Hospital, Novumhuset Plan 4, SE-141 86 Stockholm, Sweden
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Park JY, Kim DY, Suh DS, Kim JH, Kim YM, Kim YT, Nam JH. Significance of the Complete Surgical Staging of Stage I Malignant Ovarian Germ Cell Tumors. Ann Surg Oncol 2016; 23:2982-7. [DOI: 10.1245/s10434-016-5234-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Indexed: 11/18/2022]
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Pashankar F, Hale JP, Dang H, Krailo M, Brady WE, Rodriguez-Galindo C, Nicholson JC, Murray MJ, Bilmire DF, Stoneham S, Arul GS, Olson TA, Stark D, Shaikh F, Amatruda JF, Covens A, Gershenson DM, Frazier AL. Is adjuvant chemotherapy indicated in ovarian immature teratomas? A combined data analysis from the Malignant Germ Cell Tumor International Collaborative. Cancer 2016; 122:230-7. [PMID: 26485622 PMCID: PMC5134834 DOI: 10.1002/cncr.29732] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 08/09/2015] [Accepted: 08/11/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND There is a debate regarding the management of ovarian immature teratomas (ITs). In adult women, postoperative chemotherapy is standard except for stage I, grade 1 disease, whereas surgery alone is standard in pediatric patients. To determine the role of chemotherapy, a pooled analysis of pediatric and adult clinical trials was conducted. METHODS Data from 7 pediatric trials and 2 adult trials were merged in the Malignant Germ Cell International Collaborative data set. Four trials included patients with newly diagnosed pure ovarian ITs and were selected (Pediatric Oncology Group/Children's Cancer Group Intergroup Study (INT 0106), Second UKCCSG Germ Cell Tumor Study (GC2), Gynecologic Oncology Group (GOG 0078 and GOG 0090). Adult and pediatric trials were analyzed separately. The primary outcome measures were event-free survival (EFS) and overall survival (OS). RESULTS One hundred seventy-nine patients were included (98 pediatric patients and 81 adult patients). Ninety pediatric patients were treated with surgery alone, whereas all adult patients received chemotherapy. The 5-year EFS and OS were 91% and 99%, respectively, for the pediatric cohort and 87% and 93%, respectively, for the adults. There were no relapses in grade 1 patients, regardless of the stage or age. Only 1 adult patient with a grade 2 IT relapsed. Among grade 3 patients, the 5-year EFS was 0.92 (0.72-0.98) for stage I/II and 0.52 (0.22-0.75) for stage III in the pediatric cohort (P = .005) and 0.91 (0.69-0.98) for stage I/II and 0.65 (0.39-0.83) for stage III/IV in the adult cohort (P = .01). Postoperative chemotherapy did not decrease relapses in the pediatric cohort. CONCLUSIONS The grade was the most important risk factor for relapse in ovarian ITs. Among grade 3 patients, the stage was significantly associated with relapse. Adjuvant chemotherapy did not decrease relapses in the pediatric cohort; its role in adults remains unresolved. Cancer 2016;122:230-237. © 2015 American Cancer Society.
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Affiliation(s)
| | - Juliet P. Hale
- Department of Paediatric Oncology, Royal Victoria Infirmary, Newcastle Upon Tyne Hospitals Trust, Newcastle Upon Tyne, United Kingdom
| | - Ha Dang
- Children’s Oncology Group, Monrovia, California
| | - Mark Krailo
- University of Southern California, Los Angeles, California
| | - William E. Brady
- Gynecologic Oncology Group Statistics and Data Center, Roswell Park Cancer Institute, Buffalo, New York
| | | | - James C. Nicholson
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Matthew J. Murray
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | | | - Sara Stoneham
- Children’s and Young Persons Cancer Services, University College London Hospital Trusts, London, United Kingdom
| | - G. Suren Arul
- Birmingham Children’s Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | - Thomas A. Olson
- Aflac Cancer Center, Children’s Healthcare of Atlanta, Emory University, Atlanta, Georgia
| | - Daniel Stark
- Leeds Institute of Cancer Studies and Pathology, Leeds Institute of Oncology and St. James’s University Hospital, Leeds, United Kingdom
| | | | - James F. Amatruda
- University of Texas Southwestern Medical Center, Dallas, Texas,Children’s Medical Center, Dallas, Texas
| | | | | | - A. Lindsay Frazier
- Dana-Farber Cancer Institute and Boston Children’s Hospital, Boston, Massachusetts
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Hurteau JA, Febbraro T. Germ cell tumors: Treatment consensus across all age groups through MaGIC [MalignantGerm CellInternationalCollaborative]. Cancer 2015; 122:181-3. [DOI: 10.1002/cncr.29729] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 09/17/2015] [Accepted: 09/21/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Jean A. Hurteau
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology; NorthShore University HealthSystem, Evanston Hospital; Evanston Illinois
- Clinical Professor, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Pritzker School of Medicine; University of Chicago; Chicago Illinois
| | - Terri Febbraro
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology; NorthShore University HealthSystem, Evanston Hospital; Evanston Illinois
- Fellow, Division of Gynecologic Oncology, Department of Obstrectics and Gynecolcolgy; University of Chicago Pritzker School of Medicine; Chicago Illinois
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Management of bilateral malignant ovarian germ cell tumors: a MITO-9 retrospective study. Int J Gynecol Cancer 2015; 25:203-7. [PMID: 25569816 DOI: 10.1097/igc.0000000000000358] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Bilaterality is rare in malignant ovarian germ cell tumors (MOGTs). The bilateral ovarian involvement represents a critical issue when diagnosed in young women desiring to preserve fertility. The aim of this study was to evaluate clinical characteristic and management of patients bilateral MOGTs. METHODS Patients affected by bilateral MOGT and treated at MITO group centers were reviewed. RESULTS In 145 patients with MOGTs, 5.5% were bilateral. Three patients were affected by dysgerminoma (associated with bilateral gonadoblastoma in 1), 2 by immature teratoma, 2 by mixed germ cell tumors, and 1 by embryonal carcinoma. International Federation of Gynecology and Obstetrics stage was 3 IB, 1 IC, 3 IIIC, and 1 IV. Three patients received radical surgery, and the patient with dysgerminoma associated with gonadoblastoma received bilateral adnexectomy. Four patients received fertility-sparing surgery; 2 patients received unilateral salpingo-oophorectomy and contralateral cystectomy; in 2 patients, the ovaries were completely transformed in neoplastic tissue; suspecting a contralateral dysgerminoma histology, a unilateral salpingo-oophorectomy and contralateral biopsy were performed, and the contralateral neoplastic ovary was left unresected. Six patients received adjuvant chemotherapy. Seven patients are disease free after a median follow-up of 54 months. The patient affected by embryonal carcinoma died of disease. Two patients resumed menstruation, and one had a pregnancy. A compromised ovarian function was found in 2 patients, and they were addressed to oocyte cryopreservation. CONCLUSIONS Bilateral MOGTs have a good prognosis. In dysgerminoma histology, residual disease could be left to spare fertility. An oncological and reproductive function follow-up is recommended.
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Reddihalli PV, Subbian A, Umadevi K, Rathod PS, Krishnappa S, Nanaiah SP, Bafna UD. Immature teratoma of ovary--outcome following primary and secondary surgery: study of a single institution cohort. Eur J Obstet Gynecol Reprod Biol 2015; 192:17-21. [PMID: 26142911 DOI: 10.1016/j.ejogrb.2015.06.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Revised: 06/15/2015] [Accepted: 06/16/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To analyse the clinical presentation, treatment - primary and secondary debulking and outcomes with focus on recurrences in ovarian immature teratoma. STUDY DESIGN This is a single institution, retrospective analysis of 24 women who presented to a gynecologic oncology unit from 1999 to 2011 with ovarian immature teratoma. Patient's clinical presentation, operative and chemotherapy details were included in a database. Follow up details regarding recurrence and management and future outcomes were also noted. Overall survival was calculated from the date of registration to last follow up or date of death. Survival curve was constructed by Kaplan-Meier method. RESULTS Immature teratoma accounted for 11% of 218 malignant germ cell tumors. Of the 24 patients, pain was the predominant symptom and abdominal mass was the commonest clinical presentation. Sixteen out of 24 patients presented in Stage I and grade 3 tumors were found in 43% of patients. Six patients had only unilateral salpingo oophorectomy and no staging procedure. Twelve patients underwent staging, with omentectomy being the commonest procedure. All but one, had cisplatin based combination chemotherapy. Six patients underwent secondary debulking of recurrence. Most recurrences were recorded in Stage III, higher grade tumors. With secondary cytoreduction and platinum based chemotherapy, it was possible to salvage most recurrences as well. Overall survival after a mean follow-up of 39 months was 91.6%. CONCLUSION Majority of the patients did well with conservative surgery in terms of survival, menstrual and reproductive function. Platinum based chemotherapy was indicated in higher grade and higher stage tumors as recurrences commonly occurred in this subgroup of patients. Recurrences could be salvaged with selected secondary cytoreduction and platinum based chemotherapy.
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Affiliation(s)
- Pallavi V Reddihalli
- Department of Gynecologic Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - Anbukkani Subbian
- Department of Gynecologic Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India.
| | - K Umadevi
- Department of Gynecologic Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - Praveen S Rathod
- Department of Gynecologic Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - Shobha Krishnappa
- Department of Gynecologic Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - Shakuntala P Nanaiah
- Department of Gynecologic Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - Uttam D Bafna
- Department of Gynecologic Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
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Mangili G, Sigismondi C, Lorusso D, Pignata S. Surveillance Policy for Stage IA Malignant Ovarian Germ Cell Tumors in Children and Young Adults. J Clin Oncol 2014; 32:2814-5. [DOI: 10.1200/jco.2014.55.9617] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Giorgia Mangili
- Istituto Di Ricovero e Cura a Carattere Scientifico, San Raffaele Hospital, Milan, Italy
| | - Cristina Sigismondi
- Istituto Di Ricovero e Cura a Carattere Scientifico, San Raffaele Hospital, Milan, Italy
| | - Domenica Lorusso
- Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico, National Cancer Institute, Milan, Italy
| | - Sandro Pignata
- Istituto Nazionale Tumori Fondazione G. Pascale, Istituto Di Ricovero e Cura a Carattere Scientifico, Naples, Italy
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Gadducci A, Lanfredini N, Tana R. Menstrual function and childbearing potential after fertility-sparing surgery and platinum-based chemotherapy for malignant ovarian germ cell tumours. Gynecol Endocrinol 2014; 30:467-71. [PMID: 24702194 DOI: 10.3109/09513590.2014.907262] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Malignant ovarian germ cell tumours (MOGCT) account for 5% of all ovarian malignancies. Their elevated chemosensitivity, the frequent unilaterality and the young age of patients have strongly supported the conservative surgery as the standard approach, often followed by adjuvant platinum-based chemotherapy. The risk for recurrence is not affected by the performance of conservative versus radical surgery. During chemotherapy 50% of patients become amenorrhoeic but more than 95% of them resume normal menses after treatment completion. Literature has reported several healthy babies born after fertility-sparing surgery with or without chemotherapy for MOGCT. The incidence of miscarriages is in the normal range, whereas malformation rate is slightly higher compared to general population, without any difference between chemotherapy-treated and -untreated patients. Therefore, young women with MOGCT must be reassured of their excellent chances of survival and fertility preservation following conservative surgery and adjuvant platinum-based chemotherapy.
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Affiliation(s)
- Angiolo Gadducci
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa , Pisa , Italy
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Saber MM, Zeeneldin AA, El Gammal MM, Salem SE, Darweesh AD, Abdelaziz AA, Monir M. Treatment outcomes of female germ cell tumors: the Egyptian National Cancer Institute experience. J Egypt Natl Canc Inst 2014; 26:103-8. [PMID: 24841162 DOI: 10.1016/j.jnci.2014.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 03/05/2014] [Accepted: 03/06/2014] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION Female germ cell tumors (GCTS) are rare tumors that carry a good prognosis. AIM To report the experience of the Egyptian National Cancer Institute (ENCI) in managing female GCTs. METHODS This retrospective study included 19 females with ovarian GCTs presenting to the ENCI between 2006 and 2010. RESULTS The median age was 23years. Ovaries were the primary site in all patients. Dysgerminoma and teratoma were the predominant pathologies followed by mixed GCT in females. Unilateral ovariectomy or ovarian tumorectomy were the classic surgical procedures with R0 resection being feasible in most cases. Surveillance was adopted in six patients with stage I disease. Chemotherapy was administered in 63% of ovarian GCTs with BEP being the commonest regimen with reasonable tolerability and good response rates. The median OS and EFS were not reached. The projected 5-year OS rate was 93.8%. Both OS and EFS were better in patients responding to chemotherapy than non-responders (p<0.002). Stage of disease did not significantly affect OS or EFS. CONCLUSIONS Female GCTs rarely affect Egyptian females. They have good prognosis.
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Affiliation(s)
- Magdy M Saber
- Medical Oncology Department, NCI, Cairo University, Egypt
| | | | | | - Salem E Salem
- Medical Oncology Department, NCI, Cairo University, Egypt
| | | | | | - Manar Monir
- Department of Medical Statics, NCI, Cairo University, Egypt
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Ertas IE, Taskin S, Goklu R, Bilgin M, Goc G, Yildirim Y, Ortac F. Long-term oncological and reproductive outcomes of fertility-sparing cytoreductive surgery in females aged 25 years and younger with malignant ovarian germ cell tumors. J Obstet Gynaecol Res 2013; 40:797-805. [PMID: 24320102 DOI: 10.1111/jog.12253] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 07/28/2013] [Indexed: 11/29/2022]
Abstract
AIM To evaluate the long-term oncological and reproductive outcomes of patients aged 25 years and younger who were treated by fertility-sparing cytoreductive surgery (FSCS) plus adjuvant chemotherapy (ACT) or observation alone for malignant ovarian germ cell tumors (MOGCT). METHODS Records of 42 eligible female patients treated for MOGCT between 1 May 1995 and 31 December 2010 at two centers were analyzed retrospectively. A telephone questionnaire was performed to gather reproductive and menstrual history. RESULTS One patient was treated without FSCS and two patients were lost to follow-up. The mean age of the remaining 39 patients was 18.4 ± 3.2 years. Eighteen of the tumors were histologically pure dysgerminomas (PD) and 21 were non-dysgerminomatous tumors (non-DT). Thirteen patients (33%) presented with stage II-III disease. Optimal cytoreduction was achieved in 34 of the 39 patients (87%). Systematic pelvic and para-aortic lymphadenectomy was performed in 31 of the 39 patients (79.5%). The frequency of lymph node metastasis was 29% (9/31). Twenty-seven patients (69.2%) received ACT. Disease recurred in six (15.3%) patients, all in the non-DT group. Four of six underwent secondary optimal FSCS followed by chemotherapy. Retroperitoneal nodal recurrence was detected in two of these four patients (50%). Four deaths occurred, three due to chemoresistant aggressive disease and one due to secondary acute myelocytic leukemia. The overall survival rates for patients with PD and non-DT were 100% and 81.4%, respectively. Twenty-three of 27 patients who received ACT continued their regular menses. Sixteen spontaneous pregnancies and one pregnancy by intrauterine insemination were achieved by 21 patients who attempted conception. CONCLUSION Either primary or secondary FSCS followed by ACT seems to be a feasible and safe approach to preserving future fertility and hormonal function in young patients with MOGCT.
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Affiliation(s)
- Ibrahim Egemen Ertas
- Department of Gynecologic Oncology, Tepecik Education and Research Hospital, Izmir, Turkey
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Malignant ovarian germ cell tumors: presentation, survival and second cancer in a population based Norwegian cohort (1953-2009). Gynecol Oncol 2013; 131:330-5. [PMID: 24001518 DOI: 10.1016/j.ygyno.2013.08.028] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 08/23/2013] [Accepted: 08/25/2013] [Indexed: 11/20/2022]
Abstract
PURPOSE To quantify and compare survival in women with malignant ovarian germ cell tumors (MOGCTs) in Norway before and after the introduction of cisplatin-based chemotherapy (around 1980), and to explore the association between different types of treatment and the development of a second cancer. PATIENTS AND METHODS We identified 351 patients diagnosed with MOGCTs from 1953 to 2009 in the Cancer Registry of Norway. Ovarian cancer-specific survival was calculated separately for patients diagnosed before and after 1980. Patients were divided into subgroups by histological subtype (pure dysgerminoma, malignant teratoma, other MOGCTs) and extent of disease (localized and metastatic). We estimated the cumulative incidence of a second cancer in 10-year MOGCT survivors. Kaplan-Meier estimates were used, and p<0.05 was considered significant. RESULTS 20-Year ovarian cancer-specific survival increased from 59% (95% CI 51% to 66%) before 1980 to 88% (95% CI 83%-93%) thereafter. Significant improvement was observed in all subgroups. No second cancer was diagnosed in any of 31 10-year MOGCT survivors treated with surgery only; second cancer was diagnosed in 23 of 139 patients who underwent cytotoxic treatment (98 radiotherapy ± chemotherapy, 41 chemotherapy only; p=0.08). Patients aged >50 years had a significantly poorer ovarian cancer-specific survival than younger patients (HR=5.98, 95% CI 3.39-10.57) after adjustment for histological subtype and stage at presentation. Our results favor the treatment of patients with metastatic MOGCTs at large cancer centers. CONCLUSION Today women with MOGCTs have an excellent prognosis if treated according to modern therapeutic principles.
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Colombo N, Peiretti M, Garbi A, Carinelli S, Marini C, Sessa C. Non-epithelial ovarian cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2012; 23 Suppl 7:vii20-6. [DOI: 10.1093/annonc/mds223] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Resende Barbosa LC, Coldibelli Francisco AM, Vieira Archângelo SDC, Moreira Soares FC, Tessari Ferreira MC, Maia RL. Bilateral immature ovarian teratoma in a 12-year-old girl: case report. Rev Assoc Med Bras (1992) 2012. [DOI: 10.1016/s0104-4230(12)70172-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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