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Abstract
PURPOSE OF REVIEW Sex cord-stromal tumours (SCSTs) are rare ovarian cancers. As in the literature, only small case series or case reports are published, gathering solid evidence about their management is challenging. Surgery plays a pivotal role, and accurate staging is one of the most important prognostic factors. This review focuses on the current evidence for surgical staging in the management of SCSTs. RECENT FINDINGS Staging procedures have been inferred by epithelial ovarian cancers; however, they are often only partially performed, and most SCSTs therefore end up incompletely staged, raising the issue of the need for restaging or further treatments. In addition, some parts of the staging procedure have been questioned over the years, and lymphadenectomy is now considered unnecessary for SCSTs.The generally favourable prognosis of SCSTs, the introduction of minimally invasive surgery and fertility-sparing approaches is empowering the question of which staging procedures are beneficial for these patients. We reviewed the role of each staging procedure proposed by the guidelines in light of new scientific updates. SUMMARY Surgical staging should always be performed. It includes peritoneal samplings (peritoneal washing, multiple peritoneal biopsies, omental biopsy and biopsy of any suspicious area), whereas lymphadenectomy could be omitted. Laparoscopy may be considered a feasible approach.
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Bergamini A, Ferrandina G, Candotti G, Taccagni G, Scarfone G, Bocciolone L, Cassani C, Marinaccio M, Pignata S, Candiani M, Mangili G. Stage I juvenile granulosa cell tumors of the ovary: A multicentre analysis from the MITO-9 study. Eur J Surg Oncol 2021; 47:1705-1709. [PMID: 33583630 DOI: 10.1016/j.ejso.2021.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/29/2021] [Accepted: 02/03/2021] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Juvenile type granulosa cell tumor (JGCTs) are extremely rare, mainly diagnosed in young women and pre-pubertal girls at stage I disease. Literature is scanty and guidelines regarding the optimal management are still controversial. The aim of this study is to add on the experience of the MITO group (Multicenter Italian Trials in Ovarian Cancer). METHODS Clinicopathological data from patients with stage I JGCTs were retrospectively collected. Descriptive statistics were used to characterize the patient population. Clinicopathological features and treatment variables were evaluated for association with relapse. RESULTS Seventeen patients were identified. Surgical approach was laparoscopic and open for 7 (41%) and 10 (59%) patients, respectively. Fertility sparing surgery (FSS) was performed in 15 patients (88%): unilateral salpingo-oophorectomy (USO) in 11 patients, cystectomy with subsequent USO in 2 patients and cystectomy alone in the remaining 2. Adjuvant chemotherapy was given in 2 cases. After a median follow up time of 80 months, no recurrences were registered. CONCLUSIONS Given the available data, minimally invasive surgery is safe in stage I JGCTs. Because of the good prognosis and of the young age of patients, FSS can be chosen in most of the cases. The role of cystectomy deserves further validation. The need of adjuvant chemotherapy in stage I disease is still unclear, even if available data does not seem to support treatment over surveillance.
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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.
| | - 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
| | - Giorgio Candotti
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Milan, Italy; Università Vita Salute San Raffaele, Milan, Italy
| | - Gianluca Taccagni
- Department of Surgical Pathology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Giovanna Scarfone
- Department of Obstetrics, Gynecology, and Neonatology, University of Milan, Ospedale Maggiore Policlinico, Milan, Italy
| | - Luca Bocciolone
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Chiara Cassani
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo, Pavia, Italy
| | - Marco Marinaccio
- Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncological Science (DIMO), University of Bari, Bari, Italy
| | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, 80138 Naples, Italy
| | - Massimo Candiani
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Milan, Italy; Università Vita Salute San Raffaele, Milan, Italy
| | - Giorgia Mangili
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Milan, Italy
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Bergamini A, Ferrandina G, Candiani M, Cormio G, Giorda G, Lauria R, Perrone AM, Scarfone G, Breda E, Savarese A, Frigerio L, Gadducci A, Mascilini F, Maneschi F, Cassani C, Marchetti C, Cecere SC, Biglia N, De Giorgi U, Raspagliesi F, Lorusso D, Mangili G. Laparoscopic surgery in the treatment of stage I adult granulosa cells tumors of the ovary: Results from the MITO-9 study. Eur J Surg Oncol 2018; 44:766-770. [PMID: 29576462 DOI: 10.1016/j.ejso.2018.03.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 02/16/2018] [Accepted: 03/05/2018] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Surgery represents the mainstay of treatment of stage I adult type granulosa cell tumors of the ovary (AGCTs). Because of the rarity and indolent course of the disease, no prospective trials are available. Open surgery has long been considered the traditional approach; oncological safety of laparoscopy is only supported by small series or case reports. The aim of this study was to compare the oncological outcomes between laparoscopic and open surgery in stage I AGCTs treated within the MITO (Multicenter Italian Trials in Ovarian cancer) Group. METHODS Data from patients with stage I AGCTs were retrospectively collected. Clinicopathological features were evaluated for association with relapse and death. Survival curves were calculated using the Kaplan-Meier method and compared with the log-rank test. The role of clinicopathological variables as prognostic factors for survival was evaluated using Cox's regression model. RESULTS 223 patients were identified. Stage 1A, 1B and 1C were 61.5%, 1.3% and 29.6% respectively. 7.6% were apparently stage I. Surgical approach was laparoscopic for 93 patients (41.7%) and open for 130 (58.3%). 5-years DFS was 84% and 82%, 10-years DFS was 68% and 64% for the laparoscopic and open-group (p = 0.6).5-years OS was 100% and 99%, 10 years OS was 98% and 97% for the laparoscopic and open-surgery group (p = 0.8). At multivariate analyses stage IC, incomplete staging, site of primary surgery retained significant prognostic value. CONCLUSION The present study suggests that surgical route does not affect the oncological safety of patients with stage I AGCTs, with comparable outcomes between laparoscopic and open approach.
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Affiliation(s)
- A Bergamini
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Milan, Italy.
| | - G Ferrandina
- Department of Obstetrics and Gynecology, Gynecology Oncology Unit, Catholic University of Sacred Heart of Rome, Italy
| | - M Candiani
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Milan, Italy
| | - G Cormio
- Department of Biomedical Science and Human Oncology, University of Bari, Bari I, Bari, Italy; Gynecologic Oncology Unit, IRCCS National Cancer Institute "Giovanni Paolo II" Bari, Italy
| | - G Giorda
- Gynecological Oncology Unit, Centro di Riferimento Oncologico - National Cancer Institute, Aviano, Italy
| | - R Lauria
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Napoli, Italy
| | - A M Perrone
- Department of Gynecology Oncology, Institute of Obstetrics and Gynecology, S. Orsola Hospital, Bologna, Italy
| | - G Scarfone
- Department of Obstetrics, Gynecology and Neonatology, IRCCS Fondazione Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - E Breda
- Medical Oncology Unit Ospedale S Giovanni Calibita Fatebenefratelli, Rome, Italy
| | - A Savarese
- Division of Medical Oncology 1, Regina Elena Cancer Institute, Rome, Italy
| | - L Frigerio
- Department of Obstetrics & Gynaecology, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - A Gadducci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - F Mascilini
- Department of Obstetrics and Gynecology, Gynecology Oncology Unit, Catholic University of Sacred Heart of Rome, Italy
| | - F Maneschi
- Gynecology and Obstetric Unit, AO San Giovanni Addolorata, Rome, Italy
| | - C Cassani
- Department of Obstetrics and Gynaecology Fondazione IRCCS Policlinico San Matteo-University of Pavia, Pavia, Italy
| | - C Marchetti
- Department of Gynecological-Obstetrical and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - S C Cecere
- Division of Medical Oncology, Department of Uro-Gynaecological Oncology, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Naples, Italy
| | - N Biglia
- Obstetrics and Gynaecology Unit, Umberto I Hospital, Department of Surgical Sciences, School of Medicine, University of Turin, Turin, Italy
| | - U De Giorgi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola (FC), Italy
| | - F Raspagliesi
- Gynecologic Oncology Unit, IRCCS National Cancer Institute Foundation, Milan, Italy
| | - D Lorusso
- Gynecologic Oncology Unit, IRCCS National Cancer Institute Foundation, Milan, Italy
| | - G Mangili
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Milan, Italy
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Laparoscopic management of early-stage malignant nonepithelial ovarian tumors: surgical and survival outcomes. Int J Gynecol Cancer 2013; 23:249-55. [PMID: 23318909 DOI: 10.1097/igc.0b013e318272e754] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Laparoscopic management in patients with malignant nonepithelial ovarian tumors (MNEOTs) was unpopular owing to the solid nature and relatively large size of the tumors. The purpose of this study was to evaluate the role of laparoscopy for MNEOTs. METHODS Between January 1989 and September 2010, 28 patients with MNEOTs underwent laparoscopic surgery at our institution. These patients' clinicopathologic data were retrospectively reviewed from medical records. RESULTS Cases included 20 sex cord-stromal tumors (18 granulosa cell and 2 Sertoli-Leydig cell) and 8 malignant germ cell tumors (4 dysgerminomas, 2 immature teratomas, 1 choriocarcinoma, and 1 yolk sac tumor). The patients' median age was 27 years (range, 16-35 years) for those with malignant germ cell tumors and 42 years (range, 7-57 years) for those with stromal tumors. The median primary tumor diameter was 10.4 cm (range, 3.3-20.8 cm). Laparoscopic pelvic and para-aortic lymph node dissections were performed in 9 cases. Laparoscopic removal of primary tumor and omentectomy were performed in 26 and 6 cases, respectively. Hand-assisted laparoscopic surgery was performed for one huge tumor that could not be entered into the endobag. The median operating time was 102 minutes (range, 45-300 minutes), and the median postoperative hospital stay was 3 days (range, 2-10 days). All patients had stage I disease. Five patients received adjuvant chemotherapy, and the median interval to chemotherapy was 14 days (range, 2-21 days). No intraoperative complication or conversion to laparotomy was observed. Only one postoperative febrile morbidity occurred. The median follow-up was 34.5 months (1-185 months). One patient developed recurrence, which was treated with chemotherapy. No patient died of their disease. CONCLUSION This is the first case series report of laparoscopic surgery for MNEOTs. Laparoscopic management seems feasible and safe without compromising survival. With additional evidence, laparoscopic surgery could be a safe therapeutic option for management of early-stage MNEOTs.
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Zou CC, Liang L, Dong GP, Zhao ZY. Peripheral precocious puberty: a retrospective study for six years in Hangzhou, China. J Paediatr Child Health 2008; 44:415-8. [PMID: 18564081 DOI: 10.1111/j.1440-1754.2008.01320.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM To evaluate the clinical and aetiopathogenesis of peripheral precocious puberty (PPP) in Chinese children. METHODS A total of 91 PPP children were reviewed. Clinical features including age, gender, stage of pubertal development, presenting symptoms, features and aetiopathogenesis were investigated. RESULTS They were 65 girls (71.4%) and 26 boys (28.6%) with a median age of 3.6 years. The median age of girls and boys were 3.7 and 3.4 years, respectively, with a significant difference (P = 0.048). Congenital adrenal cortical hyperplasia (CAH) patients with a median age of 0.2 years were younger than other patients. The major complaint was the appearance of breast buds (56.6%), followed by menstruation (5.5%), vaginal discharge (5.5%) and vomiting (4.4%). Heterosexual PPP was common in CAH girls (10 cases) while exogenic sexual steroid exposure was common in boys (10 cases). Major cause of PPP was gonadal abnormalities (34.1%), including 24 girls with autonomous isolated ovarian cysts, one with Sertoli's cell ovarian tumour, five with testicular tumours and one with testotoxicosis. CAH was the most common cause of PPP in boys. Exogenous sexual steroid exposure was the third cause. MeCune-Albright syndrome was also found in three cases. It was noted that the causes of 24 cases (26.4%), including 20 girls and 4 boys, were still unknown. CONCLUSION The results imply that PPP is a common matter of children in the department of endocrinology. It is more frequently in girls. History, physical examination, clinical suspicion and imaging detection should be considered carefully to diagnose and investigate the aetiopathogenesis.
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Affiliation(s)
- Chao Chun Zou
- Department of Endocrinology, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China
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