Malignant Ovarian Germ Cell Tumors in Pediatric Age Group: A Clinicopathological Study over 21 Years in Eastern Rajasthan (India)

Rajendra Kumar Tanwar,Harsh Goyal,Madhu Saxena,Shankar Lal Mohanpuria,Bharti Saxena,Man Mohan Agarwal,Laxmi Agarwal

doi:10.11648/j.crj.20200804.11

Abstract

Background: The aim of this study is to analyze the clinicopathological features, diagnosis and treatment outcome of rare cases of malignant ovarian germ cell tumors in a government tertiary care hospital centre keeping fertility preservation surgery as a goal in young girls below 21 years of age. Methods: This is a retrospective study comprising of 24 patients diagnosed to have malignant ovarian germ cell tumors who attend the department of Radiation Oncology from 1998 to 2019 over 21 years period. The patients were evaluated on the basis of their age, obstetric history, investigations, and serum tumor markers estimation. All patients were staged according to FIGO, ECOG score were noted. Unilateral Salphingo oophorectomy (USO) with or without staging laparotomy surgery was done and BEP chemotherapy regimen was given. Response to treatment was evaluated by regular clinical examination, radiological and tumor marker studies. Results: In our study 17 patients were in FIGO stage III and 6 patients were in stage IV. The size of the primary tumor was 10-20 cm. in 15 patients. The various histology observed was-dysgerminoma -8, malignant teratoma-5, mixed germ cell tumor-5, yok sac tumor-4 and embryonal carcinoma in 2 patients. Eighteen patients underwent fertility preservation surgery i.e. USO - 15, and 3 patients underwent USO with staging laparotomy. In 14 patients 3-4 cycles of adjuvant chemotherapy (BEP regimen) was administered and all of them achieved complete remission. Conclusion: Malignant ovarian germ cell tumors carries excellent prognosis in spite of advanced stage disease. Patients should be referred to oncology centre and to be operated by gynecologic oncologist/ oncosurgeon. Adjuvant chemotherapy should be given to achieve complete remission.

Highlights

The pediatric age group includes adolescence i.e. up to 21 years days
[2] Among malignant ovarian germ cell tumors (MOGCT), the incidence of immature teratoma are most common 42-48%, followed by dysgerminoma 24-27%, mixed germ cell tumors (GCT) 14-20% and yok sac tumor (YST) formally known as endodermal sinus tumor in 11-12%. [3, 4] The pure embryonal carcinoma and choriocarcinoma are rarely seen in ovary rather they are seen as a component of mixed GCT of ovary
[10] In the present study dysgerminoma was most common histological subtype followed by malignant teratoma, mixed GCT, yok sac tumor and embryonal carcinoma

Summary

Introduction

The pediatric age group includes adolescence i.e. up to 21 years days. The malignant germ cell tumors of the ovary account for 2-3% of all ovarian cancers and occur mostly in their early twenties. Rajendra Kumar Tanwar et al.: Malignant Ovarian Germ Cell Tumors in Pediatric Age Group:. A Clinicopathological Study over 21 Years in Eastern Rajasthan (India) of malignant ovarian germ cell tumors (MOGCT) has been achieved during past three decades because of major development in the area of proper histological diagnosis, clinical staging, tumor marker estimation, immunohistochemistry, facilities of oncosurgery and adjuvant chemotherapy. The aim of this study is to analyze the clinicopathological features, diagnosis and treatment outcome of rare cases of malignant ovarian germ cell tumors in a government tertiary care hospital centre keeping fertility preservation surgery as a goal in young girls below 21 years of age. The various histology observed was-dysgerminoma -8, malignant teratoma-5, mixed germ cell tumor-5, yok sac tumor-4 and embryonal carcinoma in 2 patients.

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