Preoperative Differentiation of Benign and Malignant Non-epithelial Ovarian Tumors: Clinical Features and Tumor Markers.

Liliana Aparecida Lucci de Angelo Andrade,Luís Otavio Sarian,Adriana Yoshida,Sophie Françoise Derchain,Tiago Augusto Gomes,Elizabeth Aparecida Campos

doi:10.1055/s-0040-1712993

Liliana Aparecida Lucci de Angelo Andrade, Luís Otavio Sarian + Show 4 more

Open Access

https://doi.org/10.1055/s-0040-1712993

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Abstract

To evaluate the role of clinical features and preoperative measurement of cancer antigen 125 (CA125), human epididymis protein (HE4), and carcinoembryonic antigen (CEA) serum levels in women with benign and malignant non-epithelial ovarian tumors. One hundred and nineteen consecutive women with germ cell, sex cord-stromal, and ovarian leiomyomas were included in this study. The preoperative levels of biomarkers were measured, and then surgery and histopathological analysis were performed. Information about the treatment and disease recurrence were obtained from the medical files of patients. Our sample included 71 women with germ cell tumors (64 benign and 7 malignant), 46 with sex cord-stromal tumors (32 benign and 14 malignant), and 2 with ovarian leiomyomas. Among benign germ cell tumors, 63 were mature teratomas, and, among malignant, four were immature teratomas. The most common tumors in the sex cord-stromal group were fibromas (benign) and granulosa cell tumor (malignant). The biomarker serum levels were not different among benign and malignant non-epithelial ovarian tumors. Fertility-sparing surgeries were performed in 5 (71.4%) women with malignant germ cell tumor. Eleven (78.6%) patients with malignant sex cord-stromal tumors were treated with fertility-sparing surgeries. Five women (71.4%) with germ cell tumors and only 1 (7.1%) with sex cord-stromal tumor were treated with chemotherapy. One woman with germ cell tumor recurred and died of the disease and one woman with sex cord-stromal tumor recurred. Non-epithelial ovarian tumors were benign in the majority of cases, and the malignant cases were diagnosed at initial stages with good prognosis. The measurements of CA125, HE4, and CEA serum levels were not useful in the preoperative diagnosis of these tumors.

Highlights

Adnexal masses are commonly found on gynecological imaging in women of all ages.[1]
Non-epithelial ovarian tumors were benign in the majority of cases, and the malignant cases were diagnosed at initial stages with good prognosis
According to the last classification of World Health Organization (WHO),[5] germ cell tumors of ovary comprise dysgerminoma, yolk sac tumor, embryonal carcinoma, non-gestational choriocarcinoma, mature teratoma, immature teratoma, mixed germ cell tumor, monodermal teratomas and tumors with malignant transformation arising from a dermoid cyst

Summary

Introduction

Adnexal masses are commonly found on gynecological imaging in women of all ages.[1]. It is estimated that 5 to 10% of women will be submitted to surgery to investigate an adnexal mass in their lifetime.[2]. According to the last classification of World Health Organization (WHO),[5] germ cell tumors of ovary comprise dysgerminoma, yolk sac tumor, embryonal carcinoma, non-gestational choriocarcinoma, mature teratoma, immature teratoma, mixed germ cell tumor, monodermal teratomas and tumors with malignant transformation arising from a dermoid cyst. Mature teratoma, is the most common benign ovarian neoplasia, most occur during reproductive years, with a peak incidence between 20 and 40 years of age.[6] Benign mature teratomas comprise 95% of all germ cell tumors, and only 5% of germ cell tumors are malignant.[6]

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