Workflow for Management of Gonadal Neoplasm in 2 Patients with Differences of Sex Development Enrolled in an Experimental Gonadal Tissue Cryopreservation Protocol

Abstract

To outline our experimental gonadal tissue cryopreservation (GTC) protocol that does not disrupt standard of care in medically-indicated gonadectomy for patients with differences of sex development (DSD), including highlighting the multidisciplinary collaborative protocol for when neoplasm is discovered in these cases. Two patients with complete gonadal dysgenesis (CGD) who were undergoing medically-indicated prophylactic bilateral gonadectomy elected to pursue GTC. Both were found to have germ cell neoplasia in situ (GCNIS) on initial pathologic analysis, requiring recall of the gonadal tissue, which had been cryopreserved. Cryopreserved gonadal tissue was successfully thawed and transferred to pathology for complete analysis. No germ cells were identified in either patient nor were found to have malignancy, so further treatment beyond gonadectomy was not indicated. Pathologic information was communicated to each family, including that long-term GTC was no longer possible. Organizational planning and coordination between the clinical care teams, GTC laboratory and pathology were key to handling these cases with neoplasia. Processes that anticipated the possibility of discovering neoplasia within tissue sent to pathology and the potential need to recall GTC tissue to complete staging included: (1) documenting the orientation and anatomical position of tissue processed for GTC, (2) defining parameters in which tissue will be recalled, (3) efficiently thawing and transferring GTC tissue to pathology, and (4) coordinating release of pathology results with verbal communication from the clinician to provide context. GTC is desired by many families and at the time of gonadectomy and is: (1) feasible for patients with DSD and (2) did not inhibit patient care in two patients with GCNIS.