Germ Cell Elements Research Articles

Teratomas in infancy and childhood. A 54-year experience at the Children's Hospital Medical Center.

The clinical and pathologic features of 254 teratomas from 245 patients are reviewed. All patients were 21 years of age or younger and were treated at the Children's Hospital Medical Center from 1928 to 1982. Tumors arose in the following anatomic sites: sacrococcygeal (102), ovary (94), head and neck (14), retroperitoneum (12), mediastinum (11), testes (eight), central nervous system (nine), liver (two), abdominal wall, and back (one each). One hundred twenty-four tumors (49%) were detected in the newborn period. Teratomas characteristically contained elements derived from all three embryonic germ layers. Tumors with any recognizable component of embryonal carcinoma or other malignant germ cell elements at the time of initial surgery were excluded. Immature teratomas were significantly larger than mature tumors in nearly all sites where statistical analysis was possible. The single most important factor affecting prognosis was whether the tumor could be resected successfully at initial surgery. No patient who did not undergo surgery, or in whom only partial resection was possible, survived the disease--regardless of other treatments used. Based upon the experience reported here the authors conclude: 1) complete surgical resection is the treatment of choice for all childhood teratomas; and 2) this is one of the few childhood tumors where decisions regarding adjuvant therapy must be individualized, particularly with regard to site of origin and age of the patient.

Second primary neoplasm in a dysgerminoma patient

Dysgerminoma is a rare germ-cell tumour of the ovary. Like its testicular counterpart, it is very radiosensitive; in the absence of any other germ-cell elements, dysgerminoma reponds well to radiation therapy. A cure rate of over 80% has been reported (Freel et al., 1979). Our case developed carcinoma of the pelvic colon at the age of 29 years, following the treatment of dysgerminoma 15 years previously.

IMMATURE (MALIGNANT) TERATOMA OF THE OVARY. A CLINICAL AND PATHOLOGIC STUDY OF 58 CASES

Fifty-eight immature ovarian teratomas were studied. Neoplams with other germ cell elements (endodermal sinus tumor, choriocarcinoma, and dysgerminoma) were excluded so that the clinical and pathologic features of pure immature teratomas could be defined and correlated with the prognosis. The primary tumors and their metastatic growths were graded from 0 to 3. Forty were stage I; nine, stage II; and nine, stage III. The size and stage of teratomas were related to survival, but it was the grade of the primary tumor that best determined the likelihood of extraovarian spread, and it was the grade of the metastases that related best to the subsequent course. Actuarial survival was 63% at 5 years and also at 10 years. Regardless of the grade of the primary tumor, only one of six with grade 0 metastases progressed, and that neoplasms may not have been adequately sampled. Two of five neoplasms having grade 1 metastases did not progress, and two of six patients with grade 2 metastatic growths were living after relatively long intervals. All seven patients with grade 3 metastases died with tumor, none surviving more than 2.1 years. Survival of patients with grade 1, 2, and 3 neoplasms was 81, 60, and 30% respectively. The importance of adequate sampling of primary tumor and metastases for estimating prognosis and determining therapy is stressed.

Immature (malignant) teratoma of the ovary: a clinical and pathologic study of 58 cases.

Fifty-eight immature ovarian teratomas were studied. Neoplams with other germ cell elements (endodermal sinus tumor, choriocarcinoma, and dysgerminoma) were excluded so that the clinical and pathologic features of "pure" immature teratomas could be defined and correlated with the prognosis. The primary tumors and their metastatic growths were graded from 0 to 3. Forty were stage I; nine, stage II; and nine, stage III. The size and stage of teratomas were related to survival, but it was the grade of the primary tumor that best determined the likelihood of extraovarian spread, and it was the grade of the metastases that related best to the subsequent course. Actuarial survival was 63% at 5 years and also at 10 years. Regardless of the grade of the primary tumor, only one of six with grade 0 metastases progressed, and that neoplasms may not have been adequately sampled. Two of five neoplasms having grade 1 metastases did not progress, and two of six patients with grade 2 metastatic growths were living after relatively long intervals. All seven patients with grade 3 metastases died with tumor, none surviving more than 2.1 years. Survival of patients with grade 1, 2, and 3 neoplasms was 81, 60, and 30% respectively. The importance of adequate sampling of primary tumor and metastases for estimating prognosis and determining therapy is stressed.