Malignant Germ Cell Research Articles

Pregnancy following surgery and chemotherapy for ovarian germ cell tumors.

e16550 Background: Malignant ovarian germ cell tumours(OGCT) are a rare disease, accounting for 2% of all malignant ovarian tumours diagnosed in Ireland between 1994 - 2010. They affect a younger population than epithelial ovarian cancer, with the highest number of cases in the second and third decade. In this report, we present a review of patients treated in a tertiary referral centre. Methods: We performed a retrospective review over a 26 year period in our institution. We examined clinical records, pathology, pharmacy and surgical databases to identify patients with ovarian germ cell tumours who were treated in our institution. Results: During the period 1986 – 2012, twenty patients were treated and followed at this institution for malignant ovarian germ cell tumor (OGCT). Eighteen patients are alive and well at a median follow up of 14.5 years (range 0.5 – 26). Nineteen patients received platinum based chemotherapy with a median number of four cycles (range 2 – 6) required to achieve complete remission. Twenty percent of patients had yolk sac histology; the next commonest were immature teratomas and mixed germ cell tumour (10 & 15% respectively). The commonest chemotherapy regimen used was BEP (bleomyocin, etoposide and cistplatin). Six patients (30%) underwent resection of residual disease post chemo revealing mature teratoma/necrotic tissue. During follow up, four patients had progressive or recurrent disease. Two patients at resection had mature teratomas found on histological examination. The remaining two patients (10%) had progressive disease and died within a short time period. In our patient population, nine of nine attempting pregnancy have been successful. There have been 12 pregnancies carried to term; mother and child in each case are well. At a median follow up of 14.5 years (range 0.5 – 26), there have been no second malignancies and no toxicities attributable to chemotherapy. Conclusions: We have shown that platinum based chemo in OGCT is associated with preservation of fertility in these young women. In our series there have been no adverse affects in women or their infants. Platinum based chemo highly successful in curing OGCT and this confirms that it is associated with preserved fertility in these young women.

Abstract 5321: An informative clinical applicable serum miRNAs 371-3 and 302/367 test for (germ cell) cancer patients.

Abstract Expression of microRNAs (miR) can be unique and specific for malignant cells, as shown for human germ cell cancers (GCC), i.e., seminomas (SE) and nonseminomas (NS). GCC are the most frequent malignancy in Caucasian young males. They show high expression of the embryonic stem cell miR clusters 371-3 and 302/367, related to their cancer stem cell component. No recurrent DNA copy number changes of these miR and mutation in DICER was found in more than 250 primary GCC samples. Current clinically used serum markers for GCC are the proteins AFP and hCG, which are informative in a selection of patients (minority with a SE, and majority of those with a NS: i.p. yolk sac tumor and/or choriocarcinoma). Although the fore-mentioned miR have been suggested as serum markers for GCC, no robust protocol is available so far. A novel, sensitive and specific pipeline for miRNA profiling in body fluids is developed based on a magnetic anti-probe bead purification step (ABC miRNA purification kit, Life Technologies). This method shows stable recovery based on multiple synthetic non-human spike-ins, allowing calibration. Out of a set of 9 potential serum-specific controls, two were identified by Normfinder and geNorm as most stable (miR-20a and 93), therefore used for normalization. This TSmiR test was applied to five series of serum samples for independent learning and validation, including 47 controls (N), 80 GCC (adult and pediatric) (T), 11 matched pre- and post-orchidectomy samples, and 12 no-GCC testicular tumors (no-GCC). TSmiR demonstrated a consistent, significant increase (p<0.0064) of miR-371-3 and 367 levels in serum of patients with GCC. Power was demonstrated using mean comparison, Kohonen Self Organizing Maps, Principal Component Analysis and ROC analysis. Matched pre- and post-orchidectomy samples demonstrated suitability for follow-up purposes. TSmiR outperformed the traditional serum markers (sensitivityall samples 98%, specificityall samples 48%; sensitivityAFP= 3% and 45%; sensitivityhCG= 62% and 66%, in SE and NS, respectively). The combined serum AFP/hCG and TSmiR test identified all T samples correctly. In conclusion, a highly reproducible and informative novel serum test for patients with a germ cell malignancy is developed, suitable to be prospectively tested for diagnosis and follow-up purposes. Citation Format: Ad Gillis, Martin Rijlaarsdam, Ronak Eini, Lambert Dorssers, Yvonne van der Zwan, Matthew Murray, James Nicholson, Nicholas Coleman, Klaus-Peter Dieckmann, Ganzafar Belge, Joern Bullerdieck, Katharina Biermann, Stefan White, Leendert H. Looijenga. An informative clinical applicable serum miRNAs 371-3 and 302/367 test for (germ cell) cancer patients. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 5321. doi:10.1158/1538-7445.AM2013-5321

Yolk Sac Tumors: An Aggressive Germ Cell Malignancy in Adolescents

Ovarian yolk sac tumors, previously called endodermal sinus tumors, account for less than 1% of ovarian malignancies, but 20% of germ cell malignancies. Due to the rarity of these tumors, there are few detailed descriptions of their presentation and clinical features. We report four cases of yolk sac tumors at our institution over a short five-month period. The purpose of this report is to alert and educate general practitioners regarding these malignancies as they present in adolescents.

Multicenter randomized controlled clinical study for the operative treatment of malignant ovarian germ cell tumors

To investigate the operative treatment for first-treated patients with malignant ovarian germ cell tumors who need preservation of fertility. The clinical data of 105 patients who were treated with fertility-sparing surgery in 11 hospitals from 1992 to 2010 were collected to evaluate the outcomes of different primary surgical operative procedures. All 105 cases were performed the surgeries that preserved fertility and divided into three groups according to the surgical approaches, comprehensive staging surgery group: 47 cases (44.8%) received comprehensive staging surgeries that including the ipsilateral oophorectomy + omentectomy + retropertoneal lymph node dissection ± appendectomy + multiple biopsies;oophorectomy group:45 cases (42.9%)received ipsilateral oophorectomy ± biopsy of contralateral ovary ± omentectomy;tumor resection group:13 cases (12.4%) received enucleation of the mass with preservation of the ovary. Differences were compared among the three groups of patients in the surgery-related indicators, complications, fertility and prognosis. (1) Surgery-related indicators:the average blood loss of the comprehensive staging surgery group, the oophorectomy group and the tumor resection group were 496, 104 and 253 ml, the mean operation time were 176, 114 and 122 minutes, respectively, and there were significant differences among three groups (P = 0.011, P = 0.000). (2) Complication:the surgical complication rates of the three groups were 17% (8/47), 0 and 1/13, with significant differences (P = 0.015). (3) Reproductive function status: the pregnancy rate and birth rate of the three groups were no significant differences (9/19 vs. 7/19 vs. 2/3, P = 0.515; 8/19 vs. 5/19 vs. 2/3, P = 0.636). (4) PROGNOSIS: the recurrence rate of the three groups were significant differences [13% (6/47) vs. 0 vs. 2/13, P = 0.013], but the death rate with no significant differences [6% (3/47) vs. 0 vs. 0, P = 0.129]; The five-year survival rate of three different groups were 89%, 100% and 100% (P > 0.05), while disease free survival rate were 85%, 100% and 83% (P < 0.05), respectively. Compared with comprehensive staging surgery, oophorectomy group have higher surgical security and satisfactory prognosis, considerable pregnancy rates and birth rate. The tumor resection security may be reliable, but the prognosis is poor.

Clinical and Radiologic Signs of Relapsed Ovarian Germ Cell Tumor: Tissue Is the Issue

Malignant ovarian germ cell tumor is a rare disease, but with current treatment strategies including surgery and platinum based chemotherapy survival is excellent. After treatment, intensive followup is indicated to encounter tumor relapse at an early stage. This case describes a 22-year-old female with a history of common variable immune deficiency (CVID) who underwent a resection of a large ovarian germ cell tumor followed by 4 cycles of cisplatin and etoposide resulting in clinical complete remission. During followup, she developed a mass at the umbilicus and ascites. Initially, the cytology of the ascites was interpreted as tumor positive, suspicious of relapse of the disease, but tumor markers remained negative. However, during laparoscopy it turned out to be a mature teratoma, which can develop after chemotherapy, the so called growing teratoma syndrome. In retrospect, the ascites was false positive. This case shows that current diagnostic tools are not sufficient to distinguish between vital tumor and mature teratoma and can be misleading. Tumor biopsy and/or laparoscopic inspection are therefore indicated.

Development of malignant germ cells - the genvironmental hypothesis

Human germ cell tumors are of interest because of their epidemiology, clinic and patho-biology. Histologically, they are subdivided into various elements, with similarities to embryogenesis. Recent insight triggered development of a higher order division into five types of human germ cell tumors. In the context of male germ cells, only three are relevant; Type I: teratomas and yolk sac tumors of neonates and infants; Type II: seminomas and nonseminomas of (predominantly) adolescents and adults; and Type III: spermatocytic seminomas of the elderly. Various animal models, both occurring spontaneous or induced, are reported, of which their relevance is still a matter of debate. Recent multidisciplinary studies have led to a significant increase in our understanding of the parameters involved in the earliest pathogenetic steps of human germ cells tumors, particularly the seminomas and nonseminomas (Type II). This paper will discuss a number of interesting insights into the normal and aberrant regulation of germ cell development, resulting in the so-called genvironmental hypothesis. This assumes a subtle interaction between environmental- and (epi)genetic parameters, resulting in clinical/phenotypical characteristics. These influence signaling pathways and thereby developmental processes, including gonadal development, germ cell proliferation, maturation and apoptosis. In the case of a disturbed physiology, either due to the germ cell itself, or the micro-environment, embryonic germ cells, during a specific window of sensitization, might be blocked in their maturation, resulting in carcinoma in situ or gonadoblastoma, the precursors of seminomas and nonseminomas. The level of testicularization of the gonad determines the histological composition of the precursor. These insights will allow a better definition of individuals at risk of developing a germ cell malignancy, and allow a better selection of scientific approaches to elucidate the corresponding pathogenesis.

Cancer of the ovary, fallopian tube, and peritoneum

The Gynecologic Oncology Committee of FIGO in 2014 revised the staging of ovarian cancer, incorporating ovarian, fallopian tube, and peritoneal cancer into the same system. Most of these malignancies are high-grade serous carcinomas (HGSC). Stage IC is now divided into three categories: IC1 (surgical spill); IC2 (capsule ruptured before surgery or tumor on ovarian or fallopian tube surface); and IC3 (malignant cells in the ascites or peritoneal washings). The updated staging includes a revision of Stage IIIC based on spread to the retroperitoneal lymph nodes alone without intraperitoneal dissemination. This category is now subdivided into IIIA1(i) (metastasis ≤10 mm in greatest dimension), and IIIA1(ii) (metastasis >10 mm in greatest dimension). Stage IIIA2 is now microscopic extrapelvic peritoneal involvement with or without positive retroperitoneal lymph node metastasis. This review summarizes the genetics, surgical management, chemotherapy, and targeted therapies for epithelial cancers, and the treatment of ovarian germ cell and stromal malignancies.

Prognostic factors analysis in patients with ovarian malignant germ cell tumor treated with fertility-preserving surgery

To analyse the clinicopathologic factors affecting prognosis and fertility of patients with malignant ovarian germ cell tumor (MOGCT). The medical records and follow up data of 106 patients with MOGCT treated at Affiliated Tumor Hospital of Guangxi Medical University between January 1986 and December 2010.Kaplan-Meier method was used to analyse survival curves. The different prognoses between different clinicopathologic factor was evaluated by univariate analysis and log-rank test. The multivariate analysis was performed by the Cox proportional hazard regression method. Logistic regression analysis was used to evaluate the influence of different factors on the prognoses and fertility. The median age at primary treatment was 22 years old (range: 9 - 61 years old), 59 patients received fertility-preserving surgery, 45 patients received radical surgery, only 2 cases performed biopsy; 94 patients received postoperative adjuvant chemotherapy. Median follow-up time was 56.5 months (range: 2 - 309 months), there were 11 cases recurrences, 23 cases died from cancer. Of 47 patients live without tumor, 45 patients had normal menstrual. Of the 39 patients desiring pregnancy, 31 cases got 33 successful pregnancies, resulting in 33 live births. There is no statistically significant difference (P > 0.05) in progression free survival (PFS; 67.6% versus 63.3%) and overall survival (OS; 70.0% versus 64.1%) and mortality [15% (9/59) versus 31% (14/45)] between fertility-preserving surgery patients and radical surgery patients. The univariate analysis showed that the pathological types, postoperative residual tumor size, lymph nodes and omental resection were associated with OS (P < 0.1), and postoperative residual tumor size, chemotherapy cycles, lymph nodes and omental resection were associated with PFS (P < 0.1). The multivariate analysis showed only the postoperative residual tumor size was independent prognostic factor of OS (P = 0.039), and postoperative residual tumor size, chemotherapy cycles, lymph nodes resection were independent prognostic factors of PFS (P < 0.05). There is no statistically significant difference in OS, PFS and fertility between fertility-preserving surgery patients treated with or without a comprehensive staging surgery (P > 0.05). MOGCT can achieve a good prognosis after surgery combined chemotherapy. Postoperative residual tumor size is independent prognostic factor of PFS and OS. Comprehensive staging surgery could not improve prognosis. Fertility-preserving surgery plus adjuvant chemotherapy appeared to have little or no effect on prognosis and fertility.

920 The Effects of N-Acetyl-L-Cysteine on Bleomycin Induced Apoptosis Were Determinated in Malignant Testicular Germ Cell Tumours by Flow Cytometry

920 The Effects of N-Acetyl-L-Cysteine on Bleomycin Induced Apoptosis Were Determinated in Malignant Testicular Germ Cell Tumours by Flow Cytometry

Malignant Germ Cell–Like Tumors, Expressing Ki-1 Antigen (CD30), Are Revealed during in Vivo Differentiation of Partially Reprogrammed Human-Induced Pluripotent Stem Cells

Because many of the genes used to produce induced pluripotent stem cells (iPSCs) from somatic cells are either outright established oncogenes, such as c-myc and Klf4, or potentially related to tumorigenesis in various cancers, both the safety and the risks of tumorigenesis linked to iPSC generation require evaluation. In this work, we generated, by lentivirus-mediated gene transfer of Oct4, Sox2, Nanog, and Lin28, two types of iPSCs from human mesenchymal stem cells and human amniotic fluid-derived cells: fully reprogrammed iPSCs with silencing of the four transgenes and partially reprogrammed iPSCs that still express one or several transgenes. We assessed the behavior of these cells during both their differentiation and proliferation using in vivo teratoma assays in nonobese diabetic mice with severe combined immunodeficiency. In contrast to fully reprogrammed iPSCs, 43% of partially reprogrammed iPSC cases (6 of 14 teratomas) generated major dysplasia and malignant tumors, with yolk sac tumors and embryonal carcinomas positive for α-fetoprotein, cytokeratin AE1/AE3, and CD30. This correlated with the expression of one or several transgenes used for the reprogramming, down-regulation of CDK 1A mRNA (p21/CDKN1A), and up-regulation of antiapoptotic Bcl-2 mRNA. Therefore, the oncogenicity of therapeutically valuable patient-specific iPSC-derived cells should be scrupulously evaluated before they are used for any clinical applications.

Familial germ cell tumor

Familial testicular germ cell tumors are well known in literature. Only few cases are reported where both brother and sister of the same family suffered from germ cell malignancies. We present a family where the proband is a survivor of ovarian dysgerminoma stage IA. Her elder male sibling became acutely ill and was detected to have disseminated testicular malignancy with grossly elevated markers and vegetations in the mitral valve leaflets. Despite all measures he could not be saved. Presence of germ cell malignancies in the siblings of different sex in the same family points toward a genetic susceptibility. Literature review revealed only six similar cases. A discussion regarding the rare occurrence of familial germ cell malignancies with the affected family members may be worthwhile.

"Mixed germ cell testicular tumor" in an adult female

The androgen insensitivity (testicular feminization) syndrome was described by Morris in phenotypic females with 46XY karyotype, presenting with primary amenorrhea, adequate breast development, and absent or scanty pubic or axillary hair. Gonads consist usually of seminiferous tubules without spermatogenesis. These patients have a 5–10% risk of developing germ cell tumors, usually after the complete development of secondary female sexual characteristics. We hereby report a case considered as a female with married life of 15 years, who was operated for severe abdominal pain. Phenotype characters were that of female. Microscopic examination of the tumor from the abdomen revealed germinoma and yolk sac tumor with adjacent seminiferous tubules. Karyotyping showed 46XY. Final diagnosis of malignant mixed germ cell tumor in androgen insensitivity syndrome was made. Surveillance may be the most appropriate option when these conditions are initially diagnosed in adulthood to prevent development of germ cell tumors.

Clinical analysis of 15 cases of malignant ovarian germ cell tumors with lung metastasis

To investigate the clinical characteristics, diagnosis, treatment and prognosis of malignant ovarian germ cell tumors (MOGCT) with lung metastasis. Fifteen patients of MOGCT with lung metastasis treated in Peking Union Medical College Hospital from Jan. 1982 to Dec. 2010 was retrospectively analyzed. (1) Clinical characteristics: the average onset age of these 15 patients is (23 ± 11) years old (6 - 48 years). The majority of these patients presented with abdominal pain (8/15) or irregular vaginal bleeding (4/15) as their initial symptoms. The primary tumor located in the left ovary in 8 cases, right ovary in 6 cases, and both sides in only 1 case. Metastatic lesions were confined to the lung in 12 patients, while the other 3 patients were found to have multi-site distant metastasis. (2) DIAGNOSIS:all 15 cases included 9 pure non-gestational ovarian choriocarcinoma (NGOC), 3 MOGCT containing choriocarcinoma component (one mature teratoma with choriocarcinoma component, one endodermal sinus tumor with embryonal carcinoma and choriocarcinoma components, one choriocarcinoma with dysgerminoma component), 2 embryonal carcinoma, one immature teratoma. Only one patient in these 15 cases was correctly diagnosed before surgery. (3) Time of lung metastasis:of 12 MOGCT with choriocarcinoma component, 11 patients were found to have lung metastasis in the course of their primary treatment, only 1 had lung metastasis 2 months after the synthetic treatment finished. Three MOGCT patients without choriocarcinoma component were all found to have lung metastasis when tumor relapsed in the advanced stages of the disease. (4) TREATMENT:all 15 patients received multi-agent chemotherapy combined with surgery. The mean courses of chemotherapy for these patients were 16 courses (5 - 43 courses). (5) PROGNOSIS: of these 15 cases, complete remission was obtained in 10 patients of NGOC or mixed ovarian germ cell tumors with choriocarcinoma component, 3 patients (one NGOC, one endodermal carcinoma and one immature teratoma, respectively) died in the course of treatment as result of tumor progression, 2 progressed cases (one NGOC and one endodermal carcinoma respectively) abandoning therapy were lost to follow up. MOGCT with lung metastasis are more often to found in NGOC patients. These patients could obtain high complete remission rate after standard multi-agent chemotherapy combined with surgery. The prognosis of MOGCT with lung metastasis containing choriocarcinoma component are better than that of those without containing choriocarcinoma component.

Hyperglycosylated hCG, hCGβ and Hyperglycosylated hCGβ: Interchangeable cancer promoters

IntroductionSeveral groups are researching cancers, and showing that hCGβ is a promoter of cancer growth and malignancy. Recent research shows that some hCGβ is present as Hyperglycosylated hCGβ. Other groups studied Hyperglycosylated hCG as a promoter of choriocarcinoma and germ cell malignancies. The question therefore arises, are Hyperglycosylated hCG, hCGβ and Hyperglycosylated hCGβ interrelated or interchangable promoters of cancer? MethodsThe actions of Hyperglycosylated hCGβ, hCGβ and Hyperglycosylated hCG are investigated in 7 cell lines, Jar and JEG-3 choriocarcinoma cell lines, NTERA germ cell cancer line, SCaBER and T24 bladder epithelial carcinoma lines, KLE and Hec-1-a endometrial adenocarcinoma and epithelial carcinoma cell lines. Actions of promoters on cell growth are investigated. ResultsThe actions of Hyperglycosylated hCG, hCGβ and Hyperglycosylated hCGβ appear to be interchangeable in all cell lines investigated. DiscussionAll hCG-related cancer promoters seem interrelated, working through a similar mechanism, antagonism of apoptosis through know receptors such as TGFβ receptors in all cancers studied.

The treatment and prognosis of intracranial nongerminomatous malignant germ cell tumors in pineal region

Objective To investigate the clinical feature,treatment and prognosis of intracranial nongerminomatous malignant germ cell tumors (NGMGCTs) in pineal region.Methods Records of 34 such kind patients treated in our hospital between Jan 2000 and Jan 2010 were reviewed retrospectively.Clinical manifestations,diagnosis,treatment and outcome were analyzed in each patient.All tumors were microsurgically removed by occipital transtentorial approach (Poppen) and treated with radiotherapy combined chemotherapy.Results The tumor was totally removed in 32 cases,sub - totally in 2.In these 34 cases,all were verified by pathology,viz.11 immature teratomas,2 teratoma with malignant transformation,6 choriocarcinoma,2 embryonal carcinomas and 1 yolk sac tumors,12 mix germ cell tumors.Thirty - one patients were followed up.The overall 1 - year survival rate was 97％,3 - year survival rate 62％ and 5 -year survival rate 44％.Immature teratomas 1 - year survival rate was 100％,3 - year survival rate 67％.Teratoma with malignant transformation 1 - year survival rate was 100％,1 - year survival rate was 33％.Choriocarcinoma,embryonal carcinomas and yolk sac tumors 1 - year survival rate was 88％,3 - year survival rate 55％,5 - year survival rate 33％.Mix germ cell tumors 1 - year survival rate was 100％,3 -year survival rate 67％,5 - year survival rate 67％.Conclusion The majority of pineal region NGMGCTs can be diagnosed by clinical manifestations,imaging data and tumor markers pre - operatively Surgery remains the first choice for NGMGCT based on tumor histology.Combined regimen of surgical resection,radiotherapy and chemotherapy is mostly effective. Key words: Pineal region; Germ cell tumors; Prognosis; Treatment

Phase II/pharmacodynamic trial of PD0332991 in patients with breast, colon, germ cell, and epithelial tumors containing amplification of CCND1.

3088 Background: The cell cycle is dysregulated in most patients with epithelial cancers, through activating mutations or overexpression of cell cycle proteins, or loss of cell cycle inhibitors such as p53, p16, etc. A proportion of tumors also have amplification of CCND1, which encodes cyclin D1. In a Phase I trial of the cdk4/6 inhibitor PD0332991 we found prolonged stable disease in patients with several types of epithelial cancer. We now report a phase II trial of PD0332991 in patients with four disease types: breast cancer, Kras-mutant colorectal cancer, resistant germ cell malignancies, and any tumor demonstrated to have amplification of cyclin D1, as assessed by FISH. Methods: Eligible pts were treated with PD0332991 125 mg daily for 21 of 28 days. The primary objective was to determine the progression-free survival in cohorts of 15 patients per tumor type. Secondary objectives include anti-tumor activity, pharmacodynamics (PD) and pharmacokinetics (PK). Results: We screened 79 patients with these characteristics for Rb positivity: 26 had positive staining and were treated. Toxicity was limited to myelosuppression, mainly neutropenia, as had been observed in the phase I study. Of nine patients with colorectal cancer, five had 18F-FLT PET/CT performed before and after about 5 weeks of therapy as a pharmacodynamic marker. Maximum SUV values were computed for tumor (up to five lesions) and lumbar vertebral bodies (sum of five) as a marker of marrow effect. Bone marrow SUV values varied by a factor of three between patients, but intrapatient variability was minimal. Following treatment, marrow SUV values declined by a mean of 21.3% (range +1.7 to -55%). A similar decrease in tumor SUV values was observed (mean 27.5% decrease, range -7.3 to -47.5%), and four of the five patients had a decrease of > 25%. Pharmacokinetic studies are in progress to relate to PD markers of toxicity and activity, and to expand a model derived from Phase I data. Conclusions: PD0332991 is a well-tolerated cell cycle inhibitor with evidence of disease control in patients with various tumor types. Preliminary data in colorectal cancer suggest that FLT PET may provide a pharmacodynamic measure of drug activity.

Protocol for the Examination of Specimens From Pediatric and Adult Patients With Extragonadal Germ Cell Tumors

The College of American Pathologists offers these protocols to assist pathologists in providing clinically useful and relevant information when reporting results of surgical specimen examinations. The College regards the reporting elements in the ‘‘Surgical Pathology Cancer Case Summary (Checklist)’’ portion of the protocols as essential elements of the pathology report. However, the manner in which these elements are reported is at the discretion of each specific pathologist, taking into account clinician preferences, institutional policies, and individual practice. The College developed these protocols as an educational tool to assist pathologists in the useful reporting of relevant information. It did not issue the protocols for use in litigation, reimbursement, or other contexts. Nevertheless, the College recognizes that the protocols might be used by hospitals, attorneys, payers, and others. Indeed, effective January 1, 2004, the Commission on Cancer of the American College of Surgeons mandated the use of the checklist elements of the protocols as part of its Cancer Program Standards for Approved Cancer Programs. Therefore, it becomes even more important for pathologists to familiarize themselves with these documents. At the same time, the College cautions that use of the protocols other than for their intended educational purpose may involve additional considerations that are beyond the scope of these documents.

Germ cell tumors of the ovary

Ovarian germ cell malignancies are rare tumors primarily affecting young women of reproductive age. Advances in modern therapy have allowed patients with primitive germ cell tumors (dysgerminoma, y...

Survival and reproductive outcomes in women treated for malignant ovarian germ cell tumors

ObjectiveThe objective of this study is to review all malignant germ-cell tumors (MOGCTs) treated at our institution, focusing on reproductive outcomes and menstrual function of patients treated with fertility-sparing surgery and adjuvant chemotherapy. MethodsWe performed a retrospective chart review of patients treated for MOGCTs between January 1, 1979 and March 31, 2008. Charts of identified patients were abstracted and data were collected. Patients who had fertility-sparing surgery were contacted and a telephone questionnaire was performed to gather reproductive and menstrual history. ResultsForty patients were treated for MOGCTs at our institution. Mean age at the time of diagnosis was 26.5years (range, 10–48years). Histologic subtypes were: immature teratoma (52.5%), dysgerminoma (27.5%), yolk sac tumor (10.0%), mixed germ cell tumor (7.5%), and choriocarcinoma (2.5%). Thirty-five percent of tumors were FIGO stages II–IV. Twenty-seven patients (67.5%) were treated with chemotherapy postoperatively, 23 (85%) of whom received bleomycin, etoposide and cisplatin (BEP). There were three recurrences, but no deaths.Fertility-sparing surgery was performed in 22 patients (55%), 16 of whom received adjuvant chemotherapy. Fourteen of these patients were contacted. Of the 10 remaining patients desiring pregnancy, 8 (80%) had 11 successful spontaneous pregnancies, one required in-vitro fertilization, and the other required donor egg in-vitro fertilization, resulting in 14 live births. All 14 patients had normal menstrual cycles within one year of completing chemotherapy. ConclusionsOverall survival was 100% among patients with both local and advanced MOGCTs, including those who underwent fertility-sparing surgery. Fertility-sparing surgery plus adjuvant chemotherapy appeared to have little or no effect on fertility or menstrual cycles.

Bilateral Testicular Epidermoid Cysts

Testicular epidermoid cysts are the most common benign tumors of the testes, but account for only 1-2% of all testicular tumors. In a young man presenting with a testicular mass, a high index of suspicion must be maintained for the malignant testicular germ cell tumor, which is 50-times more common than testicular epidermoid cyst. Bilateral testicular epidermoid cysts are a very rare condition, with only a few reports in the literature. It is extremely important in this condition to make a correct pre-operative diagnosis on imaging to enable a testis-sparing surgery.