Malignant Germ Research Articles

Nomograms to predict the prognosis in malignant ovarian germ cell tumors: a large cohort study

BackgroundMalignant ovarian germ cell tumors (MOGCTs) are rare gynecologic neoplasms. The use of nomograms that are based on various clinical indicators to predict the prognosis of MOGCTs are currently lacking.MethodsClinical and demographic information of patients with MOGCT recorded between 2004 and 2015 were obtained from the Surveillance, Epidemiology, and End Results database, and Cox regression analysis was performed to screen for important independent prognostic factors. Prognostic factors were used to construct predictive calculational charts for 1-year, 3-year, and 5-year overall survival (OS). The externally validated case cohort included a total of 121 MOGCT patients whose data were recorded from 2008 to 2019 from the database of the Shengjing Hospital of China Medical University.ResultsA total of 1401 patients with MOGCT were recruited for the study. A nomogram was used to forecast the 1-year, 3-year, and 5-year OS using data pertaining to age, International Federation of Gynecology and Obstetrics (FIGO) staging, histological subtype and grade, and surgical type. Nomograms have a more accurate predictive ability and clinical utility than FIGO staging alone. Internal and external validation also demonstrated satisfactory consistency between projected and actual OS.ConclusionsA nomogram constructed using multiple clinical indicators provided a more accurate prognosis than FIGO staging alone. This nomogram may assist clinicians in identifying patients who are at increased risk, thus implementing individualized treatment regimens.

An Unusual Presentation of Sacrococcygeal Germ Cell Tumor With Autoimmune Hemolytic Anemia as a Paraneoplastic Syndrome

The tumors that induce autoimmune hemolytic anemia (AIHA) are usually hematological neoplasms such as malignant lymphoma and chronic lymphocytic leukemia. AIHA associated with germ cell tumors is very rare with literature limited to case reports with most of them reported with ovarian dermoid, which abated with the removal of the tumor. We report an unusual presentation of AIHA with malignant sacrococcygeal germ cell tumor in a 3-year-old child, which rapidly disappeared after the excision of a sacrococcygeal teratoma.

Fertility sparing surgery in malignant ovarian Germ cell tumor (MOGCT): 15\xa0years experiences

AimWe aim to evaluate the reproductive outcome of fertility-sparing surgery and chemotherapy among young women diagnosed with MOGCT of any stage.MethodsIn the current retrospective study we evaluated 79 patients with malignant ovarian germ cell tumors (MOGCT) who visited at Imam Center, Vali-e-asr Hospital, Gynecologic Oncology department during 2001–2016. Reproductive outcomes (menstruation status and childbearing) followed fertility-preserving surgery and adjuvant chemotherapy by filling questionnaires. Statistical analysis was done with SPSS software, Chi-Square Tests were done, and significance was determined at P ≤ 0.05. Results among 79 young women who underwent fertility-sparing treatment, 72 patients followed up for reproductive outcome, and 7 patients excluded because of death (3 cases), XY genotyping (3 cases), and bilateral ovarian involvement (1 case). The mean age at presentation was 23 years. (Range: 19–33 years). The 5 and 10-year disease-free survival rate was 87% and 94.4%, respectively. The overall survival rate (OSR) was 94.4% at 5 and 10 years. Regular menstruation recovered in 60 of 72 patients after treatment (83%). All patients without adjuvant chemotherapy experienced regular menstruation, while normal menstruation was retrieved in 78% in the adjuvant chemotherapy group at the end of treatment. This retrieval of regular menstruation was not dependent on the age or number of chemotherapy cycles. 19 of 26 patients who attempted pregnancy were led to delivery (73%). No one required infertility treatments. The mean of chemotherapy cycles is related to a successful pregnancy.ConclusionWe showed patients with MOGCT could become pregnant and give birth if they desire. The advanced tumor stage wasn't the convincing factor for avoiding fertility preservation. Fertility sparing surgery with adjuvant chemotherapy is a safe treatment and results in a high fertility rate.

The effect of fertility-sparing surgery on sexuality and global quality of life in women with malignant ovarian germ cell and sex cord stromal tumors: an analysis of the CORSETT database of the AGO study group

PurposeMalignant ovarian germ cell (MOGCT) and sex cord stromal tumors (SCST) are ovarian neoplasms that affect disproportionally young women. Little is known about the impact of surgical and adjuvant management of these patient’s sexual life. This study investigated the effect of fertility-sparing surgery on sexual activity and global quality of life (gQoL) in women with MOGCT and SCST.MethodsCORSETT was an observational, multicenter, mixed retrospective/prospective cohort study of the AGO study group. Women of any age who had been diagnosed with MOGCTs and SCSTs between 2001 and 2011 were asked to complete the Sexual Activity Questionnaire (SAQ) and the EORTC QLQ-C30.ResultsIn total, 355 patients were included. Of these, 152 patients with confirmed histological diagnosis had completed the questionnaires. A total of 106 patients were diagnosed with SCST and 46 with MOGCT.Totally, 83 women (55%) were sexually active. After fertility-sparing surgery, patients had a 2.6 fold higher probability for being sexually active than after non-fertility-conserving treatment (unadjusted odds ratio (OR) 2.6, p = 0.01). After adjustment for age, time since diagnosis, FIGO stage, histology and phase of disease, the OR dropped to 1.8 (p = 0.22).Of the sexually active patients, 35 (42%) reported high levels of discomfort during intercourse; 38% after fertility-sparing; and 58% after non-fertility-sparing surgery (adjusted OR 2.8, p = 0.18).Women with fertility-conserving treatment reported a significantly better global QoL (Fadj 2.1, 6.2 points difference, p = 0.03) but not more pleasure during intercourse than women without fertility-sparing surgery (Fadj 0.4, p = 0.52).ConclusionFertility preserving approaches should be offered to every patient, when oncologically acceptable.

УЗ-признаки герминогенных опухолей яичников у беременных перед хирургическим лечением или химиотерапией

The problem of ovarian tumor differential diagnosis is solved using comprehensive ultrasound examination at different levels of efficiency. However, ultrasound imaging is an operator-dependent technique due to subjective interpretation of results. The study was aimed to assess the ultrasound signs of benign and malignant ovarian germ cell tumors (OGCTs) in pregnant women in order to determine the feasibility of surgical treatment and chemotherapy. The study was carried out using the logistic regression models. A group of 199 pregnant women with benign and malignant OGCTs were enrolled. Of them, 183 patients had benign, and nine patients had malignant tumors. In order to assess menstrual function and fertility, seven pregnant women were enrolled, who had previously received treatment for malignant OGCTs. Pre-operative assessment results were compared with morphological assessment data. Organ-preserving surgical treatment was performed (unilateral adnexectomy); if necessary, the patients received cisplatin-based chemotherapy. Perinatal outcomes were assessed. The median observation time between the malignant OGCT detection and the end of the study was 66 months (12–240 months). It was found that comprehensive ultrasound examination and logistic regression models (sensitivity 100%, specificity 92.3%, overall accuracy 92.8%) enabled differential diagnosis of benign and malignant OGCTs. The number of unnecessary surgical procedures in patients with benign OGCTs was been limited, the pregnancy and childbirth outcomes were improved. Nine pregnant women received organ-preserving surgical treatment for malignant OGCTs, and three patients received chemotherapy after surgery, which allowed the patients to realize their reproductive potential.

Abstract A04: Childhood cancer incidence among specific Asian and Pacific Islander populations in the U.S.

Abstract Background: We sought to explore variation in childhood cancer incidence rates among specific Asian and Pacific Islander (API) groups. Despite high genetic diversity in this region of the world, API groups in the United States are often combined into a single race/ethnic group. Methods: The Surveillance, Epidemiology, and End Results (SEER) Detailed Asian/Pacific Islander (2000-Centered) data was used for this analysis. Cancer diagnoses occurring between January 1998 to December 2002 from 14 SEER registries were included. Detailed racial/ethnic population data from the 2000 census was used to calculate incidence rates for individual races with at least 500,000 individuals. We also combined this data into groups based on geographic regions and genetic similarity, which included East Asia (China, Japan, Korea; n=377 cases), Southeast Asia (Vietnam, Laos, Cambodia; n=136 cases), Asian Indian/Pakistan (n=163 cases), Oceania (Guam, Samoa, Tonga; n=29 cases), and the Philippines (n=199 cases). Incidence rate ratios (IRR) and 95% confidence intervals (CI) were calculated comparing each API regional group to non-Hispanic Whites (NHW), and each API regional group to East Asians. Results: Incidence rates among detailed Asian and Pacific Islander groups varied. Acute lymphoblastic leukemia (ALL) was significantly lower in children of SE Asian (IRR 0.59, 95% CI 0.42, 0.82) and Filipino (IRR 0.73, 95% CI 0.57, 1.00) descent compared to non-Hispanic Whites. Acute myeloid leukemia (AML) was more common among children from Oceania compared to NHW (IRR 3.44, 95% CI 1.63, 7.28). Central nervous system (CNS) cancers were less common among East Asian (IRR 0.74, 95% CI 0.58, 0.96), SE Asian (IRR 0.45, 95% CI 0.28, 0.73), and Filipino (IRR 0.48, 95% CI 0.32, 0.72) children compared to NHW. When comparing the incidence of cancers among API regions, few clear patterns emerged. The incidence of AML in children from Oceania was nearly four times that in East Asians (IRR 3.88, 95% CI 1.64, 9,.11), though roughly the same among all other regions. The incidence rates of ALL (IRR 0.63, 95% CI 0.41, 0.97) and malignant gonadal germ cell tumors (IRR 0.29 95% CI 0.08, 0.97) were lower in SE Asians compared to East Asians. Lymphoma was twice as common in Asian Indians/Pakistani children compared to East Asians (IRR 2.13, 95% CI 1.33, 2.29). Conclusions: The variation observed in cancer incidence patterns among these groups is important and may indicate differences in underlying etiology and/or exposure patterns. These findings highlight possible disparities in cancer incidence between specific API groups. Citation Format: Kristin J. Moore, Aubrey K. Hubbard, Lindsay A. Williams, Logan G. Spector. Childhood cancer incidence among specific Asian and Pacific Islander populations in the U.S. [abstract]. In: Proceedings of the AACR Special Conference on the Advances in Pediatric Cancer Research; 2019 Sep 17-20; Montreal, QC, Canada. Philadelphia (PA): AACR; Cancer Res 2020;80(14 Suppl):Abstract nr A04.

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

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.

Incidence of malignant mixed ovarian germ cell tumours in a tertiary care hospital: A five year retrospective study

Incidence of malignant mixed ovarian germ cell tumours in a tertiary care hospital: A five year retrospective study

Malignant Ovarian Germ Cell Tumors. Literature Review

Malignant Ovarian Germ Cell Tumors. Literature Review

Persistently elevated alpha-fetoprotein associated with chronic hepatitis B during chemotherapy for malignant ovarian germ cell tumors: a case series and a review of the literature

BackgroundAlpha-fetoprotein (AFP) plays a crucial role in the management of malignant ovarian germ cell tumors (MOGCTs) and is an important reference index for chemotherapy termination. However, a high level of AFP can also be caused by several benign diseases, causing confusion and impacting treatment decisions.Case presentationWe described four patients who were diagnosed with MOGCTs; the histologic subtype in two of them was mixed MOGCTs (yolk sac tumor with mature teratoma), while the rest was immature teratoma. The serum AFP level of each patient was abnormal before surgery, but it was still persistently elevated around 300 ng/ml even after additional cycles of chemotherapy. All patients were thoroughly evaluated, but we did not find any evidence of disease progression or residual tumors. Liver function tests were normal, whereas serum assays revealed positive of hepatitis B surface antigen, and two patients had a high level of HBV-DNA. They were chronic carriers of hepatitis B virus and never received relevant treatments. Then they were managed with tumor surveillance and the antiviral treatment. Thereafter, the AFP levels presented a slowly decreasing trend.ConclusionsFalse elevation of AFP in MOGCTs is a rare condition and should be assessed with a comprehensive evaluation to avoid unnecessary treatments.

Ovarian Cancer

Ovarian cancer is a catchall term encompassing a wide variety of relatively uncommon heterogeneous diseases notable for having a gradual decrease in incidence over the past decade. Epithelial ovarian carcinoma predominates, especially the high-grade serous variant distinguished by few reliable signs or symptoms, exceptional difficulty in early detection, and poor prognosis despite aggressive surgery and chemotherapy. The recent discovery that many of these tumors actually arise from the fallopian tube has led to rapid acceptance of opportunistic salpingectomy as a convenient, low-risk method of prevention. Other advances in genetic testing, minimally invasive surgery, and novel-targeted therapies have greatly expanded the management of this disease in the past few years. Sex cord-stromal tumors, chiefly the granulosa cell variant, are rarely encountered, occur across a wide range of ages, are largely impervious to chemotherapy, and yet highly curable. Malignant ovarian germ cell tumors are even rarer, generally present during the teens, are exquisitely sensitive to chemotherapy, and also very curable. Providing expert care to women with ovarian cancer has become increasingly complex due to emerging practice-changing data at multiple points of diagnosis, treatment, and surveillance. Fortunately, the past few years have greatly expanded our understanding of this dreaded disease. This review contains 5 tables, and 29 references. Key Words: epithelial ovarian cancer, maintenance therapy, neoadjuvant chemotherapy, primary debulking surgery

Progress of malignant ovarian germ cell tumor

Malignant ovarian germ cell tumor (MOGCT) is a kind of primordial germ cell tumors deriving from embryonic gonads. It mainly occurs in adolescent women and is characterized with the rapid growth and high degree of malignancy. The traditional treatment methods include whole uterus and bilateral accessory resection or tumor cytoreductive surgery, although the patients have recovered after surgery, they lose their reproductive function. With the progress of chemotherapy research, the treatment mode of MOGCT has undergone fundamental changes, which provides new possibility of maintaining the reproductive function of patients with MOGCT. Key words: Malignant ovarian germ cell tumor; Prognosis; Treatment outcome

46, XY pure gonadal dysgenesis with malignant mixed germ cell tumor: a case report and literature review

46, XY pure gonadal dysgenesis with malignant mixed germ cell tumor: a case report and literature review

METASTATIC CARDIAC TUMORS: LITERATURE REVIEW AND OWN OBSERVATION OF TESTICULAR TUMOR METASTASIS IN THE RIGHT VENTRICLE OF THE HEART

Tumors of the heart are uncommon and usually benign (in 93% cases myxomas are observed). More often secondary, metastatic tumors are detected in the heart, as a rule, at pronounced progression of the malignant neoplasm with multiple lesions of other internal organs (lung, pleura, liver, etc.). Literature review on cardiac metastases of different tumors is given. Own observation of a young man with rare single metastasis of malignant testicular germ cell tumor with predominance of embryonic carcinoma in the right ventricle of the heart is presented; the primary tumor was detected after metastasis revealing. The diagnostic algorithm using routine histological study supplemented with immunohistochemistry, including detection of cytokeratin pan, cytokeratin5/6, cytokeratin7, CD30, OCT4, TTF-1, hCG, and AFP markers expression, is described.

Prognostic significance of residual disease in advanced stage malignant ovarian germ cell tumors

Objective To investigate the prognostic significance of complete gross resection following cytoreductive surgery for patients with advanced stage malignant ovarian germ cell tumors. Methods The National Cancer Data Base was accessed and patients diagnosed with an advanced stage (II-IV) malignant ovarian germ cell tumor who underwent primary cytoreductive surgery between 2011 and 2014 were selected for further analysis. For analysis purposes two groups were formed: patients with complete gross resection and those with macroscopic residual disease. Demographic and clinico-pathological characteristics were compared with the chi-square and Mann–Whitney U test. Univariate survival analysis was performed with the log-rank test after generation of Kaplan–Meier curves, while a Cox proportional hazard model was constructed to evaluate mortality after controlling for confounders. Results A total of 343 patients who met the inclusion criteria were identified. Residual disease status was available for 276 patients: the rate of complete gross resection was 69.2 %. By univariate analysis there was no difference in overall survival between patients in the complete gross resection and macroscopic residual disease groups, P= 0.26; 3-year overall survival rates: 86.4 % and 82.8 %, respectively. No difference in overall survival was noted following stratification by histology; P = 0.64 and P = 0.24 for dysgerminoma and non-dysgerminoma tumor groups. After controlling for stage IV disease, histology and the administration of chemotherapy, macroscopic residual disease was not associated with a worse mortality (HR: 1.22, 95% CI: 0.61 to 2.46). Conclusions Macroscopic residual disease following primary cancer-directed surgery was not associated with a worse prognosis in a cohort of patients with advanced stage malignant ovarian germ cell tumors.

Minimally invasive staging for apparent stage I malignant ovarian germ cell tumors

Minimally invasive staging for apparent stage I malignant ovarian germ cell tumors

Childhood malignant ovarian germ cell tumors: a single institution experience

Childhood malignant ovarian germ cell tumors: a single institution experience

Fertility-sparing surgery in advanced stage malignant ovarian germ cell tumor: a case report

BackgroundMalignant ovarian germ cell tumor is a rare type of disease, which generally has a good prognosis due to the high chemosensitivity of this type of tumor.Fertility preservation is an important issue because malignant ovarian germ cell tumor commonly affects young women. Although conservation is the standard for early stage, it becomes more debatable as the disease progresses to more advanced stages.Aim: Report the case of a patient with an International Federation of Gynecology and Obstetrics Stage IIIc malignant ovarian germ cell tumor, who had conservative surgery and chemotherapy with a good fertility outcome.Case presentationA 23-year-old North African woman with a left malignant ovarian germ cell tumor stage IIIc was treated by left adnexectomy and omentectomy followed by chemotherapy. A 15-year follow-up showed no signs of relapse, and she completed three full-term natural pregnancies.ConclusionsMalignant ovarian germ cell tumor is a rare ovarian tumor with a good prognosis. It is usually associated with a good fertility outcome in early stages. However, due to the rarity of the disease in advanced stages, the fertility outcome for this group of patients is not clear. This lack of data surrounding advanced stages points to the need for a meta-analysis of all published cases.

Yolk sac tumor in a 20 years old patient

Yolk sac tumor or endodermal sinus tumor is a rare malignant ovarian germ cell tumor (is a borderline tumor) diagnosed in young females up to 25 years old. Histopathological it resembles the mesenchyme of the primitive yolk sac. Microscopically it presents the following triad: Schiller-Duval bodies, reticular aspect and PAS+ hyaline droplets (α-fetoprotein). The diagnosis of Yolk sac tumor is made by dosing serum α-fetoprotein, ultrasound and MRI – DWI imaging. It requires surgical treatment, followed by chemotherapy (new therapies – platin or carboplatin, etoposide, bleomycin) [1]. Survival prognosis at 5 years is of 80% for stage I. Differential diagnosis is with Brenner tumor, ovarian clear cell carcinoma, dysgerminoma, malignant teratomas, androblastoma, dermoid cyst.

Ovarian Yolk Sac Tumour in a Girl − Case Report

Yolk sac tumours are rare ovarian malignancies accounting for less than 1% of malignant ovarian germ cell tumours. They are mostly seen in adolescents and young women and are usually unilateral making fertility preservation imperative. Raised alpha-feto protein level is the hallmark of this tumour. We describe stage III yolk sac tumour in a girl child.