Malignant Ovarian Germ Cell Tumors Research Articles

609P Effect of lymphadenectomy on fertility and prognostic outcomes in adult patients with clinically early-stage malignant ovarian germ cell tumours during fertility-sparing surgery: A retrospective multicenter study

Malignant ovarian germ cell tumors(MOGCT), as a rare type of the ovarian malignancies, have an excellent prognosis when treated by surgery followed by platinum-based chemotherapy. Based on the current clinical practice guidelines, systematic lymphadenectomy (LND) can be omitted for child and adolescent patients with early-stage MOGCT. However the clinical role of LND for adult patients with early-stage MOGCT remains ambiguous. The purpose of this retrospective multicenter study was to evaluate the effect of systematic LND on prognostic and fertility outcomes in adult patients with clinically stage I malignant ovarian germ cell tumors MOGCTs who received fertility-sparing surgery (FSS) treatment. This study included 168 adult MOGCTs patients who underwent FSS and were deemed to have disease clinically confined to the ovary during surgery (stage I) between 2005 to 2020 from four major university-teaching hospitals. The Propensity score matching (PSM) algorithm was adopted to reduce the bias resulting from differences of clinical characteristics. Of the 168 patients, 92 (54·8%) underwent LND and 76 (45·2%) did not. Sixty patients attempted pregnancy, with the pregnancy rate of 81·7% and live birth rate of 66·7%. In the before PSM cohort, no-LND patients showed a better pregnancy rate than LND patients (93.3% versus 70.0%, P=0.020). However, in the after PSM cohort, there were no significant differences in pregnancy rates (92.9% versus 76.9%, P=0.326). Univariate logistic regression analysis showed that age ≤25 years (OR 3.50, 95%CI 1.11-11·01, P=0.032) correlated with better live birth. Regarding the prognosis, only 3 (0.18%) patients had recurrence and no patient died after a median follow-up of 65 months. Disease-free survival (DFS) was similar between patients treated with LND and no-LND in the before and after PSM cohorts(P>0.05). LND provided no significant benefit on both prognostic and fertility outcomes for adult patients with clinically early-stage (stage I) MOGCTs who underwent FSS in our study. Meanwhile, age ≤25 years was associated with a better live birth rate.

Effect of lymphadenectomy on fertility and prognostic outcome in adult patients with clinically early-stage malignant ovarian germ cell tumors during fertility-sparing surgery: A retrospective multicenter study (178)

<b>Objectives:</b> Malignant ovarian germ cell tumors (MOGCTs), as a rare type of ovarian malignancies, are commonly present in children as well as young women and have an excellent prognosis when treated by surgery, followed by platinum-based chemotherapy. Based on the current National Comprehensive Cancer Network (NCCN) clinical practice guidelines, systematic lymphadenectomy (LND) can be omitted for child and adolescent patients with early-stage MOGCTs. However, the clinical role of LND for adult patients with early-stage MOGCTs remains ambiguous. The purpose of this retrospective multi-center study was to evaluate the effect of systematic LND on prognostic and fertility outcome in adult patients with clinically stage I MOGCTs who received fertility-sparing surgery (FSS) treatment and to investigate the clinical-pathologic factors associated with fertility outcomes. <b>Methods:</b> This study included adult MOGCTs patients who underwent fertility-sparing surgery (FSS) and were deemed to have disease clinically confined to the ovary at the time of the surgery (stage I) between January 2005 to June 2020 from four medical institutions. All patients were classified into two groups: the LND group (patients who underwent systematic pelvic and/or para-aortic lymphadenectomy) and the no-LND group (patients who did not undergo lymphadenectomy). Propensity score matching (PSM) algorithm was adopted to reduce the bias resulting from the differences in clinical characteristics between the two groups. The Chi-square test and the Kaplan-Meier analysis were used to compare the fertility outcome as well as the disease-free survival (DFS). The univariate logistic regression analysis was performed to evaluate the clinical-pathologic factors associated with fertility outcomes. <b>Results:</b> A total of 168 adult patients with clinically stage I MOGCTs who received FSS treatment were enrolled in the study. There were 92 (54.8%) patients in the LND group and 76 (45.2%) patients in the no-LND group, with a median age of 26 years (range:18-44 years). Only two (2.6%) patients had lymph nodal metastasis. Among a total of 60 patients who attempted pregnancy, 49 (81.7%) succeeded to conceive, and 40 (66.7%) delivered successfully. In the before PSM cohort, patients in the no-LND group showed a better pregnancy rate than the LND group (93.3% vs 70.0%, p=0.020). However, in the after PSM cohort, there was no significant difference in pregnancy rates between no-LND and LND groups (92.9% vs 76.9%, p=0.326). Univariate logistic regression analysis showed that age ≤25 years (OR: 3.50, 95% CI: 1.11-11.01, p=0.032) correlated with a better live birth rate. Regarding the prognostic outcome, only three (0.18%) patients had recurrence after a median follow-up of 65 months and no patient died after surgery. In the before and after PSM cohort, the 5-year DFS for patients in the LND and the no-LND groups were 97.6% versus 97.9% (p=0.707) and 89.3% versus 95.0% (p=0.335), respectively. There was no significant difference in DFS between the LND and no-LND groups in the before and after PSM cohorts. <b>Conclusions:</b> Lymphadenectomy provided no significant benefit in both prognostic and fertility outcomes for adult patients with clinically early-stage (stage I) MOGCTs who underwent FSS in our study. Moreover, age ≤25 years was associated with favorable fertility outcomes for early-stage MOGCTs patients after FSS treatment. Our study suggests that abandonment of LND seems to be a preferred choice for clinically stage I adult MOGCTs patients with FSS treatment.

Early adjuvant chemotherapy administration for patients with advanced stage (III-IV) malignant ovarian germ cell tumors is associated with a survival benefit (153)

Objectives: Malignant ovarian germ cell tumors (MOGCTs) are usually chemo-sensitive but characterized by rapid tumor growth. While for patients with epithelial ovarian carcinoma, delay in adjuvant chemotherapy administration is associated with worse oncologic outcomes, data for patients with MOGCT are scarce. The present study aimed to evaluate the impact of adjuvant chemotherapy administration timing on the survival of patients with advanced-stage MOGCTs who underwent surgical resection. Methods: The National Cancer Database (NCDB) was accessed. Patients with no history of another tumor diagnosed between 2004 and 2015 with stage III-IV MOGCT, who underwent surgical resection and received multi-agent chemotherapy, had known surgery-chemotherapy intervals, and at least one month of follow-up were identified. Overall survival (OS) was compared between patients who received chemotherapy 1-4 weeks (early administration group) and 4-12 weeks (late administration group) from surgery with the log-rank test following generation of Kaplan-Meier curves. A Cox model was constructed to control for a priori selected confounders. Results: A total of 622 patients with advanced-stage MOGCT who met the inclusion criteria were identified. The median surgery-chemotherapy interval was 25 days (IQR: 18). The early and late chemotherapy administration groups included 393 (63.2%) and 229 (36.8%) patients, respectively. Patients in the early administration group were younger (median age: 22 vs 24 years, p<0.001) compared to those in the late administration group. However, the two groups were comparable in terms of patient race, insurance status, presence of medical comorbid conditions, tumor histology, and disease stage (p>0.05). By univariate analysis, patients in the early administration group had better OS than those in the late administration group (p=0.004); 5-year OS rates were 87.5% and 77.6%, respectively. After controlling for patient age, race, presence of medical comorbid conditions, tumor histology, and disease stage, late chemotherapy administration was associated with worse survival (HR: 1.99, 95% CI: 1.34, 3.01). Conclusions: For patients with advanced-stage MOGTCs, administration of chemotherapy within four weeks from surgery should be strongly considered since delay may be associated with worse overall survival. Objectives: Malignant ovarian germ cell tumors (MOGCTs) are usually chemo-sensitive but characterized by rapid tumor growth. While for patients with epithelial ovarian carcinoma, delay in adjuvant chemotherapy administration is associated with worse oncologic outcomes, data for patients with MOGCT are scarce. The present study aimed to evaluate the impact of adjuvant chemotherapy administration timing on the survival of patients with advanced-stage MOGCTs who underwent surgical resection. Methods: The National Cancer Database (NCDB) was accessed. Patients with no history of another tumor diagnosed between 2004 and 2015 with stage III-IV MOGCT, who underwent surgical resection and received multi-agent chemotherapy, had known surgery-chemotherapy intervals, and at least one month of follow-up were identified. Overall survival (OS) was compared between patients who received chemotherapy 1-4 weeks (early administration group) and 4-12 weeks (late administration group) from surgery with the log-rank test following generation of Kaplan-Meier curves. A Cox model was constructed to control for a priori selected confounders. Results: A total of 622 patients with advanced-stage MOGCT who met the inclusion criteria were identified. The median surgery-chemotherapy interval was 25 days (IQR: 18). The early and late chemotherapy administration groups included 393 (63.2%) and 229 (36.8%) patients, respectively. Patients in the early administration group were younger (median age: 22 vs 24 years, p<0.001) compared to those in the late administration group. However, the two groups were comparable in terms of patient race, insurance status, presence of medical comorbid conditions, tumor histology, and disease stage (p>0.05). By univariate analysis, patients in the early administration group had better OS than those in the late administration group (p=0.004); 5-year OS rates were 87.5% and 77.6%, respectively. After controlling for patient age, race, presence of medical comorbid conditions, tumor histology, and disease stage, late chemotherapy administration was associated with worse survival (HR: 1.99, 95% CI: 1.34, 3.01). Conclusions: For patients with advanced-stage MOGTCs, administration of chemotherapy within four weeks from surgery should be strongly considered since delay may be associated with worse overall survival.

Fertility and prognosis assessment between bleomycin/etoposide/cisplatin and paclitaxel/carboplatin chemotherapy regimens in conservative treatment of malignant ovarian germ cell tumor: a multicenter and retrospective study (096)

Objectives: To evaluate the impact of bleomycin/etoposide/cisplatin (BEP) and paclitaxel/carboplatin (TC) chemotherapy regimens on fertility and prognostic outcomes among patients with malignant ovarian germ cell tumor (MOGCT) who received fertility-sparing surgery (FSS). Methods: The study included 213 women with MOGCT who underwent FSS. We performed a 3:1 propensity score matching between the BEP and TC groups. The Chi-square test and the Kaplan-Meier method were used to compare the fertility outcome, disease-free survival (DFS), and overall survival (OS). The Cox proportional hazards regression analysis was used to identify risk factors of DFS. Results: A total of 185 (86.9%) patients underwent BEP chemotherapy, and 28 (13.1%) patients underwent TC chemotherapy. The median age was 22 years (range: 8-44 years), and the median follow-up was 63 months (range: 1-191 months). Fifty-one (29.3%) patients had a pregnancy plan, 43 (84.3%) patients got pregnant, and 35 (81.4%) patients delivered successfully. Fourteen (6.6%) patients experienced recurrence, and four (1.9%) patients died. In the before and after matching cohorts, there were no significant differences in spontaneous abortion, selective termination of pregnancy, during pregnancy status, and live birth between BEP and TC groups (p >0.05). Also, there were no significant differences in DFS and OS between BEP and TC groups (p >0.05). The clinical staging is the only risk factor of postoperative recurrence (HR: 21.3, p <0.001). Conclusions: There was no significant difference between the effects of BEP and TC regimens on the fertility and prognosis of MOGCT patients who received FSS. The TC regimen seems to be a viable alternative to the BEP regimen for MOGCT patients. Objectives: To evaluate the impact of bleomycin/etoposide/cisplatin (BEP) and paclitaxel/carboplatin (TC) chemotherapy regimens on fertility and prognostic outcomes among patients with malignant ovarian germ cell tumor (MOGCT) who received fertility-sparing surgery (FSS). Methods: The study included 213 women with MOGCT who underwent FSS. We performed a 3:1 propensity score matching between the BEP and TC groups. The Chi-square test and the Kaplan-Meier method were used to compare the fertility outcome, disease-free survival (DFS), and overall survival (OS). The Cox proportional hazards regression analysis was used to identify risk factors of DFS. Results: A total of 185 (86.9%) patients underwent BEP chemotherapy, and 28 (13.1%) patients underwent TC chemotherapy. The median age was 22 years (range: 8-44 years), and the median follow-up was 63 months (range: 1-191 months). Fifty-one (29.3%) patients had a pregnancy plan, 43 (84.3%) patients got pregnant, and 35 (81.4%) patients delivered successfully. Fourteen (6.6%) patients experienced recurrence, and four (1.9%) patients died. In the before and after matching cohorts, there were no significant differences in spontaneous abortion, selective termination of pregnancy, during pregnancy status, and live birth between BEP and TC groups (p >0.05). Also, there were no significant differences in DFS and OS between BEP and TC groups (p >0.05). The clinical staging is the only risk factor of postoperative recurrence (HR: 21.3, p <0.001). Conclusions: There was no significant difference between the effects of BEP and TC regimens on the fertility and prognosis of MOGCT patients who received FSS. The TC regimen seems to be a viable alternative to the BEP regimen for MOGCT patients.

Oncology and Reproductive Outcomes Over Sixteen Years of Malignant Ovarian Germ Cell Tumors Treated with Fertility Sparing Surgery

Malignant Ovarian Germ Cell Tumors (MOGCT) are rare and frequently occur in the young reproductive age and the oncologic and reproductive outcome after Fertility-Sparing Surgery (FSS) this disease is still limited.

Grade 4 immature teratoma followed by portal vein embolization and hepatectomy with recurrence: A case report

Introduction: Immature teratomas or in another way malignant germ cell tumors are considered a very rare type of aggressive ovarian cancers. Of teratomas it represents 1%. In ovarian cancers it still presents 1% and as an overall it presents 35.6% of all malignant ovarian germ cell tumors. In most cases it has been found during the first two decades of life. Case Report: The present case describes a case of a patient who was diagnosed with immature teratoma that was treated surgically and discovered sooner to have a liver metastasis that was treated with hepatic embolization and hepatectomy. Furthermore, she developed recurrence with lung metastasis that was intended to be treated with chemotherapy. Conclusion: Prognosis of this type of cancer is reported to be good as long as it is discovered and treated early in the course. Patients usually present before metastasis. In terms of liver metastasis our patient had a hepatic embolization followed by a right hepatectomy which when compared to other reported cases almost all had a hepatectomy without embolization. Five months later our patient presented with lung metastasis which is uncommon specially after the patient had a right hepatectomy. Based on these findings our patient had a very short disease-free period which is not typical for this kind of disease. Platinum-based chemotherapy is considered the standard of care as an adjuvant therapy. This patient showed resistance to cisplatin where up to our knowledge there were no reported cases that had resistance to this regimen.

Fast-growing immature ovarian teratoma during pregnancy: a case report and a review of the literature

BackgroundImmature ovarian teratoma is one of the three common malignant ovarian germ cell tumors. However, immature ovarian teratoma in pregnancy is very rare. Due to the rare occurrence, there is little evidence regarding its diagnosis, optimal management, and prognosis. Hence, we present a case of immature teratoma diagnosed during pregnancy, and analyze its clinicopathological features, management and prognosis.Case presentationA 28-year-old woman underwent a sonographic examination revealed no abnormality in the bilateral adnexal area before 29 weeks gestational age (WGA). At 29 WGA, ultrasound demonstrated a 9.7 × 8.5 × 6.4 cm complex structure in the left adnexal area. At 30 WGA, repeated ultrasound revealed rapid growth of tumor mass, measuring 25.0 × 15.0 × 13.7 cm. An elective cesarean section combined with exploratory laparotomy was performed at 33 WGA. Intraoperative frozen pathological examination suggested left ovarian immature teratoma. Then, she underwent a complete staging surgery. Subsequently, the patient received 4 cycles of bleomycin-etoposide-cisplatin (BEP) chemotherapy. After 18 months of follow-up, there is no sign of tumor recurrence till now.ConclusionsThis case report suggests that the benefits and risks of timely treatment for patients and fetuses should be fully assessed by a multidisciplinary team. The early diagnosis, the timing of surgery and chemotherapy, the choice of chemotherapy for BEP will determine the prognosis. Surgery and combination chemotherapy with BEP play an important role in the treatment of immature teratomas in pregnancy, and could gain successful and satisfactory outcomes for mother and fetus.

Grade 4 immature teratoma followed by portal vein embolization and hepatectomy with recurrence: A case report

Introduction: Immature teratomas or in another way malignant germ cell tumors are considered a very rare type of aggressive ovarian cancers. Of teratomas it represents 1%. In ovarian cancers it still presents 1% and as an overall it presents 35.6% of all malignant ovarian germ cell tumors. In most cases it has been found during the first two decades of life. Case Report: The present case describes a case of a patient who was diagnosed with immature teratoma that was treated surgically and discovered sooner to have a liver metastasis that was treated with hepatic embolization and hepatectomy. Furthermore, she developed recurrence with lung metastasis that was intended to be treated with chemotherapy. Conclusion: Prognosis of this type of cancer is reported to be good as long as it is discovered and treated early in the course. Patients usually present before metastasis. In terms of liver metastasis our patient had a hepatic embolization followed by a right hepatectomy which when compared to other reported cases almost all had a hepatectomy without embolization. Five months later our patient presented with lung metastasis which is uncommon specially after the patient had a right hepatectomy. Based on these findings our patient had a very short disease-free period which is not typical for this kind of disease. Platinum-based chemotherapy is considered the standard of care as an adjuvant therapy. This patient showed resistance to cisplatin where up to our knowledge there were no reported cases that had resistance to this regimen.

Utility of frozen section in pediatric and adolescent malignant ovarian nonseminomatous germ cell tumors: A report from the children's oncology group

PurposeIn adult women, most malignant ovarian tumors are epithelial in origin. The use of intra-operative frozen section to distinguish between benign and malignant histology is reliable in guiding operative decision-making to determine the extent of surgical staging required. Pediatric and adolescent patients with ovarian masses have a much different spectrum of pathology with most tumors arising from germ cell precursors. This review was undertaken to assess the concordance between the intra-operative frozen section and the final diagnosis as an aid to guide extent of surgical staging in a group of pediatric and adolescent patients with malignant ovarian germ cell tumors. MethodsRecords of patients aged 0 to 20 years with malignant ovarian germ cell tumors enrolled on Children's Oncology Group study AGCT0132 were reviewed. Pathology reports from patients who had both intra-operative frozen section diagnosis and final paraffin section diagnosis were compared using descriptive statistics. By inclusion criteria for the study, all patients had a final diagnosis of malignancy with required yolk sac tumor, choriocarcinoma or embryonal carcinoma histology. Available central review of pathology final paraffin section slides were compared with final institution pathology reports. ResultsOf 131 eligible patients with ovarian germ cell tumors, 60 (45.8%) had both intra-operative frozen section and final paraffin section diagnoses available. Intra-operative frozen section diagnoses were classified as: incorrect diagnosis of benign tumor (13.3%), confirmation of malignancy (61.7%), immature teratoma (16.7%), germ cell tumor not otherwise specified (5%) and no diagnosis provided (3.3%). Intra-operative frozen section was incorrect in 23 of 60 (38.3%) patients evaluated. Central pathology review was concordant with the final institution pathology diagnosis in 76.3% of patients. Central pathology review identified additional germ cell tumor components in 23.7% of patients. ConclusionsIn pediatric and adolescent patients with a confirmed final diagnosis of ovarian germ cell malignancy, intra-operative frozen section diagnosis is not reliable to inform the extent of surgical staging required. Central review by an expert germ cell tumor pathologist provides important additional information to guide therapy.

Ovarian dysgerminoma in a 14-year-old presenting with an adnexal mass and elevated beta-human chorionic gonadotropin (beta-hCG)

Introduction: Ovarian germ cell tumors most commonly affect young women in the second and third decades of life. Dysgerminomas account for 30–50% of malignant ovarian germ cell tumors and are classically associated with elevated lactate dehydrogenase (LDH). Elevated human chorionic gonadotropin (hCG) in the setting of an adnexal mass in this age group may raise concern for ectopic pregnancy. It is critical to maintain a high index of suspicion for possible germ cell tumor in young women with adnexal masses to avoid unnecessary surgical spillage that might upstage a malignancy. We present a case of a 14-year-old female with adnexal mass and elevated hCG who was ultimately diagnosed with ovarian dysgerminoma. Case Report: A 14-year-old female presented to the emergency room with vaginal bleeding and altered mental status and was found to have a markedly elevated beta-hCG, normal LDH, and an 8 cm complex adnexal mass. She underwent minimally invasive surgery and was ultimately diagnosed with stage 1A dysgerminoma with abundant synctiotrophoblast giant cells. Patient remained in remission for four years until she began experiencing new irregular periods. This time she was found to have an elevated LDH, normal B-hCG, and a 10 cm pelvic mass. She underwent exploratory laparotomy, removal of pelvic mass, right salpingo-oophorectomy, pelvic lymph node debulking, and adjuvant chemotherapy with bleomycin, etoposide, and cisplatin (BEP). Conclusion: Dysgerminoma, the most common malignant ovarian germ cell tumor, may present with the uncommon profile of markedly elevated hCG and otherwise normal tumor markers. While ectopic pregnancy must be considered in this scenario, keeping dysgerminoma in the differential diagnosis of a young woman with a solid adnexal mass and elevated hCG may allow for intact removal of the mass, possibly helping to avoid adjuvant chemotherapy.

Impact of Optimal Therapy and Prognostic Factors in Malignant Germ Cell Tumors of Ovary: 20 Years' Institutional Experience.

The objective of this study is to analyze the impact of clinicopathological and treatment-related factors on survival in patients with malignant ovarian germ cell tumor. A total of 253 patients of ovarian germ cell malignancy were retrospectively reviewed during 2000-2019. Out of these, 111 had primary treatment at our institute, which is a dedicated regional cancer center. The remaining 142 were operated elsewhere and were referred to us for adjuvant chemotherapy or with recurrent disease. The clinicopathological and treatment-related characteristics were analyzed for association with tumor persistence/recurrence or death. Among them, 107 were dysgerminomas; 60 had endodermal sinus tumor, 53 mixed germ cell tumors, and 31 immature teratoma; and one each had embryoma and primitive germ cell tumor. The median follow-up period was 19months (range 0-214). Median time to recurrence or progression was 5months. Forty-nine patients (19.4%) had a recurrence and there were 16 (6.3%) deaths. Five-year disease-free-survival was 71.3% and 5-year overall survival rate was 88.1%, for the entire cohort. Disease-free-survival was 90.4% and overall survival was 92.1% for patients entirely treated at the reporting institute. Sub-group analysis based on treatment adequacy showed that survival rate was 91.0% in patients who had timely and complete initial treatment versus 78.3% in patients where treatment was incomplete or delayed (p = 0.032). Factors affecting relapse were tumor histology, absence of surgical staging, presence of residual disease, inadequate response to chemotherapy, treatment outside reporting institute, and incomplete/delayed chemotherapy. Significant factors adversely affecting survival were presence of post-operative residual disease, tumor histology, incomplete response to chemotherapy, and inadequate/delayed treatment at primary setting. There was no statistically significant difference based on disease stage and whether fertility-sparing surgery or non-fertility-sparing surgery was performed. Prognosis of ovarian germ cell malignancies is excellent with timely, optimal treatment. The outcome improves significantly if managed adequately in the primary setting, involving dedicated gynecologic oncologists.

Ovarian Malignant Mixed Germ Cell Tumor Composed Mainly of a Polyembryoma Pattern With Vasculogenic Mesenchymal Tumor Components.

Ovarian germ cell tumors composed of numerous well-formed embryonal bodies have been described as exhibiting a "polyembryoma pattern." In addition, some germ cell tumors are occasionally concomitant with neoplastic vascular proliferation. These include angiosarcomas and the recently reported mediastinal vasculogenic mesenchymal tumors. A 9-yr-old Japanese girl underwent surgery for a right ovarian tumor. Histologically, the polyembryoma pattern, nongestational choriocarcinoma, and vasculogenic lesions characterized by a neoplastic repetition of embryonic vasculogenesis have been intermingled. The polyembryoma pattern consisted of numerous complete and incomplete embryonal bodies and glandular structures resembling adult-type and fetal-type intestines. Vasculogenic lesions were composed of variously developed neoplastic vessels within the myxomatous stroma, which extended well beyond one low-power (40×) microscopic field. We concluded that the vasculogenic lesion in our case was the ovarian counterpart of the mediastinal vasculogenic mesenchymal tumor. After the surgery, the patient was administered adjuvant chemotherapy and was alive with no evidence of recurrence or other malignancy at 28 mo postsurgery.

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.

Non-Gestational Ovarian Choriocarcinoma: A Rare Ovarian Cancer Subtype.

Non-Gestational Ovarian Choriocarcinoma (NGOC) is an extremely rare ovarian tumor, with an incidence of less than 0.6% of malignant ovarian germ cell tumors. Its close pathologic resemblance to Gestational Ovarian Choriocarcinoma (GOC), however, requires special attention as the treatments differ greatly. NGOC typically affects patients in late adolescence or early reproductive years. As a result, NGOCs are often misdiagnosed as ectopic pregnancies due to their common presentation of bleeding, abdominal pain, adnexal mass, and positive serum beta-HCG. On pathologic examination, the tumor is indistinguishable from GOC, and only after review of tissue for paternal genetic components can the diagnosis of NGOC be made. Imaging studies often show highly vascular lesions with further investigation with computer topography (CT) sometimes showing metastatic lesions in the lungs, pelvis, vagina, and liver. These lesions are often hemorrhagic and can lead to catastrophic bleeding. Treatment is vastly different from GOC; NGOC requires treatment with both surgical resection and chemotherapy, with Bleomycin, Etoposide, and Cisplatin (BEP) being the most used regimen. With correct diagnosis and treatment, patients can often receive fertility sparing treatment with long term survival.

Surgical management and outcomes for stage 1 malignant ovarian germ cell tumours: A UK multicentre retrospective cohort study

ObjectiveTo describe the current surgical management of stage 1 malignant ovarian germ cell tumours and correlated oncological outcomes.Study Design: We undertook a retrospective study of all stage 1 primary ovarian germ cell tumours treated in four major UK gynaecology oncology centres over 12 years. We assessed route of surgery, fertility-sparing approaches, ovarian cystectomy alone, and surgical staging and correlated these with clinical outcomes. ResultsEighty-six patients were followed-up for a median of 4.4 years (IQR 4.3). The median age was 26 (range 11–47). There were 24 (27.9%) dysgerminomas, 13 (15.1%) yolk sac tumours, 10 (11.3%) mixed germ cell tumours, and 39 (45.3%) immature teratomas. Overall survival was 96.6% (OS, 95% CI 91.9–100%), with event free survival of 81.8% (EFS, 95% CI 72.5–92.3) at 5 years.The majority had fertility-sparing surgery (93%, n = 80). In a subset of patients with immature teratoma, there was no significant difference in recurrence or survival if patients underwent unilateral cystectomy only or salpingo-oophorectomy. Laparotomy was the most common approach (n = 66, 76.7%), used more frequently for larger tumours > 10 cm. Surgical staging procedures were undertaken in 42 (48.6%) patients with no significant difference in rates of staging across histological subtypes. Peritoneal biopsies were taken in 11 (12.7%), omental assessment in 40 (46.5%) and lymphadenectomy in 10 (11.6%). There was no significant difference in EFS between patients who underwent staging procedures (83%, CI 71–98%) versus those that did not (84%, CI 72–98%). There was no significant difference in the rate of staging procedures in paediatric (42.1% 8/19) and adult (57.9% 34/67) populations. ConclusionsAcross all histologies and ages, the absence of surgical staging did not impact upon disease free or overall survival in this cohort. This study also raises the possibility of a role for ovarian cystectomy in immature teratoma. These findings warrant investigation in larger prospective studies.

Management of malignant dysgerminoma of the ovary

The evolution of treatment for malignant ovarian germ cell tumors has been one of the most successful in the history of gynecologic oncology, with dysgerminoma as the most common type of malignant ovarian germ cell tumors. Since the introduction of platinum-based chemotherapy in the 1980s, 5-year survival rates for early-stage dysgerminomas have been close to 100%, and as high as 98% for advanced stages. Despite this remarkable achievement, many questions remain in routine treatment. By performing a literature review, we aim to highlight both the current treatment of malignant dysgerminoma and unanswered questions in the modern management of this disease. These issues relate firstly to surgical therapy, such as the role of routine omentectomy and lymphadenectomy, the value of complete surgical resection, and the possibility of fertility-sparing surgery. Second, chemotherapy and the question of the possibility of de-escalation in early stages and the potential of neoadjuvant chemotherapy in advanced stages will be addressed. Finally, a brief overview of the current developments of new drug treatment regimens will be given.

A Case Report on Malignant Ovarian Germ Cell Tumor

Introduction: A germ cell is a type of Tumor that arises from germ cell (GCT). Germ cell tumors are both cancerous and benign. The gonads contains majority of germ cell (ovary and testis). GCT that arise outside the gonads could be the result of embryo devlopment errors.&#x0D; Clinical Findings: Abdominal mass without pain, backache, and weight loss.&#x0D; Diagnostic Evaluation: HCG and alphafetoprotein level in the blood identifying women with malignant ovarian germ cell tumor is beneficial. Serum alphafetoprotein and HCG is elevated as condition progress.&#x0D; Therapeutic Intervention: Patient treated with inj. Bleomycin, inj. Cisplatin, inj.Etoposide, tab Pan 40 miligram and inj. Emset.&#x0D; Conclusion: A 3year old female was admitted in AVBRH Sawangi Meghe wardha with the major complaint of right abdominal swelling for 6 month, both when they observed abdominal mass without pain and swelling was small in size and backache and weight loss.

Magnetic resonance imaging of pure ovarian dysgerminoma: a series of eight cases

BackgroundImaging findings have a prominent role in early and correct identification of ovarian dysgerminoma, the most common ovarian malignant germ cell tumor (OMGCT). Despite Computed Tomography (CT) is widely used, Magnetic Resonance Imaging (MRI) has proved to be superior in adnexal masses characterization. Limited data and small series are available concerning MRI aspects of dysgerminoma.Case presentationFrom January 2012 to December 2018, a database of solid ovarian masses was retrospectively reviewed. Eight patients with histologically proven pure ovarian dysgerminoma and complete imaging available were identified and analyzed. Imaging findings were evaluated separately by two radiologists expert in female genito-urinary MRI.ConclusionsMRI findings of a lobulated, purely solid, encapsulated mass with hyper-intensity of lobules and hypo-intensity of septa on T2w images contribute to differentiate dysgerminomas from other ovarian neoplasms.

Fertility-Sparing Surgery for Ovarian Cancer.

(1) Background: although most patients with epithelial ovarian cancer (EOC) undergo radical surgery, patients with early-stage disease, borderline ovarian tumor (BOT) or a non-epithelial tumor could be offered fertility-sparing surgery (FSS) depending on histologic subtypes and prognostic factors. (2) Methods: we conducted a systematic review to assess the safety and fertility outcomes of FSS in the treatment of ovarian cancer. We queried the MEDLINE, PubMed, Cochrane Library, and Cochrane (“Cochrane Reviews”) databases for articles published in English or French between 1985 and 15 January 2021. (3) Results: for patients with BOT, FSS should be offered to young women with a desire to conceive, even if peritoneal implants are discovered at the time of initial surgery. Women with mucinous BOT should undergo initial unilateral salpingo-oophorectomy, whereas cystectomy is an acceptable option for women with serous BOT. Assisted reproductive technology (ART) can be initiated in patients with stage I BOT if infertility persists after surgery. For patients with EOC, FSS should only be considered after staging for women with stage IA grade 1 (and probably 2, or low-grade in the current classification) serous, mucinous or endometrioid tumors. FSS could also be offered to patients with stage IC grade 1 (or low-grade) disease. For women with serous, mucinous or endometrioid high-grade stage IA or low-grade stage IC1 or IC2 EOC, bilateral salpingo-oophorectomy and uterine conservation could be offered to allow pregnancy by egg donation. Finally, FSS has a large role to play in patients with non- epithelial ovarian cancer, and particularly women with malignant ovarian germ cell tumors.

Multidisciplinary management of ovarian germ cell tumours-a single institutional study from India.

BackgroundOvarian germ cell tumours constitute a heterogeneous group of neoplasm with malignant potential being seen in 5% of cases. There is limited data on treatment outcomes of patients with malignant ovarian germ cell tumours (MOGCT). Here, we present our hospital audit of patients with MOGCT.Material and methodsThis is a retrospective data review of patients with MOGCT treated between May 2011 and December 2019. Patients were treated with staging laparotomy and adjuvant chemotherapy, wherever applicable. Surveillance was allowed for those at low risk for recurrence. Clinicopathologic features and treatment details were recorded, and survival analysis was performed.ResultsSixty-five patients with a median age of 25 years (range: 11–52 years) were treated during the study period. The most common histology was immature teratoma in 35.3% of cases. International Federation of Gynecology and Obstetrics stage IC was the most common stage of presentation (47%). Surveillance was advised for 12.3% of cases. Systemic therapy was given in 51 (78%) patients. At a median follow-up of 46 months (range: 1–109 months), the median progression-free survival (PFS) was not reached. Five-year PFS was 79.3% (95% CI: 65.8–88). The most common toxicity was febrile neutropenia (22%) among those who received systemic therapy.ConclusionImmature teratoma was the most common histology in our series. The majority presented in the early stage. MOGCT is a highly curable disease with surgery and systemic therapy.