Ovarian Germ Cell Tumors Research Articles

A-167 Repeatedly Positive Serum and Urine Beta-HCG Results in Non-Pregnant Patients—Application of Clinical Decision Support

Abstract Background In January of 2020, a 48-year-old woman, status post bilateral tubal ligation was postponed colonoscopy due to a positive urine and serum pregnancy point of care (POC) test. The quantitative serum HCG levels were normal at 4.9 mIU/mL (reference range 0–8 mIU/mL). Follow-up showed that over the prior year there were other 6 similar incidents when nonpregnant patients showed positive qualitative pregnancy results with quantitative HCG levels within “nonpregnancy” normal range being brought to the attention of the laboratory. Methods We assessed the possibility of a detection/measurement error including possible interfering antibodies. The likelihood of interfering substances/antibodies that would interact with 2 different types of POC detection systems (urine qualitative—Clinitest HCG Pregnancy test from Siemens Medical Solutions USA, serum qualitative—Pregnancy HCG Rapid Test from Cardinal Health) and serum quantitative—is very low, especially given that both serum and urine specimens were affected, and interfering antibodies are not normally excreted into urine. Testing of the diluted sample showed results like the neat specimen which further excludes interferences in the quantitative reaction as well as a possible hook effect. Based on this we concluded that the results were accurate.Chart review showed that 6 months prior, she had another quantitative HCG test performed using the same instrumentation obtaining a value of 6.6 mIU/mL. At this time a transvaginal ultrasound excluded the presence of any masses or abnormal findings. FSH (47.8 mIU/ml) and LH (49.8 mIU/ml) were found to be within the perimenopausal range. Qualitative serum and urine test were found to be repeatedly positive, while the quantitative tests were within nonpregnancy range, over several months. Retrospective chart review of the other 6 cases revealed similar pattern. Pregnancy, certain tumors (gestational trophoblastic neoplasia, ovarian germ cell tumor), kidney failure and menopause will manifest with increased HCG production. In (peri)menopausal women the pituitary produces HCG up to 14 mIU/mL in association with increased levels of FSH. The qualitative tests were repeatedly positive over several months while the quantitative results remained unchanged, excluding the diagnosis of pregnancy or tumors, and supporting the conclusion that these results are menopause related. Results To avoid similar future incidents we added the following comment to the POC test results: “If the result does not fit the clinical picture, please repeat testing on a new sample collected 48–72 h later or order serum HCG quantitative” We also added for the quantitative HCG result, the following comment: “Peri- and postmenopausal patients may have increased HCG of pituitary origin up to 14 mIU/mL. If the result does not fit the clinical picture, FSH measurement can be used for additional information.” During the 12 months preceding the implementation of the comments we had 6 incidents of positive qualitative HCG results in non-pregnant (peri)menopausal patients brought for investigation, and none during the 24 months after that. Conclusion The addition of the interpretative comment as clinical decision support increased the efficiency of the medical service, staff engagement and most importantly, patient satisfaction and safety.

Fertility-sparing approach to malignant ovarian germ cell tumors - Oncologic and obstetric outocome: A retrospective study.

To evaluate oncologic (such as disease-free and overall survival) and obstetric outcomes in patients diagnosed with malignant ovarian germ cell tumors (MOGCTs). Patients diagnosed with MOGCTs between March 2007 and February 2022 were evaluated and patients who underwent fertility sparing surgery were included in this retrospective study. The obstetric and oncologic outcomes were evaluated by collecting data up until the patient's last follow-up visit from the hospital records and patient files. The study was approved by Başkent University Institutional Review Board (KA23/124). Seventy FSS patients were included in this study. The median age of the patients was 22.5 years (range: 11-37). The median follow-up time was 92.0 months (10-189). Immature teratoma was the most common histological subtype (32.9%). Bilateral involvement was detected in only one patient with immature teratoma (1.4%). The 5-year DFS rates of immature teratoma, dysgerminoma, yolk sac, and mixed germ cell histologic types were 91.1%, 94.1%, 82.4%, and 88.9%, respectively (P: 0.716). The 5-year OS rates of the same histologic types were 95.7%, 100%, 88.2%, and 88.9%, respectively (P = 0.487). All patients (100%) had a regular menstrual cycle after the completion of adjuvant treatment. The mean time between the last chemotherapy and menstruation was 4.38 months. To date, a total of 34 patients tried to conceive after the completion of disease treatment. A total of 23 (67.6%) patients conceived, resulting in 27 live births in 22 (100%) patients. Fertility preservation should be the first treatment option in MOGCTs in young patients due to the unilateral involvement of the disease and its chemosensitive nature.

Systematic Review of the Survival Outcomes of Neoadjuvant Chemotherapy in Women with Malignant Ovarian Germ Cell Tumors.

Randomized clinical trials assessing the efficacy of neoadjuvant chemotherapy (NACT) for advanced epithelial ovarian cancer have predominantly included women with high-grade serous carcinomas. The response rate and oncological outcomes of NACT for malignant ovarian germ cell tumors (MOGCT) are poorly understood. This study aimed to examine the effects of NACT on women with MOGCT by conducting a systematic review of four public search engines. Fifteen studies were identified, and a further descriptive analysis was performed for 10 original articles. In those studies, most women were treated with a bleomycin, etoposide, and cisplatin regimen, and one to three cycles were used in most studies. Four studies comparing NACT and primary debulking surgery showed similar complete response rates (n = 2; pooled odds ratio [OR] 0.90, 95% confidence interval [CI] 0.15-5.27), comparable overall survival (n = 3; 87.0-100% versus 70.0-100%), disease-free survival (n = 3; 87.0-100% versus 70.0-100%), recurrence rate (n = 1; OR 3.50, 95%CI 0.38-32.50), and adverse events rate from chemotherapy between the groups. In conclusion, NACT may be considered for the management of MOGCT; however, possible candidates for NACT use and an ideal number of NACT cycles remain unknown. Further studies are warranted to validate the efficacy of NACT in advanced MOGCT patients.

Characterizing Lymphovascular Invasion in Pediatric and Adolescent Malignant Ovarian Nongerminomatous Germ Cell Tumors: A Report from the Children's Oncology Group

BackgroundLymphovascular invasion (LVI) has been identified as a poor prognostic factor for a variety of tumors; however, its significance in malignant ovarian germ cell tumors (MOGCT) in pediatric and adolescent patients is not well described. We aim to clarify the significance of LVI in the subset of patients with nongerminomatous MOGCT. MethodsRecords of patients 0–20 years of age with MOGCT enrolled on Children's Oncology Group study AGCT0132 were reviewed. Patients with documented presence or absence of LVI in either institutional or central review pathology reports were included. ResultsOf 130 patients with MOGCTs, 83 patients had of the presence or absence of LVI documented in their pathology report. 42/83 patients (50.6%) were found to have LVI present. The estimated odds of having LVI was higher in patients with stage II and III disease, 11 years and older and with the presence of choriocarcinoma. Event-free survival (EFS) and overall survival (OS) remained high in patients with LVI. Approximately 50% of patients with a documented LVI status in either institutional pathology report or central review were found to have LVI. ConclusionsThe presence of LVI was higher in tumors with adverse risk factors including higher stage and age greater than 11 years. While LVI was not associated with EFS or OS in the intermediate risk group, further work is necessary to determine the effect of LVI on long-term disease-free survival. We, therefore, recommend routinely incorporating LVI status into institutional pathology reports for pediatric and adolescent patients with MOGCT. Level of EvidenceIII.

Germ Cell Tumors Ovary “Dysgerminoma” with Mayer-Rokitansky-Kuster-Hauser Syndrome

Background: Ovarian Germ Cell Tumors originate from primitive germinal cells and can be either malignant or benign. MRKH syndrome is characterized by congenital hypoplasia of the uterus and upper vagina and can occur due to disrupted fusion of the Mullerian ducts. Diagnosis of ovarian tumors in MRKH patients is difficult but can be characterized by abdominal pain and distended.Objective: The aim of this case report is to explain the diagnostic methods and interventions performed in patients with ovarian tumors and MRKH syndrome.Case Presentation: A 25-year-old female came to the hospital with complaints of a lower abdominal lump three months ago. It was followed by severe pain, weight loss, shortness of breath, and yellowish vaginal discharge. Physical examination showed anemia, obesity, and a vagina size of 7cm with a probe. Chest X-ray showed a mass in the mediastinum and pleural effusion, and USG showed suspicion of an ovarian cyst and uterine agenesis.Conclusion: Ovarian tumor with MRKH syndrome is a rare case. Diagnosis was based on the patient’s history, clinical findings, radiologic examination, and confirmed with laparotomy and histopathology. Regular examinations are recommended to prevent and identify genital tract problems and pelvic diseases in women, especially adolescents.

Pitfalls of Ovarian Dysgerminoma

This is a narrative review based on published articles, using the following criteria: key words “ovarian dysgerminoma” and “MRI (Magnetic Resonance Imaging)”; PubMed access; full-length English articles since inception to May 2023; original studies and case reports/series. Exclusion criteria were ovarian tumors other than dysgerminomas, non-English papers, nonhuman studies, and reviews. Dysgerminomas are the most common ovarian malignant germ cell tumors, accounting for 1-2% of all primary ovarian neoplasms.

Prognostic factors and clinic-pathologic characteristics of ovarian tumor with different histologic subtypes-a SEER database population study of 41,376 cases.

Ovarian cancer is considered the leading cause of cancer-related deaths among all gynecological malignancies and a significant reason for mortality in women. This cohort study aimed to explore the survival trends of malignant ovarian tumors (MOT), cancer antigen 125 (CA125) level, and clinicopathological prognostic factors of MOT by histological subtype. Using the Surveillance, Epidemiology, and End Results (SEER) database, a total of 41,411 MOT cases diagnosed between January 2005 and December 2014 were extracted. According to the histological classification of MOT, four categories were included: epithelial ovarian carcinoma (EOC), malignant ovarian germ cell tumors (MOGCTs), malignant ovarian sex cord-stromal tumors (MOSCSTs) and ovarian neuroendocrine tumors (ONTs). We analyzed disease-specific survival (DS) and overall survival (OS) among the four categories, and their histological subtypes. Kaplan-Meier method was used to estimate survival curves, and log-rank test was used to evaluate differences between curves. Univariate and multivariate Cox proportional hazards models were applied to evaluate the prognostic impact of MOT. Significant predictors related to improved OS were younger age, low grade, early FIGO stage and localized SEER stage, while positive/elevated CA125 level was a risk factor. For MOGCT and MOSCST, 3-, 5- and 10-year DS rate estimates were all >80%, followed by ONT around 70%. Malignant epithelial cancer showed low DS rate at 3-year (70.7%), 5-year (58.7%), and 10-year (47.3%). EOC patients had the worst outcome, whereas MOGCT cases had the most favorable survival. Positive/elevated CA125 level led to poor prognosis. Furthermore, younger age, low grade, early FIGO stage and localized SEER stage were significant predictors for improved OS.

Ovarian preservation in gynecologic oncology: current indications and techniques.

Early menopause represents a relevant clinical issue for women. Nevertheless, this issue should be balanced with the risks of ovarian metastasis, ovarian recurrence, and the risk of recurrence in hormone-sensitive gynecological cancers. The purpose of this review was to provide an overview on current indications and techniques of ovarian preservation in patients with gynecological cancers. The potential discussion about ovarian conservation could be proposed to patients with FIGO-stage IA grade 1-2 endometrioid endometrial cancer aged 40 years or less, FIGO-stage IB1-IB2 node-negative cervical cancer with squamous cell carcinoma and HPV-associated adenocarcinoma, FIGO-stage IA-IC grade 1-2 serous, endometrioid, mucinous expansile pattern ovarian cancer, any stage germ cell ovarian tumors, and FIGO-stage IA sex cord-stromal tumors. Technique to perform ovarian transposition in cervix cancer is also reported. Ovarian conservation is a surgical approach that involves preserving one or both ovaries during the treatment of gynecologic cancers. This approach has gained popularity in recent years, as it offers several benefits to the patient, including the preservation of hormonal function and fertility. The decision to perform ovarian conservation depends on several factors, such as the stage and type of cancer, the patient's age, fertility desire, and should be carefully discussed with patients.

Squamous Cell Carcinoma Arising in a Mature Cystic Teratoma of the Ovary: Case Report

Introduction: The mature cystic teratoma of the ovary is the most common type of ovarian germ cell tumor. Despite the fact that they are typically benign, malignant transformation is a rare but well-documented phenomenon that occurs in roughly 1-2% of cases. The development of squamous cell carcinoma from an advanced cystic teratoma has been reported in the literature. Case presentation: We present a case of a 68-year-old post-menopausal female who was incidentally discovered in an endocrin consultation with a right pelvic mass. According to histopathological diagnosis, squamous cell carcinoma arising in a mature cystic teratoma is diagnosed as a reason for the mass in the right adnexa of the patient. Conclusion: Squamous-cell carcinoma that develops in an advanced cystic teratoma is a rare condition for which there is no research to guide medical care. Clinical trials might assist clarify the best treatment options for patients with secondary squamous-cell carcinoma of the ovaries with such a system and the improvement of therapeutic hypotheses.

Premature ovarian insufficiency caused by the treatment of ovarian malignant mixed germ cell tumor: a case report

Background: Premature ovarian insufficiency (POI) will bring women early and long-term adverse consequences, including estrogen deficiency-related symptoms (hot flashes, sweating, decreased libido, insomnia, etc.) and significantly increases the risk of chronic diseases including Alzheimer's disease, cardiovascular disease and osteoporosis, along with increased risk of early death. More importantly, POI has greater harm to women’s fertility. Mostly the causes of POI are unknown. Most important are iatrogenic factors such as radiotherapy, chemotherapy and surgery, which increase the risk of POI.

Cases of Yolk sac tumor associated with gynecological malignant tumor

BackgroundYolk sac tumour (YST) is the second most common ovarian germ cell tumour and usually presents in children and young women. However, tumours rarely occur as malignant gynaecological tumours with YST components.Case presentationWe present one case of endometrioid carcinoma and clear cell carcinoma with YST components and two other cases of YSTs associated with high-grade serous carcinoma of the ovary in females. After surgery and adjuvant chemotherapy, the patient with endometrioid carcinoma had progressive disease and died 20 months later, and the other two were still alive at the last follow-up.ConclusionsTo our knowledge, these mixed neoplasm associations are unusual, and these cases illustrate the diagnosis and prognosis of YST associated with malignant gynaecological tumours, emphasizing early recognition and aggressive treatment.

Clinical Challenges in the Management of Malignant Ovarian Germ Cell Tumours.

Nonepithelial ovarian cancers (NEOC) are a group of rare malignancies, including germ cell tumours (GCT) and sex cord-stromal tumours (SCST), along with small-cell carcinomas and sarcomas. GCTs represent 2-5% of ovarian cancers, with a yearly incidence of 4:100,000, and they usually affect young women and adolescents. Precursory germ cells of the ovary form the basis of GCT. They are histologically classified into primitive GCT, teratomas, and monodermal and somatic-type tumours associated with dermoid cysts. A primitive GCT can be either a yolk sac tumour (YST), dysgerminoma, or mixed germ cell neoplasm. Teratomas are either mature (benign) or immature (malignant). Given that malignant GCTs occur rarely compared to epithelial ovarian tumours (EOC), greater focus is required in their diagnosis and treatment. In this article, we review the epidemiology, clinical manifestations, diagnosis, and molecular biology, along with the management and therapeutic challenges.

Molecular Biology of Pediatric and Adult Ovarian Germ Cell Tumors: A Review.

Ovarian germ cell tumors (OGCTs) are rare in adults; indeed, they occur predominantly in children, adolescents, and young adults, and they account for approximately 11% of cancer diagnoses in these groups. Because OGCTs are rare tumors, our current understanding of them is sparse; this is because few studies have investigated the molecular basis of pediatric and adult cancers. Here, we review the etiopathogenesis of OGCTs in children and adults, and we address the molecular landscape of these tumors, including integrated genomic analysis, microRNAs, DNA methylation, the molecular implications of treatment resistance, and the development of in vitro and in vivo models. An elucidation of potential molecular alterations may provide a novel field for understanding the pathogenesis, tumorigenesis, diagnostic markers, and genetic peculiarity of the rarity and complexity of OGCTs.

A case of missed mixed germ cell tumor of ovary in pregnancy

Ovarian germ cell tumor accounts for 18-26% of all ovarian cancers complicating pregnancy. This is a rare case of mixed germ cell tumor of ovary, misdiagnosed antenatally as uterine fibroid. A 34-year-old primigravida at 37 weeks + 5 days POG came in latent labor. Term scan showed fibroid of 11x 9cms in posterior wall in lower uterine segment with central cystic area. She underwent emergency LSCS and delivered a male baby weighing 2.005 kg. On exteriorization of uterus, a 10 x 8 cm necrotic mass was present posterior to uterus in rectovaginal space measuring 10 x 8 cm. It was concluded as FIGO Stage IC1 ovarian carcinoma.Histopathology of the mass showed mixed germ cell tumor: 60% yolk sac tumor and 40% dysgerminoma. MRI done after 2 weeks showed a lesion of 10.4 x 9.5 x 7.3 cm in rectovaginal pouch compressing and displacing the rectum posteriorly and to the left side, also displacing uterus and bladder anteriorly, Left ovary normal, Right ovary not visualized. Hence, she received 4 cycles of chemo comprising cisplatin and etoposide.After chemo, PET scan showed a lesion of 6.7x 6.2 x 4.2 cm in the rectovaginal area just right to the midline with right ovary not being visualized separately. Hence, she underwent laparoscopic right oophorectomy. Histopathology showed extensive regressive changes with occasional scattered atypical cells with no conclusive evidence of residual tumor. Follow up serum LDH and AFP are within normal limits and advised to follow up once in 3 months to look for any recurrences. : Any mass during pregnancy even if found to be benign, should be further evaluated and monitored regularly to reduce the morbidity /mortality to the mother.

Expression of p16 Tumor Suppressor Protein in Malignant Ovarian Germ Cell Tumors; Immunohistochemical Study.

Malignant ovarian germ cell tumors represent small percentage of malignant ovarian neoplasms but they affect significantly young age group. To investigate the immunohistochemical expression of p16 tumor suppressor protein in malignant ovarian germ cell tumors. Twenty-two malignant ovarian germ cell tumors (five dysgerminoma, eight immature teratoma, and nine yolk sac tumors), twenty mature cystic teratoma tumors and twenty normal ovarian tissue were immunohistochemically stained with p16 monoclonal antibody. Ki67 immunohistochemical staining was done for malignant ovarian germ cell tumors to assess proliferation. We found that p16 tumor suppressor protein is overexpressed in all malignant ovarian germ cell tumors in both nuclear and cytoplasmic locations compared to control and to mature cystic teratoma (p-value <0.001). Cytoplasmic p16 expression was significantly correlated to Ki67 proliferation index in malignant ovarian germ cell tumors (p-value = 0.033, r = 0.445). Overexpression of p16 in malignant ovarian germ cell tumors denotes that dysfunction of the cyclin dependent kinase pathway is involved in tumorigenesis of malignant ovarian germ cell tumors.

Cancer Stem Cell Markers Are Differentially Expressed in Malignant Ovarian Germ Cell Tumors.

The objective of this study was to analyze the expression and potential clinical role of cancer stem cell (CSC) markers in malignant ovarian germ cell tumors (MOGCT). CD34, CD44, and SOX2 protein expression by immunohistochemistry was analyzed in 49 MOGCT from patients treated in Norway during the period 1980-2011. Expression was analyzed for association with tumor type and clinicopathologic parameters. Tumors were diagnosed as dysgerminoma (DG; n=15), immature teratoma (IT; n=15), yolk sac tumor (YST; n=12), embryonal carcinoma (n=2), and mixed MOGCT (n=5). Tumor cell CD34 expression was significantly more common in YST, whereas stromal expression was only seen in IT (both P <0.001). CD44 was infrequently expressed, most often focally, in tumor cells, particularly in YST ( P =0.026). CD44 was widely expressed in leukocytes, most prominently in DG. SOX2 was most frequently expressed in IT, with predominantly focal expression in some YST and uniform absence in DG ( P <0.001). Stromal CD34 ( P =0.012) and tumor cell SOX2 expression ( P =0.004) were negatively associated with the involvement of the ovarian surface, presumably due to the low incidence of this event in IT. No significant association was found between CSC marker expression and other clinicopathologic parameters, including age, laterality, tumor diameter, and FIGO stage. In conclusion, CSC markers are differentially expressed in various MOGCT types, suggesting differences in the regulation of cancer-related processes. Expression of CD34, CD44, and SOX2 does not appear to be associated with clinical parameters in this patient group.

Role of Computed Tomography Imaging in Pediatric Abdominal Masses

Introduction: Abdominal masses are commonly encountered in the pediatric population, with a broad differential diagnosis that encompasses benign and malignant entities. The main goal of abdominal imaging in the context of a suspected pediatric abdominal mass is to confirm its presence, as nonneoplastic entities can mimic an abdominal mass, and to detect specific imaging findings that narrow the differential diagnosis. Computed Tomography (CT) is currently the most powerful and versatile imaging procedure for the evaluation of abdominal masses It plays an important role in characterizing the mass and extent of disease and assisting in presurgical planning [1].&#x0D; Aim: The purpose of this article is to describe the role of CT imaging in evaluation of pediatric abdominal masses.&#x0D; Materials and Methods: Five case reports of abdominal masses in pediatric age group have been discussed.&#x0D; All the five patients underwent CT scan on Philips brilliance 256 slice machine.&#x0D; CT imaging findings with their histopathological diagnosis have been described.&#x0D; Case Summary:&#x0D; Case 1 :Wilm’s tumor&#x0D; Case 2 : Rhabdomyosarcoma&#x0D; Case 3 : Ewing’s sarcoma of sacrum&#x0D; Case 4 : Germ cell tumor of ovary&#x0D; Case 5 : Pelvic myxoid chondrosarcoma&#x0D; Conclusion: Abdominal masses in the pediatric age group include a spectrum of lesions of diverse origin and significance. CT imaging plays a key role in defining the characteristics and extent of mass lesions found in infants and children. Imaging with histopathological correlation can be very helpful in the management of the patient.

Abstract #1398490: The Enigma of Malignant Struma Ovarii

Struma ovarii is a rare form of ovarian germ cell tumor with at least 50% of mature thyroid tissue. Most of them are benign with malignant transformation occurring in only < 5% of tumors. Malignant struma ovarii presenting with follicular-type carcinoma is extremely rare. We present an interesting case of malignant struma ovarii with follicular carcinoma. 66-year-old female was referred with a diagnosis of malignant struma ovarii. She was previously evaluated at emergency room when she presented with right lower quadrant abdominal pain. CT scan done at that time revealed 6.5 cm right adnexal lesion which increased from 3.9 cm from 13 years ago. She subsequently underwent total abdominal hysterectomy with bilateral salpingo-oopherectomy with pathology showing 10.5 cm poorly differentiated follicular thyroid carcinoma with in struma ovarii component of an ovarian teratoma. There was capsular and focal angioinvasion. PET/CT done later was negative for malignancy and the thyroid ultrasound showed no thyroid nodules or neck adenopathy. Laboratory examination revealed TSH and free T4 levels within normal range. She underwent total thyroidectomy and then underwent recombinant human thyrotropin stimulated radioactive iodine treatment with 150 mCi of I-131. Post therapy whole body scan showed increased radiotracer activity in the left pelvic region for which additional SPECT-CT was performed which confirmed that the increased radiotracer activity along the anterior aspect of the left superior iliac bone was misregistered bowel and there was no destructive osseous lesion involving the left iliac bone on the corresponding CT. There is no other evidence of focal iodide activity to suggest extra-thyroidal disease. She is being continued on levothyroxine 100 mcg. Post treatment stimulated thyroglobulin levels were 0.7 ng/mL with negative thyroglobulin antibodies. Because of its rarity and absence of consensus on diagnosis and treatment, there are no established guidelines for management of malignant struma ovarii. The decision to perform thyroidectomy and administer radioiodine after oophorectomy are based on the reports from case series and depends on the presence of metastatic disease and the risk of recurrence. In our patient, large size of the tumor and presence of poorly differentiated follicular carcinoma indicated higher risk of recurrence warranting total thyroidectomy and radioiodine treatment. As she had good treatment response, goal of levothyroxine therapy is to maintain between 0.1-0.5 mU/L. Monitoring of serum stimulated thyroglobulin annually is recommended for 2 years after surgery and, if negative, unstimulated levels annually thereafter.

Prognosis of lymphadenectomy in malignant ovarian germ cell tumor.

The routine application of lymphadenectomy remains a controversial part of surgical staging in malignant ovarian germ-cell tumor (MOGCT). Thus, studies are needed to explore the prognostic significance of lymphadenectomy in MOGCT. The goal of this retrospective study was to report the clinical outcomes of lymph node dissection (LND) and non-LND in MOGCT surgeries. A total of 340 cases of MOGCTs were included: 143 patients (42.1%) had LND and 197 (57.9%) had no LND. The OS rates at 5 years in the LND and non-LND group were 99.3% vs. 100%, respectively. The DFS rates at 5 years in the LND and non-LND group were 88.8% vs. 88.3%. Forty-three patients (12.6%) were successfully pregnant during the postoperative follow-up. There were 44 recurrences (12.9%) and six deaths (1.8%). Stage was an independent prognostic factor for DFS in the multivariate analysis. Pathology was reported as an independent prognostic factor associated with OS in the multivariate analysis. Lymphadenectomy had no significant influence on the OS (P=0.621) or disease-free survival rate (P=0.332) of patients with MOGCT.

METASTATIC YOLK SAC TUMOUR: A DIAGNOSTIC DILEMMA CASE REPORT AND LITERATURE REVIEW

Ovarian germ cell tumors (OGCTs) account for about 15~20% 1 of all ovarian neoplasms . Malignant ovarian germ cell tumors (MOGCTs) are rare, accounting for 3–5% of all 2 malignant ovarian neoplasms . Yolk sac tumor (YST) also referred to as endodermal primitive tumor is the second most 3 common tumor in MOGCTs. YST accounts for 20% of MOGCTs and commonly affects young women and adolescent girls between 18-30 years of age. Around one third 1 of YSTs affect premenarchal girls. When compared with epithelial ovarian tumors, YST is highly malignant with a propensity for rapid growth and acute development of symptoms. YSTs rapidly metastasize, intruding all intra4 abdominal structures as well as retroperitoneal lymph nodes. Before the advent of combination chemotherapy, YSTs were associated with poor prognosis. The introduction of novel chemotherapeutic regimens has been associated with signicantly improved 5-year survival rates of YST from 14% 5 to nearly 90%. The prognosis even for the advanced stages has remarkably improved with the addition of cisplatin to the 6 chemotherapy regimens.