Progress of malignant ovarian germ cell tumor / 肿瘤研究与临床

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.

Fertility-sparing surgery for a prepubertal female with malignant ovarian germ cell tumor

@#<p style="text-align: justify;">Malignant ovarian germ cell tumors are rare ovarian malignancies accounting for 3 to 5% of all ovarian malignancies. 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 tumor. Presented is a case of a premenarcheal 13 year old female diagnosed with yolk sac tumor and who underwent fertility-sparing surgery and adjuvant platinum-based chemotherapy post-operatively, with good outcome. In young patients, conservative surgery with adjuvant chemotherapy has made the preservation of fertility possible, even in patients with advanced disease. The increase in cure rates has shifted the focus of recent studies to the long term menstrual, reproductive, and gynecologic outcomes in these patients. </p>

Outcomes after bleomycin, etoposide and cisplatin combination chemotherapy in patients with ovarian yolk sac tumor / 대한산부인과학회지

OBJECTIVE: The aim of this study was to evaluate the oncologic and reproductive outcomes of patients with ovarian yolk sac tumor after bleomycin, etoposide, cisplatin (BEP) chemotherapy following surgery. METHODS: Of 145 patients with histologically confirmed malignant ovarian germ cell tumor, 43 had yolk sac tumor and received BEP chemotherapy after surgery. A retrospective analysis of these patients was performed. RESULTS: The mean age of 43 patients was 24.8 years (range, 7 to 59 years). Thirty eight patients were nulliparous. Of 179 BEP chemotherapy cycles, grade 1~2 hematologic and non-hematologic adverse events occurred in 46 cycles in 21 patients. Thirty nine patients showed complete remission, 1 patient showed partial remission, and 3 patient had progressive disease during BEP chemotherapy. After median follow-up time of 57 months (range, 3 to 153 months), 5 patients had recurrent disease and three of them died of disease. The 5-year recurrence free survival rate and overall survival rate were 86% and 94%, respectively. After chemotherapy, all but one premenarchal patients had normal menstruation. Of them 5 patients tried to conceive and 3 of them succeeded in pregnancy. CONCLUSION: BEP chemotherapy was very safe and effective in patients with ovarian yolk sac tumor. Survival outcomes are excellent and reproductive outcomes are promising after BEP chemotherapy.

Growing teratoma syndrome in a post laparoscopic excision of ovarian immature teratoma / 부인종양

A 26-year-old girl was referred to us in December 2008 with progressive pelvic mass while on chemotherapy. In May 2008, she presented with large adnexal mass and high alpha-fetoprotein (AFP, 265.7 ng/mL; normal range, 0 to 10). She underwent laparoscopic right salpingo-oophorectomy with staging. Since histology was immature teratoma grade I, FIGO stage 1 she was kept on surveillance. In September 2008, she developed recurrent pelvic mass with AFP levels of 2,400 ng/mL. Three courses of chemotherapy (bleomycin-etoposide-cisplatin) were given. Post-chemotherapy AFP normalized but tumor size increased. CT-scan (abdomen-pelvis) showed a large pelvic mass with calcification specks; infiltrating the sigmoid colon and abdominal wall. With provisional diagnosis of growing teratoma syndrome she had exploratory laparotomy with excision of pelvic mass along with sigmoid colon, excision of right pelvic and subcutaneous deposits, omentectomy and sigmoid anastomosis. Left ovary, left tube and uterus appeared normal and were preserved. Histology of all masses showed mature teratoma, no immature elements. At six months follow up she is disease free and has resumed menstruation. Growing teratoma syndrome is a clinico-pathological presentation during/post-chemotherapy in malignant ovarian germ cell tumor where mature teratoma grows and requires complete surgical excision. Our case highlights the safety and adequacy concerns of laparoscopic management of malignant ovarian tumor. Literature review suggests good prospects of resumption of menses, child bearing and five year survival in case of growing teratoma syndrome.

Clinicopathological factors associated with recurrence in malignant ovarian germ cell tumor: a report of 145 cases / 中国癌症杂志

1cm)(P=0.0000)and the type of adjuvant chemotherapy implemented (non-standard chemotherapy versus standard chemotherapy)( P=0.0028). Among them tumor size was exclusively an independent factor.Conclusions:Histology、FIGO stage、residual tumor after surgery and the type of adjuvant chemotherapy were independent factors associated with recurrence in MOGCT .For those patients with high risks of recurrence, full dose and cycles of standard BEP/PVB regimen should be used.

Malignant Ovarian Germ Cell Tumors: Ovarian Function after Conservative Surgery and the Importance of Lymph Node Evaluation / 대한산부인과학회잡지

OBJECTIVE: To evaluate the long-term fertility and reproductive outcomes after conservative surgery, to observe the recurrence pattern and to elucidate the significance of retroperitoneal lymph node evaluation in patients with malignant ovarian germ cell tumors. METHODS: We reviewed the medical records of fifty patients who had been diagnosed as malignant ovarian germ cell tumors from 1991 to 2001 at Asan Medical Center. RESULTS: During on the median follow-up of 54 months, six patients recurred and five patients died. Out of the six recurred patients, three patients (50%) were found to have retroperitoneal lymph nodes involved, especially in patients with dysgerminoma and one patient contralateral ovary involved after conservative surgery. Out of the forty patients who had received conservative surgery, twenty-two (55.0%) had stage Ia tumors and thirteen (32.5%) had stage II and III. Adjuvant chemotherapy was performed for thirty- one patients (77.5%) and comprehensive surgical staging including retroperitoneal lymph node evaluation was performed for six patients (15%). During chemotherapy, fifteen patients out of nineteen with normal menstrual cycles became amenorrheic but most of them (13/15) recovered their normal menstrual cycles and gave birth to five healthy babies. Out of the thirteen patients with advanced disease who had received conservative surgery, two patients died after recurrences and one died of disease progression. CONCLUSION: Conservative surgery is the treatment of choice in young women with early stage disease, but in case of advanced disease, it requires prudent decision-making. Considering conservative surgery, retroperitoneal lymph node evaluation is needed, especially in patients with dysgerminoma.

Malignant Germ Cell Tumors of the Ovary: A Clinical and Pathological Study of 42 Cases / 대한부인종양콜포스코피학회잡지

From July, 1989 to June, 1998 forty-two patients with malignant germ cell tumors of the ovary treated in the department of Obstetrics and Gynecology, University of Ulsan, Asan Medical Center, were identified. Demographic characteristics, symptoms, signs, stage, tumor grade, mode of therapy and results of follow-up of those patients were reviewed retrospectively. The patients with malignant germ cell tumor constituted 11.1% of all ovarian malignancies and 5.6% of all ovarian germ cell tumors ecountered during this period. The most common histologic subtype was dysgerminoma (26.2%) followed by endodermal sinus tumor (23.8%) and immature teratoma (19.0%). The age of the patients ranged from 8 to 64 years (mean+/-S.D.; 26.0+/-12.9) and the mean parity was 0.8 (+/-1.6). The most frequent initial symptoms were adbominal pain (33.3%) or abdominal distension (31.0%). Most had stage I(25 cases, 59.9%) or II(6 cases, 14.3%) diseases. Elevated level of serum alpha-FP was observed in all cases of endodermal sinus tumor and embryonal cell carcinoma, CA 125 was elevated in 63.9% of all malignant germ cell tumors. Thirty-one patients (73.8%) were treated by surgery and chemotherapy and 10 patients (23.8%) by surgery only. The major chemotherapeutic regimens were BEP (bleomycin +etoposide +cisplatin) and VAC (vincristine +actinomycin-D +cytoxan). The mean follow-up duration was 24.6 (+/-23.5) months and 2-year survival rate was 88.6% (+/-0.6).