Disgerminoma ovariano na gestação: relato de caso / Ovarian dysgerminoma in pregnancy: a case report

Os disgerminomas são tumores malignos de células germinativas ovarianas, são raros, geralmente acometem mulheres em idade fértil e têm bom prognóstico e sobrevida elevada. Paciente de 20 anos, primigesta com 26 semanas de gestação, foi admitida no centro obstétrico da Fundação Hospitalar Santo Antônio em Blumenau- SC com quadro de dor abdominal intensa refratária à analgesia e desconforto respiratório. Ressonância magnética demonstrou derrame pleural, moderada ascite e volumosa lesão expansiva de aspecto sólido-cístico em anexo direito. Foram realizadas salpingo-oforectomia à direita e omentectomia parcial e coletado lavado peritoneal. Anatomopatológico evidenciou disgerminoma. A paciente seguiu acompanhamento gestacional nos serviços de pré-natal de alto risco e oncologia. Devido à imaturidade fetal, manteve-se conduta expectante e, após o parto normal com 37 semanas, foi realizado estadiamento e iniciada quimioterapia adjuvante. Devido à baixa incidência e à raridade de tumores de células malignas ovarianas, relatos de casos como este são importantes para discutir as melhores estratégias de manejo clínico.(AU)

Dysgerminomas are rare malignant ovarian germ cell tumors that generally affect adolescence and early adulthood, have a good prognosis and high survival. Patient 20 years old, gestation 1, at 26 weeks of gestation, was hospitalized at the obstetric center of Fundação Hospitalar Santo Antônio in Blumenau-SC, with severe abdominal pain refractory to analgesia and respiratory discomfort. Magnetic resonance showed pleural effusion, moderate ascites and a massive expansive lesion with a solid cystic aspect in the right ovary. Right salpingoophorectomy, partial omentectomy and peritoneal lavage were collected. Anatomopathological evidence showed dysgerminoma. Patient followed gestational follow-up at high-risk prenatal and oncology services. Due to fetal immaturity, expectant management was maintained and after vaginal delivery at 37 weeks, staging was performed and adjuvant chemotherapy was started. Due to the low incidence and rarity of ovarian malignant cell tumors, case reports such as this one are important to discuss the best clinical management strategies.(AU)

Tailored therapy and long-term surveillance of malignant germ cell tumors in the female genital system: 10-year experience / 부인종양

OBJECTIVE: To explore the appropriate treatment of malignant germ cell tumor (MGCT) in the female genital system, and to analyze the factors influencing both therapeutic response and survival outcome. METHODS: A cohort of 230-Chinese women diagnosed with MGCT of the genital system was retrospectively reviewed and prospectively followed. The demographic and pathological features, extent of disease and surgery, treatment efficiency, recurrence and survival were analyzed. RESULTS: MGCTs from different genital origins shared a similar therapeutic strategy and response, except that all eight vaginal cases were infantile yolk sac tumors. The patients' cure rate following the initial treatment, 5-year overall survival and disease-free survival (DFS) were 85.02%, 95.00%, and 86.00%, respectively. Although more extensive excision could enhance the remission rate; it did not improve the patients' survival. Instead, the level of the medical institution, extent of surgery and disease were independent prognostic factors for relapse (p<0.05). Approximately 20% of patients had recurrent or refractory disease, more than half of whom were in remission following secondary cytoreductive surgery with salvage chemotherapy. CONCLUSION: Fertility-sparing surgery with or without standardized PEB/PVB (cisplatin, etoposide/vincristine, and bleomycin) chemotherapy is applicable for female MGCTs of different origins. Comprehensive staging is not required; nor is excessive debulking suggested. Appropriate cytoreduction by surgery and antineoplastic medicine at an experienced medical institution can bring about an excellent prognosis for these patients.

Clinicopathologic characteristics of malignant germ cell tumors of ovary / 대한산부인과학회지

OBJECTIVES: The aim of this study was to evaluate the clinicopathologic characteristics of malignant germ cell tumors of ovary. METHODS: Thirty five patients who were dignosed as malignant germ cell tumors of ovary and treated in Cheil General Hospital from January 1995 to December 2003, were retrospectively analyzed. The age, chief complaints, histologic type, tumor marker, FIGO stage, maximal tumor diameter, management, survival and future pregnancy outcome were reviewed. RESULTS: The mean age was 23.4 years (8-34) and 2 patients were premenarche. The mean follow-up period was 59.6 months (16-118). Palpable lower abdominal mass and pain were the most frequent symptoms. Preoperative CA125 were checked in 32 patients and elevated in 23 patients . The tumors were ranging from 7cm to 27cm in diameter (mean : 16.6). The site of tumors was right-sided in 17(48.6%), left-sided in 15(42.9%), and bilateral in 3(8.6%) which were dysgerminomas only. Post-surgical FIGO stage was stage I in 28 cases (80.0%), stage II in 4 cases (11.4%), and stage III in 3 cases (8.6%). Histologically, immature teratomas were found most frequently (n=14, 40.0%), followed by dysgerminoma (n=10, 28.6%), endodermal sinus tumor (n=9, 25.7%), and mixed form (n=2, 5.7%). Unilateral salpingo-oophorectomy was performed in 9, cystectomy in 4, and staging operation in 22, which included 16 patients of fertility sparing operation. Postoperative chemotherapy was administered in 30 and most were BEP except one TIP. Two patients had recurred, who were stage Ic and IIIb EST at diagnosis and expired at 59 and 16 months after first operation. Recurrence rate was 5.7% and 5-year survival rate was 94.7%. During follow-up period, 8 patients were pregnant and the results were 4 normal deliveries at term, 1 missed abortion, 1 therapeutic abortion due to acne medication, 1 H-mole and 1 current pregnant state at 20 weeks without problem. CONCLUSION: These results shows that most malignant germ cell tumors of ovary is detected in early stage and have relatively excellent survival with conservative operation and combination chemotherapy.

A Clinical Study on Malignant Germ Cell Tumor of Ovary / 대한산부인과학회지

OBJECTIVE: to evaluate the clinicopathologic characteristics of patients with ovarian malignant germ cell tumor. METHODS: We reviewed records of women who had malignant germ cell tumors of the ovary from 1991-2000. RESULTS: Thirty-seven women had surgical resections of malignant ovarian germ cell tumors and most received adjuvant therapy. Twenty-five women (68%) presented with stage I disease, and 12 (32%) had more advanced disease. Histology subtypes were: immature teratoma (n=16), dysgerminoma (n=9), yolk sac tumor (n=8), choriocarcinoma (n=2), embryonal carcinoma (n=1), and mixed germ cell tumor (n=1). The frequency of positive tumor markers were aFP, CA-125, beta-hCG, CA 19-9 and LDH in decreasing order. The mean age of the patients at presentation was 23.9 years (4-58). Surgical management of the 32 patients consisted of unilateral oophorectomy, or salpingo-oophorectomy, 1 woman with stage III disease underwent bilateral salpingo-oophorectomy and 4 women underwent total abdominal hysterctomy, bilateral or unilateral adnexectomy. Thirty-two women were treated with adjuvant combination chemotherapy (BEP, VAC, VBP) according to indications. The 5-year survival rate was 100%, and 5-year disease-free rate was 91.8%. Among twelve patients who attempted pregnancy, 8 succeeded in it and delivered normal full term babies. CONCLUSION: Current therapeutic strategies can allow most women with ovarian malignant germ cell tumors to have conservative surgery without compromising survival and to preserve their reproductive potential.

A Clinicopathologic Study of 31 Cases with Ovarian Malignant Germ Cell Tumors / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to review the clinicopathologic features, recurrent rate, survival rate and controversable issues in the treatment of the ovarian malignant germ cell tumors. PATIENTS AND METHODS: From August, 1991 to November, 1998 thirty-one patients with malignant germ cell tumors of the ovary treated in the department of obstetrics and gynecology, Kosin University Medical college, were eligible and assessable. Demographic characteristics, symptoms, signs, stage, tumor grade, mode of therapy and results of follow up were reviewed retrospectively. RESULTS: The patients with malignant germ cell tumor constituted 6.37% of all ovarian malignancies during this period. Histologic subtypes were 8 dysgerminoma(25.8%), 7 endodermal sinus tumor(22.6%), 10 immature teratoma(32.3%), 3 mixed germ cell tumor(9.7%), 3 choriocarcinoma(9.7%). The age of the patients ranged from 10 to 40 years (mean +/-S.D.; 24.26 +/- 7.51). The most common symptom was abdominal pain(38.7%). Most had stageI(18 cases, 58.0%) or stageIII(5 cases, 16.2%) diseases. All patients underwent surgery as the initial treatment, and nine patients received more than one operation. Postoperative adjuvant chemotherapeutic regimens were VAC, VBP, EP, BEP, EMA, and EMA CO. The mean follow up duration was 26.0(+/- S.D.; +/- 20.3) months. The 2-year and 5-year survival rate were 91.97%(+/- S.E.; +/- 0.05) and 86.86%(+/- S.E.; +/- 0.07).

A Clinicopathologic Study of Ovarian Malignant Germ Cell Tumor / 대한산부인과학회잡지

From Jan. 1984 to Dec. 1993, 46 patients with malignant germ cell tumor of ovary were identified in tumor registry of Seoul National University Hospital. The clinicopathologic features of these patients were reviewed. The mean age of patient was 21.6 years (range 1-54), and common presenting symptoms were abdominal mass (19/46), abdominal pain (9/46), abdominal distension (7/46), and epigastric discomfort (2/46) in order. Dysgerminoma was the most common histologic type (19/46, 41.3%), followed by endodermal sinus tumor (13/46, 28.2%), mixed germ cell tumor (6/46, 13/0%), embryonal carcinoma(5/46, 10.8%), immature teratoma(2/46, 4.3%), and chorio- carcinoma (1/46, 2.1%). Among 6 mixed germ cell tumors, dysgerminoma mixed with endodermal sinus tumor component was the most frequent combination. Fifty percent of patients were with FIGO stage I, and 26% with stage III. Overall two year disease free survival was 89.1%. Patients with dysgerminoma showed more favorable 2 year disease free survival (100%) than endodermal sinus tumor or mixed germ cell tumor (84.6%, 66.6% respectively). Patients age, disease stage, histologic type and future child-bearings should be considered in the management of malignant ovarian germ cell tumor. Multicenter prospective randomized studies are needed to identify the more rational treatment strateges of these rare malignant tumors.