RESUMO
A 25-year-old man was admitted to our hospital complaining of right scrotal pain and upper abdominal pain. A computed tomographic scan indicated a right scrotal mass, a huge liver mass, and multiple lung masses, although there was no enlarged retroperitoneal lymph node swelling. Laboratory tests showed severe liver and kidney dysfunction and high levels of serum α-fetoprotein (11,997 ng/ml). Although needle biopsies of the testicular and liver masses were performed, the tissues were insufficient for a pathological diagnosis. As liver and kidney function worsened, we started chemotherapy with bleomycin, etoposide, and cisplatin (BEP chemotherapy), which was modified because of the liver and renal dysfunction. We also used continuous hemodiafiltration and rasburicase to prevent tumor lysis syndrome. After induction of chemotherapy, the liver and kidney dysfunction improved immediately and the high orchiectomy was performed on day 8 after chemotherapy. The pathological diagnosis was a yolk sac tumor. He underwent four courses of the BEP regimen and five courses of the TIN regimen (paclitaxel, ifosphamide, and nedaplatin), followed by the resection of liver metastases. There was no evidence of viable cells in the resected liver and no recurrence was evident at 1 year postoperatively.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Tumor do Seio Endodérmico/tratamento farmacológico , Nefropatias/fisiopatologia , Hepatopatias/fisiopatologia , Neoplasias Testiculares/tratamento farmacológico , Urato Oxidase/uso terapêutico , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Bleomicina/efeitos adversos , Bleomicina/uso terapêutico , Cisplatino/efeitos adversos , Cisplatino/uso terapêutico , Terapia Combinada , Tumor do Seio Endodérmico/fisiopatologia , Tumor do Seio Endodérmico/secundário , Etoposídeo/efeitos adversos , Etoposídeo/uso terapêutico , Hemodiafiltração , Humanos , Masculino , Metástase Neoplásica , Neoplasias Testiculares/patologia , Neoplasias Testiculares/fisiopatologia , Síndrome de Lise Tumoral/etiologia , Síndrome de Lise Tumoral/prevenção & controleAssuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Tumor do Seio Endodérmico/tratamento farmacológico , Neoplasias Vaginais/tratamento farmacológico , Antineoplásicos/administração & dosagem , Antineoplásicos/uso terapêutico , Bleomicina/administração & dosagem , Bleomicina/uso terapêutico , Pré-Escolar , Cisplatino/administração & dosagem , Cisplatino/uso terapêutico , Tumor do Seio Endodérmico/patologia , Tumor do Seio Endodérmico/fisiopatologia , Etoposídeo/administração & dosagem , Etoposídeo/uso terapêutico , Feminino , Humanos , Lactente , Indução de Remissão , Hemorragia Uterina/etiologia , Neoplasias Vaginais/patologia , Neoplasias Vaginais/fisiopatologiaRESUMO
Primary intra-cranial germ-cell tumours (GCT) are rare and it is important to differentiate them histologically as their prognosis and treatment is quite different. Moreover, highly malignant non-germinomatous GCT (NG GCT) comprise a small portion of these tumours with limited data available on appropriate treatment approaches. We present the case of a 22-year-old male with a unique primary skull-based yolk-sac subtype NG GCT with a literature review of current treatment options. To our knowledge, there have not been any previously published reports of a primary yolk-sac tumour arising from the petrous apex.
Assuntos
Neoplasias Encefálicas/patologia , Tumor do Seio Endodérmico/patologia , Neoplasias Encefálicas/fisiopatologia , Neoplasias Encefálicas/terapia , Tumor do Seio Endodérmico/fisiopatologia , Tumor do Seio Endodérmico/terapia , Humanos , Masculino , Adulto JovemAssuntos
Colo do Útero/patologia , Tumor do Seio Endodérmico/patologia , Neoplasias do Colo do Útero/patologia , Vagina/patologia , Neoplasias Vaginais/patologia , Adulto , Colo do Útero/diagnóstico por imagem , Colo do Útero/cirurgia , Diagnóstico Diferencial , Tumor do Seio Endodérmico/fisiopatologia , Tumor do Seio Endodérmico/terapia , Feminino , Humanos , Radiografia , Neoplasias do Colo do Útero/fisiopatologia , Neoplasias do Colo do Útero/terapia , Vagina/diagnóstico por imagem , Vagina/cirurgia , Neoplasias Vaginais/fisiopatologia , Neoplasias Vaginais/terapia , alfa-Fetoproteínas/metabolismoAssuntos
Seio Cavernoso/patologia , Fossa Craniana Média/patologia , Tumor do Seio Endodérmico/patologia , Neoplasias da Base do Crânio/patologia , Crânio/patologia , Seio Cavernoso/anatomia & histologia , Seio Cavernoso/cirurgia , Fossa Craniana Média/anatomia & histologia , Fossa Craniana Média/cirurgia , Tumor do Seio Endodérmico/fisiopatologia , Tumor do Seio Endodérmico/cirurgia , Feminino , Humanos , Lactente , Imageamento por Ressonância Magnética , Procedimentos Neurocirúrgicos/métodos , Crânio/anatomia & histologia , Crânio/cirurgia , Neoplasias da Base do Crânio/fisiopatologia , Neoplasias da Base do Crânio/cirurgiaRESUMO
Pregnancy complicated by endodermal sinus tumor of the ovary is extremely rare. The authors present a case report of a pregnant woman with persistent left adnexal mass and subsequently found to have a primary endodermal sinus tumor of the ovary that was diagnosed at 19 weeks of gestation. After left salpingo-oophorectomy had been performed, the patient chose to terminate the pregnancy before the initiation of combination chemotherapy with bleomycin, etoposide, and cisplatin. The response to chemotherapy was not satisfactory. The patient expired after seven cycles of treatment had been completed because of pulmonary fibrosis and the drug toxicity of bleomycin.
Assuntos
Tumor do Seio Endodérmico/diagnóstico , Neoplasias Ovarianas/diagnóstico , Aborto Induzido , Adulto , Antibióticos Antineoplásicos/efeitos adversos , Antibióticos Antineoplásicos/uso terapêutico , Antineoplásicos/efeitos adversos , Antineoplásicos/uso terapêutico , Antineoplásicos Fitogênicos/efeitos adversos , Antineoplásicos Fitogênicos/uso terapêutico , Bleomicina/efeitos adversos , Bleomicina/uso terapêutico , Cisplatino/efeitos adversos , Cisplatino/uso terapêutico , Tumor do Seio Endodérmico/tratamento farmacológico , Tumor do Seio Endodérmico/fisiopatologia , Etoposídeo/efeitos adversos , Etoposídeo/uso terapêutico , Evolução Fatal , Feminino , Humanos , Neoplasias Ovarianas/tratamento farmacológico , Neoplasias Ovarianas/fisiopatologia , Ovariectomia/métodos , Gravidez , Primeiro Trimestre da Gravidez , Fibrose Pulmonar/induzido quimicamenteRESUMO
OBJECTIVE: The aim of this study was to investigate the outcome and reproductive function of patients with ovarian endodermal sinus tumor (EST) after cumulative high-dose combination chemotherapy with bleomycin, etoposide and cisplatin (BEP). METHODS: Between 1995 and 2006, 1034 patients with the diagnosis of ovarian cancer were treated at a single institution. Among these patients, 51 had a confirmed diagnosis of malignant ovarian germ cell tumor (MOGCT) including 20 cases of EST. We retrospectively reviewed those patients with EST, who received BEP as adjuvant chemotherapy. The doses were 15 mg/day of bleomycin on days 1 to 3, 100 mg/m(2)/day IV of etoposide on days 1 to 3 and 20 mg/m(2)/day of cisplatin on days 1 to 5. The median number of total cycles was six (range between three and nine). RESULTS: The median age of the patients with EST was 18 years (range 5 to 36). All except two were nulliparous. The overall survival rate was 90% at a median follow-up of 70 months. Two patients (10%) had disease recurrence in the pelvis. Of the 15 patients who were treated with fertility-sparing surgery, all had regular menstruation following the completion of adjuvant chemotherapy, and two of these patients had pregnancies with live birth deliveries and no complications. CONCLUSION: In patients with EST, the cumulative high-dose BEP regimen resulted in excellent overall survival and did not seem to impair ovarian function.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Tumor do Seio Endodérmico/tratamento farmacológico , Tumor do Seio Endodérmico/fisiopatologia , Fertilidade , Neoplasias Ovarianas/tratamento farmacológico , Neoplasias Ovarianas/fisiopatologia , Ovário/fisiopatologia , Adolescente , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Bleomicina/administração & dosagem , Bleomicina/efeitos adversos , Quimioterapia Adjuvante , Criança , Pré-Escolar , Cisplatino/administração & dosagem , Cisplatino/efeitos adversos , Relação Dose-Resposta a Droga , Tumor do Seio Endodérmico/cirurgia , Etoposídeo/administração & dosagem , Etoposídeo/efeitos adversos , Feminino , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Neoplasias Ovarianas/cirurgia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: Ovarian yolk sac tumor (YST) is a very rare malignancy arising in young women. Chemotherapy has dramatically improved the prognosis. Current treatment consists of surgery followed by bleomycin, etoposide, and cisplatin (BEP) chemotherapy. However, given the rarity of this tumor, ovarian YST-specific survival and outcome after such treatment are not precisely known. PATIENTS AND METHODS: This report concerns prospectively recorded cases that were either treated at Institut Gustave Roussy (Villejuif, France) or referred there for advice about therapy. From 1990 to 2006, 52 patients underwent surgery followed by BEP chemotherapy. Data on patient characteristics, treatment, survival, and fertility outcome were analyzed to assess treatment efficacy and gonadal toxicity after achieving a complete remission. RESULTS: Thirty-five patients had stage I/II tumors while 17 patients presented with stage III/IV disease. With a median follow-up of 68 months, the overall 5-year survival and disease-free survival rates were 94% and 90%, respectively. Forty-one women underwent fertility-sparing surgery. Pregnancy was achieved in 12 of 16 (75%) women who attempted conception. Overall, 19 pregnancies have been recorded. CONCLUSIONS: BEP chemotherapy following fertility-sparing surgery is a very effective treatment of ovarian YSTs. Most of the patients who attempt conception after complete remission will have children.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Tumor do Seio Endodérmico/tratamento farmacológico , Tumor do Seio Endodérmico/cirurgia , Fertilidade , Neoplasias Ovarianas/tratamento farmacológico , Neoplasias Ovarianas/cirurgia , Adolescente , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Bleomicina/administração & dosagem , Bleomicina/efeitos adversos , Quimioterapia Adjuvante , Cisplatino/administração & dosagem , Cisplatino/efeitos adversos , Tumor do Seio Endodérmico/fisiopatologia , Etoposídeo/administração & dosagem , Etoposídeo/efeitos adversos , Feminino , Humanos , Estadiamento de Neoplasias , Neoplasias Ovarianas/fisiopatologia , Gravidez , Complicações Neoplásicas na Gravidez/fisiopatologia , Complicações Neoplásicas na Gravidez/terapia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
OBJECTIVE: Our purpose was to evaluate the prognostic factors in yolk sac tumors of the ovary. STUDY DESIGN: We performed a retrospective review of 47 patients with yolk sac tumors of the ovary from 1979 to 1997. RESULTS: Twenty-two patients had pure yolk sac tumors and 25 had germ cell tumors with yolk sac tissue as a component of the disease. The 5-year survival rate in stages I, II, III, and IV was 95%, 75%, 30%, and 25%, respectively. Patients with stage I disease had a more favorable prognosis than those with stage III and IV disease (P <.001). All patients who did not respond to chemotherapy died of this disease within 36 months of the first treatment. Chemotherapy regimens that included cisplatin gave better results than those without cisplatin (P <.05). The difference in prognosis was significant in cases in which the size of residual tumor was <2 cm in diameter (P <.01) and in cases in which ascites was either absent or <100 mL in volume (P <.05). Coexistence of other components of ovarian germ cell tumors in histologic specimens, preoperative serum alpha-fetoprotein level, fertility-sparing surgery, dissection of intrapelvic nodes, and p53 status had no significant correlation with the prognosis in this study. CONCLUSIONS: Staging and tumor-reductive surgery strongly affected the prognosis of this disease. Tumor-reductive surgery is advisable when ascites is minimal. Cisplatin-based chemotherapy after surgery was superior to chemotherapy without cisplatin; however, p53 status seemed to have no impact on chemosensitivity in yolk sac tumors of the ovary.
Assuntos
Tumor do Seio Endodérmico/fisiopatologia , Neoplasias Ovarianas/fisiopatologia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Ascite/metabolismo , Cisplatino/uso terapêutico , Tumor do Seio Endodérmico/tratamento farmacológico , Tumor do Seio Endodérmico/patologia , Tumor do Seio Endodérmico/cirurgia , Feminino , Humanos , Mortalidade , Estadiamento de Neoplasias , Neoplasias Ovarianas/tratamento farmacológico , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/cirurgia , Prognóstico , Estudos Retrospectivos , Análise de SobrevidaAssuntos
Fator Estimulador de Colônias de Granulócitos/administração & dosagem , Transplante de Células-Tronco Hematopoéticas , Neuroblastoma/terapia , Adolescente , Criança , Pré-Escolar , Tumor do Seio Endodérmico/fisiopatologia , Tumor do Seio Endodérmico/terapia , Feminino , Sobrevivência de Enxerto/efeitos dos fármacos , Humanos , Masculino , Neuroblastoma/fisiopatologia , Rabdomiossarcoma/fisiopatologia , Rabdomiossarcoma/terapia , Sarcoma/fisiopatologia , Sarcoma/terapia , Transplante Autólogo , Tumor de Wilms/fisiopatologia , Tumor de Wilms/terapiaRESUMO
BACKGROUND: Determination of serum concentration human chorionic gonadotropin (HCG) and alpha-fetoprotein (AFP) is crucial in diagnosis, prognosis, treatment, and follow-up of patients with germ cell tumors. Elevation of these markers almost indicates progression or recurrence of the germ cell tumor. However, an increase in these tumor markers can be produced by several benign causes. METHODS: The authors report nine cases of gonadal germ cell tumors that had increased serum levels of AFP without tumoral progression, recurrence, or residual tumor. RESULTS: The AFP elevations were attributed to liver damage secondary to drugs (chemotherapy, anesthetics, or antiepileptics), virus, or alcoholism. No clinical evidence (or in some cases surgical evidence) of malignant tumor activity was found in any of the patients. CONCLUSIONS: The elevation of serum levels of AFP in patients with germ cell tumors can be produced by liver dysfunction. These elevations must be interpreted with caution to avoid unnecessary treatments.