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International Journal of Gynecological... Mar 2019To investigate the prognostic significance of complete gross resection following cytoreductive surgery for patients with advanced stage malignant ovarian germ cell...
OBJECTIVE
To investigate the prognostic significance of complete gross resection following cytoreductive surgery for patients with advanced stage malignant ovarian germ cell tumors.
METHODS
The National Cancer Data Base was accessed and patients diagnosed with an advanced stage (II-IV) malignant ovarian germ cell tumor who underwent primary cytoreductive surgery between 2011 and 2014 were selected for further analysis. For analysis purposes two groups were formed: patients with complete gross resection and those with macroscopic residual disease. Demographic and clinico-pathological characteristics were compared with the chi-square and Mann-Whitney test. Univariate survival analysis was performed with the log-rank test after generation of Kaplan-Meier curves, while a Cox proportional hazard model was constructed to evaluate mortality after controlling for confounders.
RESULTS
A total of 343 patients who met the inclusion criteria were identified. Residual disease status was available for 276 patients: the rate of complete gross resection was 69.2 %. By univariate analysis there was no difference in overall survival between patients in the complete gross resection and macroscopic residual disease groups, P= 0.26; 3-year overall survival rates: 86.4 % and 82.8 %, respectively. No difference in overall survival was noted following stratification by histology; P = 0.64 and P = 0.24 for dysgerminoma and non-dysgerminoma tumor groups. After controlling for stage IV disease, histology and the administration of chemotherapy, macroscopic residual disease was not associated with a worse mortality (HR: 1.22, 95% CI: 0.61 to 2.46).
CONCLUSIONS
Macroscopic residual disease following primary cancer-directed surgery was not associated with a worse prognosis in a cohort of patients with advanced stage malignant ovarian germ cell tumors.
Topics: Adult; Cytoreduction Surgical Procedures; Female; Humans; Hysterectomy; Neoplasm Staging; Neoplasm, Residual; Neoplasms, Germ Cell and Embryonal; Ovarian Neoplasms; Prognosis; Retrospective Studies; Salpingo-oophorectomy; Young Adult
PubMed: 30700566
DOI: 10.1136/ijgc-2018-000013 -
Veterinary and Comparative Oncology Sep 2021Little evidence is available regarding the prognosis of dogs with malignant ovarian tumours. The objective of this retrospective study was to describe the outcomes and...
Little evidence is available regarding the prognosis of dogs with malignant ovarian tumours. The objective of this retrospective study was to describe the outcomes and determine the prognostic factors for dogs with malignant ovarian tumours following treatment, including surgery with or without adjuvant therapy. Eighteen dogs were studied, their median age was 12 years (range: 7-15 years), and their median body weight was 6.9 kg (range: 2.3-17.8 kg). Following histopathologic diagnoses revealed that granulosa cell tumour was the most common type (n = 9), followed by dysgerminoma (n = 5), and adenocarcinoma (n = 4). Eleven dogs had surgery alone. Seven dogs had surgery with adjuvant therapy, including chemotherapy and/or radiotherapy. The median survival time (ST) was 1009 days when only deaths owing to the ovarian tumours were considered, and predictors of median ST were T-category (≥ T3, 443 days vs ≤ T2, 1474 days; P = .002), presence of metastatic disease (present, 391 days vs absent, 1474 days; P < .001) and lymphovascular space invasion (present, 428 days vs absent, 1474 days; P = .003) in a univariate analysis. Median ST in dogs with granulosa cell tumour seemed longer than in dogs with dysgerminoma and adenocarcinoma, although the difference was statistically insignificant (1474 days vs 458 days, respectively; P = .10). Considering the good prognosis, aggressive treatment can be recommended for dogs with malignant ovarian tumours, especially early-stage cases. Despite metastasis being present at diagnosis, half of the dogs with metastasis survived for more than 1 year.
Topics: Adenocarcinoma; Animals; Dog Diseases; Dogs; Dysgerminoma; Female; Granulosa Cell Tumor; Ovarian Neoplasms; Prognosis; Retrospective Studies; Treatment Outcome
PubMed: 32700381
DOI: 10.1111/vco.12639 -
Journal of the American Animal Hospital... 2019
Topics: Animals; Antineoplastic Agents; Dog Diseases; Dogs; Dysgerminoma; Female; Ovarian Diseases; Radiotherapy
PubMed: 31099610
DOI: 10.5326/JAAHA-MS-6893 -
Neurology India 2022The challenges associated with surgeries of cavernous sinus (CS) lesions have shifted the management trend towards upfront gamma knife radiosurgery (GKRS). Although GKRS...
BACKGROUND
The challenges associated with surgeries of cavernous sinus (CS) lesions have shifted the management trend towards upfront gamma knife radiosurgery (GKRS). Although GKRS is effective in arresting the progression of certain small residual/recurrent lesions, its efficacy in alleviating neurological deficits is less evident. Furthermore, GKRS without establishing the histopathological diagnosis, at times can be detrimental.
OBJECTIVE
We present our clinical experience to reemphasize the role of surgery for CS lesions in the current era of upfront GKRS.
MATERIALS AND METHODS
We reviewed our database of 32 patients with various CS lesions treated by surgery for progressive cranial nerve deficits. The follow-up data were analyzed for the extent of resection, and in particular for improvement in their symptoms.
RESULTS
The lesions were confirmed as hemangioma (CSH)-8, meningioma-8, trigeminal schwannoma-6, chordoma-3, residual pituitary with CS extension-3, fungal granuloma-3, and dysgerminoma-1. Symptoms improved in 23 (complete in 13) and remained at least static in six patients. Follow-up ranged from 4-36 months.
CONCLUSIONS
The nature of pathology should determine the management modality in CS lesions. Excision of CS schwannomas and chordomas yields rapid clinical improvement and good long-term outcomes. Resection is preferred for large CSH and functioning pituitary tumors. Although the clinical improvement may be less dramatic, surgery debulks the meningiomas. Most importantly, surgery also establishes the histopathological diagnosis of CS lesions. Even with an easy alternative of upfront GKRS, resection has a definite role in the primary management of most CS pathologies.
Topics: Cavernous Sinus; Chordoma; Cranial Nerve Neoplasms; Follow-Up Studies; Humans; Meningeal Neoplasms; Meningioma; Neurilemmoma; Radiosurgery; Retrospective Studies; Treatment Outcome
PubMed: 35532620
DOI: 10.4103/0028-3886.344638 -
Medicina (Kaunas, Lithuania) May 2021Ovarian malignant germ cell tumors (OMGCT) represent less than 10% of all ovarian tumors. Dysgerminoma is the most common malignant primitive germ cell tumor in young... (Review)
Review
Ovarian malignant germ cell tumors (OMGCT) represent less than 10% of all ovarian tumors. Dysgerminoma is the most common malignant primitive germ cell tumor in young women, known for its curability and low propensity to invade and metastasize when diagnosed early. Herein, we report an unusual type of ovarian dysgerminoma (OD) metastasis with a brief review of the literature, lacking similar reported cases. To our knowledge, although there are several case reports of dysgerminoma metastases with variable anatomic location and presentation, vaginal metastasis has not been previously described. The local or systemic relapse together with local and distant metastasis is considered as an independent predictor of poor survival in patients with OD. In light of the absence of mutations status, our patient successfully responded to therapy. Currently, the patient remains in clinical remission. A specific follow-up plan is ongoing knowing that ovarian dysgerminomas tend to recur most often in the first 2-3 years after treatment.
Topics: Dysgerminoma; Female; Humans; Mutation; Neoplasm Recurrence, Local; Neoplasms, Germ Cell and Embryonal; Ovarian Neoplasms
PubMed: 34071828
DOI: 10.3390/medicina57060534 -
International Journal of Gynecological... Feb 2019To evaluate the role of omentectomy and lymphadenectomy in the treatment of clinically apparent early-stage malignant ovarian germ cell tumors.
OBJECTIVE
To evaluate the role of omentectomy and lymphadenectomy in the treatment of clinically apparent early-stage malignant ovarian germ cell tumors.
METHODS
We retrospectively reviewed 245 patients with malignant ovarian germ cell tumors (yolk sac tumor, dysgerminoma, and immature teratoma) and with clinically early-stage disease, who were treated at Sun Yat-sen University Cancer Center between January 1, 1970 and December 31, 2017. The survival of patients who underwent either omentectomy or lymphadenectomy, or both (omentectomy/lymphadenectomy group) was compared with that of patients who did not undergo omentectomy or lymphadenectomy (non-omentectomy/lymphadenectomy group).
RESULTS
Sixty patients were diagnosed with yolk sac tumor, 74 with dysgerminoma, and 111 with immature teratoma. Of these 245 patients, 216 patients had stage I disease, 28 patients had stage II, and 1 patient had stage IIIA. There were 190 patients who underwent omentectomy and/or lymphadenectomy and 55 patients in the non-omentectomy/lymphadenectomy group, respectively. In the omentectomy/lymphadenectomy group, 112 patients underwent both omentectomy and lymphadenectomy, 71 underwent omentectomy only, and 7 underwent lymphadenectomy only. Two hundred and fourteen of 245 patients (87.3%) received post-operative chemotherapy. Median follow-up was 73 months (range 1-388). The 10-year overall survival rates in the omentectomy/lymphadenectomy group and non-omentectomy/lymphadenectomy groups were 96.8% and 100%, respectively (p=0.340). Multivariate analysis evaluating all potential prognostic factors showed that omentectomy and lymphadenectomy are not prognostic factors for survival.
CONCLUSIONS
Omentectomy and lymphadenectomy do not appear to improve survival and may be omitted in patients with clinically apparent early-stage malignant ovarian germ cell tumors.
PubMed: 30674572
DOI: 10.1136/ijgc-2018-000078 -
Journal of Neuro-oncology Aug 2021Germ cell tumors (GCTs) are uncommon neoplasms predominantly arising in midline tissues. The prognostic significance of histopathology in predicting metastatic GCT...
INTRODUCTION
Germ cell tumors (GCTs) are uncommon neoplasms predominantly arising in midline tissues. The prognostic significance of histopathology in predicting metastatic GCT behavior is poorly understood.
METHODS
Multicenter international cohort study including 29 patients with GCTs metastatic to brain were retrospectively investigated (18 patients from Mayo Clinic and 11 patients from the intracranial germ cell tumor genome analysis consortium in Japan). Clinical characteristics were analyzed using the Chi-square test (two-tailed) for categorical variables and using the log-rank test for survival data.
RESULTS
Median age at treatment was 31 years (range 14-58). Primary disease sites were testis (71%), mediastinum (18%), and female reproductive organs (11%). Median metastatic interval was 223 days (range, 6-6124). Median follow-up was 346 days (range, 1-5356), with 16 deaths (57%) occurring after the median overall survival of 455 days. Actuarial one-year survival was 51%; 12-of-16 deaths (75%) were attributed to intracranial disease. Appearance of the same GCT subtype at the metastatic site as the primary was high for non-seminomatous GCT (NSGCT, 64-100%), but low for seminoma/dysgerminoma and mature teratoma (MT, 14, 17%, respectively). Gain of a new component was seen in 4 (20%)-3 of which included embryonal carcinoma (EC) at the primary site (75%). Incidence of cases without seminoma/dysgerminoma increased significantly after metastasis (p = 0.02). Metastatic interval was shorter in cases with histological change (199 vs 454 days, p = 0.009). Overall survival was associated with MT primary histopathology (p = 0.02).
CONCLUSION
Histological differentiation at the primary GCT site influences metastatic prognosis. Aggressive behavior is associated with NSGCT, while EC frequently demonstrates multi-directional histological differentiation after brain metastasis, and such histological dynamism is associated with shorter metastatic interval. Most metastases occurred within one year of diagnosis, emphasizing the need for close surveillance in newly diagnosed extra-cranial GCT.
Topics: Adolescent; Adult; Brain Neoplasms; Cohort Studies; Female; Humans; Male; Middle Aged; Neoplasms, Germ Cell and Embryonal; Prognosis; Young Adult
PubMed: 34272633
DOI: 10.1007/s11060-021-03810-x -
Journal of Gynecology Obstetrics and... Jun 2021Ovarian masses in pediatric population are the most common genital neoplasms, and these masses are often benign. The purpose of this study is to evaluate the pediatric...
PURPOSE
Ovarian masses in pediatric population are the most common genital neoplasms, and these masses are often benign. The purpose of this study is to evaluate the pediatric ovarian masses operated in our hospital.
METHOD
The records of patients, under the age of 18 who were operated in our hospital due to ovarian mass between 2012 and 2018 were reviewed retrospectively. Clinical findings, operational procedures, histopathologies, tumor markers and radiological images were evaluated.
FINDINGS
During the study, 146 patients (5 patients were bilateral) were evaluated. The average age of the study patients was 14.01 ± 4.02 years. 107 of the study patients were benign, 37 were malignant and 2 were borderline. The most common symptom in benign masses was tenderness in lower abdominal (75.7 %). 124 of the patients (86.1 %) were in post-menarche period. 34 of the patients had ovarian torsion. Open surgery was conducted on 79.5 % (116/146) of the patients, and laparoscopic surgery was conducted on 20.5 % (30/146). The rate of oophorectomy was 24.6 % (36/146) throughout the operations. The most frequently conducted surgical procedure was cyst excision in benign masses and oophorectomy in malignant masses. In neoplastic masses, the ratio of pelvic mass palpation; and in non-neoplastic masses, lower abdominal tenderness was more apparent. The rate of ovarian torsion was 23.6 % (25/107) in benign masses and 24.3 % (9/37) in malignant masses.
OUTCOMES
Pediatric and adolescent ovarian masses are mostly benign and majority of these occur at post-menarche period. The most common symptom was pelvic tenderness in benign masses, and palpable pelvic masses in malignant masses. For future fertility and low incidence of malignancy in these patients, ovarian preserving surgery should be considered for the first operation.
Topics: Abdominal Pain; Adolescent; Child; Cystadenocarcinoma; Dysgerminoma; Female; Humans; Laparoscopy; Ovarian Cysts; Ovarian Neoplasms; Ovarian Torsion; Ovariectomy; Retrospective Studies; Teratoma
PubMed: 32889112
DOI: 10.1016/j.jogoh.2020.101901 -
The Turkish Journal of Pediatrics 2023Primary ovarian tumors are rare in the pediatric age group. We reviewed our 40-year experience with ovarian tumors to evalute the clinical features and treatment results...
BACKGROUND
Primary ovarian tumors are rare in the pediatric age group. We reviewed our 40-year experience with ovarian tumors to evalute the clinical features and treatment results in a single institution.
METHODS
Between January 1975 and October 2015, 124 girls with primary ovarian tumor were diagnosed and treated in our center. Tumors were identified with biopsy or total resection and/or serum markers. Seventy four children were included in the treatment analysis.
RESULTS
Median age for 124 children was 11.0 years (0.73-17.63). The main complaint was abdominal pain in 85 patients (68.5%). One hundred and five patients (84.6%) had total one-sided salpingo-oophorectomy and five patients had bilateral salpingo-oophorectomy. Amongst 124 cases, 29 patients had mature teratoma, which was the most common tumor in this study. Dysgerminoma (n=21) was the most common malignant histopathologic type. Stage I disease was diagnosed in 57.2% and stage IV in 6.6% of the patients. Five year overall survival (OS) and event-free survival (EFS) for 124 children were 82.5% and 76.3% respectively. For 74 children who received treatment, 5-year OS and EFS were 75.2% and 67.1%, respectively. Age (p < 0.017), histopathological subgroup (p < 0.001), stage (p =0.003) and chemotherapy protocols (p =0.049) were significant prognostic factors for OS.
CONCLUSIONS
The survival rates in children with ovarian tumors were comparable with studies in the literature. Although patients treated with platin based regimens had better survival rates, prognosis was still poor for the patients in advanced stages. This should be the focus for further studies and improvements.
Topics: Child; Female; Humans; Antineoplastic Combined Chemotherapy Protocols; Neoplasm Staging; Ovarian Neoplasms; Prognosis; Retrospective Studies; Treatment Outcome
PubMed: 37114690
DOI: 10.24953/turkjped.2022.659 -
International Journal of Gynaecology... Jan 2022A 20-year-old woman was diagnosed with an ovarian dysgerminoma on the right ovary and underwent fertility-preserving right salpingo-oophorectomy and staging. Eight...
A 20-year-old woman was diagnosed with an ovarian dysgerminoma on the right ovary and underwent fertility-preserving right salpingo-oophorectomy and staging. Eight months later she was found to have a left ovarian solid mass. She underwent controlled ovarian hyperstimulation and oocyte cryopreservation before total abdominal hysterectomy, left salpingo-oophorectomy, and exploratory surgery were performed. The patient was optimally debulked, with no recurrent cancer to date. Thirty-six oocytes were mature and cryopreserved using vitrification. Now, the patient's mother has undergone embryo transfer that resulted in a clinical pregnancy, acting as a gestational carrier, for her daughter. To our knowledge, this is the first case describing the uterine transfer of embryos into a gestational carrier where the embryos were generated using oocytes obtained through controlled ovarian hyperstimulation in the context of active ovarian cancer. In the appropriate clinical setting, women desiring future fertility with a diagnosis of ovarian cancer without the option of ovarian-sparing surgery may be candidates for controlled ovarian hyperstimulation for the purposes of fertility preservation, especially if altruistic gestational carriers are available and willing.
Topics: Adult; Cryopreservation; Female; Fertility Preservation; Humans; Neoplasm Recurrence, Local; Oocytes; Ovarian Neoplasms; Pregnancy; Young Adult
PubMed: 34254305
DOI: 10.1002/ijgo.13824