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[Management of intra-abdominal dysgerminoma During pregnancy - A Case Report and Literature Review].Zeitschrift Fur Geburtshilfe Und... Oct 2020Dysgerminomas are rare malignant germ cell tumors. They usually arise from the ovary, but case reports describing extraovarian dysgerminomas do exist. When treated... (Review)
Review
INTRODUCTION
Dysgerminomas are rare malignant germ cell tumors. They usually arise from the ovary, but case reports describing extraovarian dysgerminomas do exist. When treated adequately the disease has a good prognosis. Dysgerminomas diagnosed during pregnancy are very rare.
METHODOLOGY
Report of extraovarian intra-abdominal dysgerminoma during pregnancy. Systematic literature review.
CASE REPORT
A 35-year-old second gravida was diagnosed with a suspected intra-abdominal mass at 20 gestational weeks. During an exploratory laparotomy, a tumor infiltrating the transverse colon and histologically identified as a dysgerminoma was resected. Ovaries were clinically unremarkable. The induction of chemotherapy was postponed until after delivery. At 34 gestational weeks the patient underwent cesarean section and tumor debulking. Four cycles of bleomycin, etoposide and cisplatin were administered. After 12 months, cystic ovaries were found. Hysterectomy with bilateral adnexectomy was performed but no malignancy found. After 16 months, the patient was still in complete remission.
CONCLUSION
We describe the first-ever published dysgerminoma in gravida primarily evolving intraabdominally and not affecting the ovaries. The decision for cytoreductive surgery, prolongation of pregnancy and postponing chemotherapy until after delivery combined the best benefit for the baby with a good maternal prognosis. Due to limited data regarding dysgerminomas in pregnancy, individual interdisciplinary concepts are mandatory.
Topics: Adult; Antineoplastic Agents; Bleomycin; Cesarean Section; Cisplatin; Dysgerminoma; Female; Humans; Ovarian Neoplasms; Pregnancy
PubMed: 32242331
DOI: 10.1055/a-1112-0506 -
Current Problems in Cancer Apr 2021Extraovarian germ cell tumors are very rare and their occurrence during pregnancy is exceptional. In this case report an abdominal mass was shown by ultrasonography,...
Extraovarian germ cell tumors are very rare and their occurrence during pregnancy is exceptional. In this case report an abdominal mass was shown by ultrasonography, during a routine monitoring of a 26-year-old pregnant woman. The patient was left under radiological control in the following months in order to bring the pregnancy to term. A few months after the delivery, the patient underwent surgery and a diagnosis of extraovarian (abdominal) dysgerminoma was made. To the best of our knowledge, there are only 3 other case reports describing an extra-gonadal dysgerminoma occurring during pregnancy. The aim of this study was to report an extremely rare tumor, whose management can be challenging first because this neoplasm has some differences from its ovarian and testicular counterparts. Furthermore, the occurrence during pregnancy makes the multidisciplinary approach mandatory since 3 distinct but not independent entities are involved (tumor, mother and fetus).
Topics: Adult; Dysgerminoma; Female; Humans; Ovarian Neoplasms; Pregnancy; Pregnant Women
PubMed: 33129566
DOI: 10.1016/j.currproblcancer.2020.100667 -
The American Journal of Surgical... Aug 2021One-hundred fourty pure dysgerminomas were evaluated with particular focus on the microscopic features as seen in 125 cases with available slides. The patients ranged...
One-hundred fourty pure dysgerminomas were evaluated with particular focus on the microscopic features as seen in 125 cases with available slides. The patients ranged from 8 to 59 years of age (mean, 24.1 y). The tumors, bilateral in 4% of the cases and with a mean tumor diameter of 13 cm, were typically soft, lobulated, homogeneous, and creamy white to tan to yellow but necrosis was found in 13%, hemorrhage in 20%, and focal cystic change in 15%. On microscopic examination, the patterns and other notable features encountered, including their frequency, were as follows: an alveolar pattern resulting from delicate fibrovascular septa (51%), diffuse (33%), macronodular (14%), insular (26%), cords (28%), solid tubular (17%), microspaces (sometimes simulating glands) (12%), follicle-like spaces (5%), prominent fibrous bands (65%), stromal edema (56%), stromal luteinization (9%), granulomatous infiltrate (46%), lymphocytic infiltrate (100%), Langhans cell type giant cells (35%), syncytiotrophoblast giant cells (6%), prominent population of cells with pale to clear cytoplasm (73%), cells with amphophilic to eosinophilic cytoplasm (53%) and vacuolated occasionally signet ring-like cells (7%). Various constellations of the above findings often resulted in an appearance different from that usually portrayed in the literature and certain tumors of very different nature being in the differential such as undifferentiated carcinoma not otherwise specified, small cell carcinoma of hypercalcemic type, and malignant lymphoma. The correct diagnosis can be arrived at by considering the usual relative youth of the patient, often rather characteristic gross features, and most crucially careful attention to the microscopic features and awareness of variant morphologic findings. Those that are particularly problematic based on this study are diffuse growth with inconspicuous fibrovascular septa, macronodules, cords, solid tubular formations, spaces ranging from small to large, and mimicking glands or follicles, prominent fibrous to edematous stroma, and cells with amphophilic to eosinophilic cytoplasm. According to the degree of difficulty and confidence of the interpreter, well-known immunohistochemical features of dysgerminoma, which largely differ from those of other neoplasms in the differential, will aid if felt indicated.
Topics: Adolescent; Adult; Child; Dysgerminoma; Female; Humans; Middle Aged; Ovarian Neoplasms; Young Adult
PubMed: 33577182
DOI: 10.1097/PAS.0000000000001687 -
International Journal of Gynecological... Nov 2019Dysgerminomas are malignant ovarian germ-cell tumors that typically affect young women. Although these tumors have an excellent response to chemotherapy, surgery is an...
BACKGROUND
Dysgerminomas are malignant ovarian germ-cell tumors that typically affect young women. Although these tumors have an excellent response to chemotherapy, surgery is an integral part of primary treatment.
OBJECTIVE
To evaluate outcomes of initial cytoreduction in patients diagnosed with dysgerminomas.
METHODS
Patients who underwent primary cytoreductive surgery for ovarian dysgerminoma between January 1985 and December 2013 were identified and included in the study. A comparison was made between patients who underwent optimal versus sub-optimal cytoreduction. Descriptive, comparative statistics and odds ratios were used to establish an association. Survival curves were performed with the Kaplan-Meier method and compared using a log-rank test. A value of p<0.05 was used to establish a statistical difference.
RESULTS
A total of 180 patients with a histologically confirmed dysgerminoma were included in the analysis. A subsection of 37 patients in stages III/IV were analyzed. The median age at diagnosis was 21 years (IQR 18-26). Histologically, 166 (92.2%) patients had pure dysgerminomas, whereas the rest had mixed histologies. The median tumor size was 18 (IQR 12-22) cm. In all stages, factors associated with optimal cytoreduction, were higher lactate dehydrogenase levels (OR=1.01; p=0.03), higher CA125 levels (OR=1.01; p=0.04), receiving adjuvant chemotherapy (OR=0.22; p<0.01), or undergoing treatment in a specialized institution (OR=12.68; p<0.01). Patients in stages III/IV, initially managed outside our institution were less likely to be taken for cytoreduction (OR=16.88; p=0.013). Other factors, including age (OR=1.02; p=0.39), pelvic lymph-node positivity (OR=2.24; p=0.36), pregnancy during follow-up (OR=0.91: p=0.80), or recurrence of disease (OR=1.93; p=0.23) were found to be similar in both groups. Overall survival was higher in optimally cytoreducted patients (100% vs 95.7%; p=0.032) including all stages, but not if considering only stages III/IV (100% vs 90%, p=0.186); disease-free survival was the same for both groups regardless of stage (94.3% vs 91.1%; p=0.36).
CONCLUSION
Patients with optimal surgeries were most likely to be treated in referral centers. Initial residual disease did not significantly alter recurrence, progression, disease-free survival, or overall survival.
Topics: Adolescent; Adult; Cytoreduction Surgical Procedures; Disease-Free Survival; Dysgerminoma; Female; Humans; Neoplasm Staging; Ovarian Neoplasms; Young Adult
PubMed: 31594835
DOI: 10.1136/ijgc-2019-000632 -
Journal of Obstetrics and Gynaecology... May 2019To discuss the finding of hypercalcemia in pediatric ovarian dysgerminoma.
OBJECTIVE
To discuss the finding of hypercalcemia in pediatric ovarian dysgerminoma.
METHODS
Two cases of pediatric ovarian dysgerminoma that presented with hypercalcemia are discussed.
RESULTS
Hypercalcemia is a rare finding in ovarian dysgerminoma.
CONCLUSION
Ovarian dysgerminoma should be considered in pediatric patients presenting with signs of hypercalcemia. Parathyroid hormone, parathyroid hormone related protein, and 1,25 dihydroxyvitamin D may elucidate the cause of hypercalcemia.
Topics: Adolescent; Child; Dysgerminoma; Female; Humans; Hypercalcemia; Ovarian Neoplasms
PubMed: 30551952
DOI: 10.1016/j.jogc.2018.05.004 -
Journal of Ovarian Research Jun 2020To investigate the spectrum of CT and MRI findings of dysgerminoma of the ovary.
BACKGROUND
To investigate the spectrum of CT and MRI findings of dysgerminoma of the ovary.
METHODS
CT and MRI imaging of 12 patients with 13 histologically proven dysgerminomas of the ovary were retrospectively reviewed. Patients ages ranged from 6 ~ 27 years (mean, 17.2 years). Two observers evaluated the following CT and MRI features of the tumor by consensus: (i) location, shape, and size; (ii) attenuation, T2 signal intensity, and ADC value; (iii) patterns of contrast enhancement; (iv) presence of fibrovascular septa; (v) presence of necrosis, hemorrhage, and calcification; (vi) presence of "ovarian vascular pedicle" sign. We also noted the extent or stage of the tumors.
RESULTS
75% lesions arised in the right ovary. Bilateral ovaries were involved in one case. Tumors displayed as a purely or predominantly solid mass (mean size, 17.0 ± 7.8 cm). Ten tumors were shaped multilobulated. The mean ADC value of lesions was 0.830 ± 0.154 × 10 mm/s. Characteristic fibrovascular septa were observed in all lesions. Among them, classic septa were present in 69% lesions. They were thin, hypointense on T2WI with a linear intense enhancement indicating the blood vessels in septa. Due to the stromal edema, fibrovascular septa may become thick even amorphous in shape, hyperintense on T2WI and even low attenuation on CT with a slight enhancement except for a bright blood vessel on the edge. Massive necrosis was observed only in one lesion. Calcification was present in 3 of the 5 tumors on CT. "Ovarian vascular pedicle" sign was present in 12 lesions. Lymphadenopathy, retroperitoneal spread, and distant metastases combined with an implantation in Douglas' cul-de-sac were present in one patient respectively.
CONCLUSION
On CT and MR images, ovarian dysgerminoma often appears as a large solid mass. The edematous condition of characteristic fibrovascular septa can be well displayed by imaging which then can guide the radiologists to make an accurate diagnosis. Calcifications often occur in the tumor. Nonspecific low ADC value and "ovarian vascular pedicle" sign may narrow the differential diagnosis.
Topics: Adolescent; Adult; Child; Dysgerminoma; Female; Humans; Magnetic Resonance Imaging; Ovarian Neoplasms; Retrospective Studies; Tomography, X-Ray Computed; Young Adult
PubMed: 32552845
DOI: 10.1186/s13048-020-00674-z -
Beitrage Zur Pathologie May 1976The importance of the Y-chromosome for the germ cell tumour development in gonadal dysgenesis has been emphasized many times. In contrast, only two cases of dysgerminoma...
The importance of the Y-chromosome for the germ cell tumour development in gonadal dysgenesis has been emphasized many times. In contrast, only two cases of dysgerminoma or gonadoblastoma had been published so far in the XO-Turner's syndrome. With this report, another case of Turner's syndrome developing a dysgerminoma in a gonadal streak is presented. No Y-chromosome containing stemline could be detected in the patient nor in the tumour. A primary genetic etiology or a mechanism related to early secondary regression or dysgenesis of the gonad are discussed as causative factors in germ cell tumour development within gonadal streaks.
Topics: Adult; Dysgerminoma; Female; Humans; Sex Chromosomes; Turner Syndrome
PubMed: 1275866
DOI: 10.1016/s0005-8165(76)80085-6 -
Avian Diseases Mar 2011This report describes a case of dysgerminoma in a 21-year-old eastern rosella (Platycercus eximius eximius) that presented with dyspnea and a severely distended coelom....
This report describes a case of dysgerminoma in a 21-year-old eastern rosella (Platycercus eximius eximius) that presented with dyspnea and a severely distended coelom. The bird was euthanatized, and a large, left-sided coelomic mass was identified. Microscopically, the mass was composed of sheets and nests of round to polygonal neoplastic cells with lacy cytoplasm. The neoplastic cells were weakly positive for vimentin and c-kit but negative for pancytokeratin, AE1, and inhibin. On the basis of the histomorphology and immunoreactivity, the neoplasm was determined to be a dysgerminoma. The variability of histologic appearance and immunohistochemical staining of dysgerminomas in humans compared with veterinary species is discussed.
Topics: Animals; Bird Diseases; Dysgerminoma; Female; Ovarian Neoplasms; Parrots
PubMed: 21500650
DOI: 10.1637/9502-081510-Case.1 -
Revue Francaise de Gynecologie Et... Jan 1988From a review of the literature, the authors present some new facts on the diagnosis of ovarian dysgerminoma, as well as a therapeutic protocol for the treatment of... (Review)
Review
From a review of the literature, the authors present some new facts on the diagnosis of ovarian dysgerminoma, as well as a therapeutic protocol for the treatment of extended forms, as well as the conservative treatment of localized forms in women wishing to become pregnant.
Topics: Dysgerminoma; Female; Humans; Neoplasm Staging; Ovarian Neoplasms; Prognosis
PubMed: 3279505
DOI: No ID Found -
Gynecologic Oncology May 2001Ovarian dysgerminomas are quite amenable to treatment and very good cure rates are achieved even with advanced disease. However, recent literature suggests that late... (Review)
Review
BACKGROUND
Ovarian dysgerminomas are quite amenable to treatment and very good cure rates are achieved even with advanced disease. However, recent literature suggests that late recurrence may be associated with a poorer prognosis and bleomycin/etoposide/cisplatin (BEP) chemotherapy may play only a limited role in its management. We present a patient who had a late recurrence of ovarian dysgerminoma with successful treatment outcome.
CASE
A 25-year-old woman was diagnosed with a stage IC ovarian dysgerminoma in 1983 and did not undergo adjuvant treatment. She had late recurrence 12 years later with good treatment response to BEP chemotherapy given in a semiadjuvant fashion.
CONCLUSION
Our case demonstrates that BEP chemotherapy still plays an important role in treatment of late recurrence in ovarian dysgerminomas provided there is small volume disease at time of detection. Also important is long-term surveillance in an effort to detect recurrence while still small in volume and potentially curable.
Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Chemotherapy, Adjuvant; Cisplatin; Dysgerminoma; Etoposide; Female; Humans; Neoplasm Recurrence, Local; Neoplasm Staging; Ovarian Neoplasms
PubMed: 11330968
DOI: 10.1006/gyno.2001.6135