Dysgerminoma of the ovary: Review of 32 cases

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 16072-16072
Author(s):  
O. Streltsova ◽  
S. Tjulandin ◽  
K. Jordaniya ◽  
V. Kuznetsov ◽  
A. Kedrova
Keyword(s):  
Adjuvant Treatment ◽  
Progressive Disease ◽  
Primary Treatment ◽  
Primary Surgery ◽  
Fertility Sparing Surgery ◽  
Platinum Based Chemotherapy ◽  
Fertility Sparing ◽  
Intercurrent Disease ◽  
Stage Ia

16072 Purpose: This study was undertaken to determine the frequency, characteristics, treatment and outcome of patients with dysgerminomas in single institution between 1990 and 2006. Methods: A total of 32 patients with pure dysgerminoma were retrospectively reviewed, among whom 23 patients had primary treatment in NNBRCRC during the period 1990–2006 and referred for follow-up (n=1) or salvage therapy after recurrence (n=9). Results: The median (range) age at presentation was 21 (14–42) years. 17 women (53%) presented with FIGO surgical stage I disease, 2 (6%) had pelvic metastases (stage II), and 9 (28%) had advanced (stage III/IV) disease. 4 patients had no comprehensive surgical staging. 2 women had evidence of dysgenetic gonads with a 46 XY karyotype. Primary surgery was done in all patients. 22 patients (69%) underwent fertility-sparing surgery. 4 (13%) patients received no adjuvant treatment after surgery due to stage Ia. All of them are alive without evidence of disease at a median (range) follow-up of 4,2 (2–6,4) years. Postoperative systemic chemotherapy was administered to 28 (87%) women. 16 of them received adjuvant chemotherapy and 12 received chemotherapy for metastatic disease. Among them 20 received platinum-based chemotherapy. Six patients had disease progression during first-line systemic treatment, all women received non-platinum-based chemotherapy. Three of them were salvage with second-line cisplatinum-based chemotherapy. Two deaths were associated with progressive disease, and one patient died of intercurrent disease. Overall, 29 women (90%) are alive without evidence of disease at a median follow-up of 68 months. Conclusions: Our date confirmed that the majority of patients can be managed with fertility sparing surgery and platinum-based adjuvant treatment without compromising survival. No significant financial relationships to disclose.

Combined Oral Medroxyprogesterone/Levonorgestrel-Intrauterine System Treatment for Women With Grade 2 Stage IA Endometrial Cancer

2017 ◽  
Vol 27 (4) ◽  
pp. 738-742 ◽  
Author(s):  
Ji Young Hwang ◽  
Da Hee Kim ◽  
Hyo Sook Bae ◽  
Mi-La Kim ◽  
Yong Wook Jung ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Progressive Disease ◽  
Medical Center ◽  
Endometrial Adenocarcinoma ◽  
Complete Response ◽  
Dilatation And Curettage ◽  
Fertility Sparing ◽  
Stage Ia ◽  
The Mean

ObjectiveThe aim of this study was to evaluate the oncologic and pregnancy outcomes of combined oral medroxyprogesterone acetate (MPA)/levonorgestrel-intrauterine system (LNG-IUS) treatment in young women with grade 2–differentiated stage IA endometrial adenocarcinoma who wish to preserve fertility.MethodsWe retrospectively reviewed the medical records of patients with grade 2 stage IA endometrial adenocarcinoma who had received fertility-sparing treatment at CHA Gangnam Medical Center between 2011 and 2015. All of the patients were treated with combined oral MPA (500 mg/d)/LNG-IUS, and follow-up dilatation and curettage were performed every 3 months.ResultsA total of 5 patients were included in the study. The mean age was 30.4 ± 5.3 years (range, 25–39 years). After a mean treatment duration of 11.0 ± 6.2 months (range, 6–18 months), complete response (CR) was shown in 3 of the 5 patients, with partial response (PR) in the other 2 patients. One case of recurrence was reported 14 months after achieving CR. This patient was treated again with combined oral MPA/LNG-IUS and achieved CR by 6 months. The average follow-up period was 44.4 ± 26.2 months (range, 12–71 months). There were no cases of progressive disease. No treatment-related complications arose.ConclusionsCombined oral MPA/LNG-IUS treatment is considered to be a reasonably effective fertility-sparing treatment of grade 2 stage IA endometrial cancer. Although our results are encouraging, it is preliminary and should be considered with experienced oncologists in well-defined protocol and with close follow-up.

Outcomes of Fertility-Sparing Surgery for Stage I Epithelial Ovarian Cancer: A Proposal for Patient Selection

2010 ◽  
Vol 28 (10) ◽  
pp. 1727-1732 ◽  
Author(s):  
Toyomi Satoh ◽  
Masayuki Hatae ◽  
Yoh Watanabe ◽  
Nobuo Yaegashi ◽  
Osamu Ishiko ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Epithelial Ovarian Cancer ◽  
Clear Cell ◽  
Stage I ◽  
Healthy Children ◽  
Favorable Histology ◽  
Fertility Sparing Surgery ◽  
Fertility Sparing ◽  
Stage Ia ◽  
Grade 3

Purpose The objective of this study was to assess clinical outcomes and fertility in patients treated conservatively for unilateral stage I invasive epithelial ovarian cancer (EOC). Patients and Methods A multi-institutional retrospective investigation was undertaken to identify patients with unilateral stage I EOC treated with fertility-sparing surgery. Favorable histology was defined as grade 1 or grade 2 adenocarcinoma, excluding clear cell histology. Results A total of 211 patients (stage IA, n = 126; stage IC, n = 85) were identified from 30 institutions. Median duration of follow-up was 78 months. Five-year overall survival and recurrence-free survival were 100% and 97.8% for stage IA and favorable histology (n = 108), 100% and 100% for stage IA and clear cell histology (n = 15), 100% and 33.3% for stage IA and grade 3 (n = 3), 96.9% and 92.1% for stage IC and favorable histology (n = 67), 93.3% and 66.0% for stage IC and clear cell histology (n = 15), and 66.7% and 66.7% for stage IC and grade 3 (n = 3). Forty-five (53.6%) of 84 patients who were nulliparous at fertility-sparing surgery and married at the time of investigation gave birth to 56 healthy children. Conclusion Our data confirm that fertility-sparing surgery is a safe treatment for stage IA patients with favorable histology and suggest that stage IA patients with clear cell histology and stage IC patients with favorable histology can be candidates for fertility-sparing surgery followed by adjuvant chemotherapy.

Dysgerminoma of the ovary 35 years on: A single institutional experience

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e16523-e16523
Author(s):  
D. Vicus ◽  
M. Beiner ◽  
S. Klachook ◽  
L. Le ◽  
O. Ginsburg ◽  
...  
Keyword(s):  
Stage I ◽  
Stage Ii ◽  
Stage Iii ◽  
Bilateral Oophorectomy ◽  
Long Term Outcome ◽  
Fertility Sparing ◽  
Institutional Experience ◽  
Stage Ia ◽  
Ovarian Dysgerminoma

e16523 Background: Ovarian dysgerminomas are rare but are relatively more common in women under 20 years of age in whom fertility is likely to be an issue. The aim of this study was to review our institutional experience in treating patients (pts) diagnosed with pure dysgerminoma. Methods: We performed a retrospective chart review of all pts diagnosed with ovarian dysgerminoma at the Princess Margaret Hospital, Toronto, between 1970 and 2005. Results: 65 pts were diagnosed with ovarian dysgerminoma, median age 21.9 years (range 8.1–64.1 yrs). 40 pts (62.5%) presented with FIGO stage IA disease; 3 (4.7%) stage IB; 6 (9.4%) stage IC; 2 (3.1%) stage II; and 13 (20.3%) at stage III, 1 unknown. Initial management was surgical for all pts: unilateral oopherectomy 47 pts (72.2%), 14 (21.5%) bilateral oophorectomy ± hysterectomy (12 pts), 3 (4.6%) cystectomy alone. 17 pts received chemotherapy, 15 adjuvant and 2 for residual disease (all post 1988); 8 for stage I, 1 for stage II, and 8 for stage III. 12 pts received etoposide and cisplatin (EP); 4 bleomycin, etoposide, and cisplatin (BEP); and 1 vincristine and cisplatin. 20 pts received adjuvant radiotherapy (all prior to 1985); 14 stage I; 1 stage II; and 5 stage III. 1 pt received a combination of adjuvant chemotherapy and radiation. 6 (9.2%) pts recurred all within 19 months of initial diagnosis. 5 of the 6 pts that recurred had stage IA disease treated with a unilateral oophorectomy, 1 received adjuvant EP. 1 pt with stage IIIC disease recurred following bilateral oophorectomy + hysterectomy and radiotherapy. Treatment of recurrent disease was by salvage surgery and chemotherapy (3 pts), radiotherapy (2 pts), and EP (1 pt). All pts who recurred responded to treatment and were alive at last follow up, median follow up 22.5 yrs (range 9.3–31.4 yrs). Median follow up, all pts, was 10.5 yrs (range 1.1 to 31.9 yrs). 15 pts attempted to conceive posttreatment; 6 had received adjuvant treatment; 4 EP; and 2 whole abdominal radiotherapy. 13 successful pregnancies and 13 live births were reported in 9 women (3 had received adjuvant EP). Conclusions: The long-term outcome of patients with an ovarian dysgerminoma is excellent. Recurrences occured within 2 years of diagnosis and are treatable. Patients can be treated with fertility sparing surgery and can expect good reproductive outcomes. No significant financial relationships to disclose.

A comparison of adjuvant therapy approaches for patients with early-stage uterine serous carcinoma.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 5517-5517
Author(s):  
Katherine Kurnit ◽  
Silvana Pedra Nobre ◽  
Bryan M. Fellman ◽  
David A Iglesias ◽  
Kristina Lindemann ◽  
...  
Keyword(s):  
Adjuvant Therapy ◽  
Adjuvant Treatment ◽  
Early Stage ◽  
Myometrial Invasion ◽  
Figo Stage ◽  
Serous Carcinoma ◽  
Stage Ia ◽  
Multivariable Analyses ◽  
Uterine Serous Carcinoma

5517 Background: Uterine serous carcinoma is a less common subtype of endometrial cancer that is associated with poorer survival. The optimal post-operative adjuvant treatment strategy for these patients remains uncertain. Methods: This multi-institutional, retrospective cohort study evaluated patients with early stage uterine serous carcinoma. Patients with FIGO Stage IA-II disease after surgery, whose tumors had serous or mixed serous/non-serous histology were included. Patients with carcinosarcoma were excluded. Clinical data were abstracted from local medical records. Summary statistics, Fisher’s exact, and Kruskal-Wallis tests were used to analyze demographic and clinical characteristics. Univariable and multivariable analyses were performed for recurrence-free survival (RFS) and overall survival (OS). Results: 634 patients were included. 77% of patients had Stage IA disease, 42% showed no myometrial invasion. The majority had pure serous histology (72%) and LVSI (76%). Adjuvant treatment varied: 12% received no adjuvant therapy, 7% had chemotherapy alone, 51% had cuff brachytherapy, 12% had cuff brachytherapy with chemotherapy (cuff/chemo), and 19% underwent pelvic radiation (EBRT). Complete RFS and OS data were available for 607 and 609 patients, respectively, and the median follow-up time was 58 months. As compared with patients who received no adjuvant therapy, patients who received cuff or cuff/chemo had improved RFS (cuff: HR 0.70, p = 0.02; cuff/chemo HR 0.53, p = 0.01) and OS (cuff HR 0.56, p = 0.001; cuff/chemo HR 0.48, p = 0.01). In a direct comparison, patients with cuff/chemo had better RFS and OS than those with chemotherapy alone (RFS HR 0.52, p = 0.03; OS HR 0.50, p = 0.05). There were no differences in RFS or OS for women who received chemotherapy alone or EBRT. Improved survival with cuff and cuff/chemo persisted on multivariable analyses (included age, stage, LVSI, adjuvant therapy type); additionally, EBRT was also associated with improved OS. In analyses limited to patients without myometrial invasion, patients with cuff or cuff/chemo had improved RFS and OS compared with observation alone. Conclusions: The use of adjuvant cuff brachytherapy with and without chemotherapy was associated with improved RFS and OS in patients with early stage uterine serous carcinoma.

Primary Treatment of Waldenstrom's Macroglobulinemia with Dexamethasone, Rituximab and Cyclophosphamide (DRC): Final Analysis of a Phase II Study

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 438-438 ◽  
Author(s):  
Meletios A. Dimopoulos ◽  
Maria Roussou ◽  
Efstathios Kastritis ◽  
Evdoxia Hadjiharissi ◽  
Marie-Christine Kyrtsonis ◽  
...  
Keyword(s):  
Median Time ◽  
Progressive Disease ◽  
Alkylating Agents ◽  
Primary Treatment ◽  
Line Treatment ◽  
Second Line ◽  
Time To Progression ◽  
Minor Response ◽  
A Minor

Abstract Abstract 438 Between November 2002 and April 2006, 72 patients with Waldenstrom's Macroglobulinemia (WM) were enrolled in this multicenter trial of primary treatment with DRC which consisted of dexamethasone 20mg IV followed by rituximab 375 mg/m2 IV on day 1 and oral cyclophosphamide 100 mg/m2 bid on days 1 to 5 (total dose 1000 mg/m2). DRC courses were repeated every 21 days for six courses and then patients without progressive disease were observed without treatment. Patient characteristics, toxicity and response data have been reported previously (Dimopoulos et al, J Clin Oncol 2007;25:3344): 83% of patients achieved a response including 7% complete, 67% partial and 9% minor responses. In June 2012 we updated this study (minimum follow-up >6 years) in order to assess time to progression, time to next treatment, type and response of second-line treatment, overall survival (OS) and cause-specific survival (CSS) in which deaths unrelated to WM or complications of treatment were censored. Second line treatment was administered to patients who experienced progressive disease and also met criteria for treatment requirement based on consensus recommendations (Kyle et al, Sem Oncol 2003;30:116). The median time to progression was 35 months (95% Confidence Interval: 22–48 months) and the median time to next treatment requirement was 51 months. Among several factors who were analyzed for their possible correlation with shorter time to progression, only lymphadenopathy was significant (p=0.028). Among 40 patients who received second line treatment, 28 patients were retreated with either rituximab alone (n=7) with DRC (n=11) or with rituximab combined with other agents (n=10) and 23 patients (82%) achieved a minor response or better. The remaining 12 patients were treated with alkylating agents (n=5), with nucleoside analogues (n=4) with bortezomib (n=2) or with high dose therapy (n=1) and 8 patients achieved a minor response or better. So far 35 (49%) patients have died including 15 patients from unrelated causes (4 lung cancer, 1 bladder cancer, 1 melanoma, 1 gastric cancer, 1 pancreatic cancer, 4 complicated of heart diseases, 2 stroke and 1 pancreatitis). One patient, who received further therapy with fludarabine, developed myelodysplastic syndrome and 2 patients developed diffuse large-B cell lymphoma (one after DRC and one after multiple treatments which included alkylating agents and fludarabine). The probability for 5-year OS and CSS is 62% and 78%, respectively while median OS and CSS is 95 and 104 months respectively (figure). Post progression survival was 82 months and median survival after second line therapy was 82 months. The International Prognostic Staging System (IPSS) is predictive for OS. The probability for 5-year OS is 100%, 67% and 48% for patients with low-, intermediate- and high- risk WM (p=0.005). We conclude that this long-term follow-up analysis of the original phase II study showed that the DRC regimen is associated with a significant median time to progression of about 3 years and that most patients who develop disease progression respond again to rituximab-based regimens. So far, this regimen has not been associated with development of secondary myelodysplasia. The DRC regimen represents an active and safe treatment choice for patient with symptomatic WM. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Early Ileocecal Resection Is an Effective Therapy in Isolated Crohn’s Disease

2021 ◽  
Vol 10 (4) ◽  
pp. 731
Author(s):  
Matthias Kelm ◽  
Friedrich Anger ◽  
Robin Eichlinger ◽  
Markus Brand ◽  
Mia Kim ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Primary Treatment ◽  
Early Surgery ◽  
Ileocecal Resection ◽  
Disease Manifestation ◽  
Terminal Ileitis ◽  
Primary Surgery ◽  
Immunosuppressive Medication

Despite the increasing incidence and prevalence of Crohn’s Disease (CD), no curative options exist and treatment remains complex. While therapy has mainly focused on medical approaches in the past, growing evidence reveals that in cases of limited inflammation, surgery can suffice as an alternative primary treatment. We retrospectively assessed the disease course and outcomes of 103 patients with terminal Ileitis who underwent primary surgery (n = 29) or received primary medical treatment followed by surgery (n = 74). Primary endpoint was the need for immunosuppressive medication after surgical treatment (ileocecal resection, ICR) during a two-years follow-up. Rates for laparoscopic ICR were enhanced in case of early surgery, but no differences were seen for postoperative complications. In case of immunosuppressive medication, patients with ICR at an early state of disease needed significantly less anti-inflammatory medication during the two-year postoperative follow-up compared to patients who were primarily treated medically. Furthermore, in a subgroup analysis for patients with localized ileocecal disease manifestation, early surgery consistently resulted in a decreased amount of medical therapy postoperatively. In conclusion primary ICR is safe and effective in patients with limited CD, and the need for immunosuppressive medication during the postoperative follow-up is low compared to patients receiving surgery at a later stage of disease.

Diethylstilbestrol exposure during pregnancy with primary clear cell carcinoma of the cervix in an 8-year-old granddaughter: a multigenerational effect of endocrine disruptors?

2020 ◽  
Author(s):  
Laura Gaspari ◽  
Françoise Paris ◽  
Nathalie Cassel-Knipping ◽  
Julia Villeret ◽  
Arnauld Verschuur ◽  
...  
Keyword(s):  
Clear Cell ◽  
Causal Link ◽  
Clear Cell Adenocarcinoma ◽  
Fertility Sparing Surgery ◽  
Fertility Sparing ◽  
History Of ◽  
Exposure During Pregnancy ◽  
Multigenerational Effects ◽  
First Time

ABSTRACT To date, vaginal/cervical clear cell adenocarcinoma (CCAC) has not been reported in the granddaughters of women treated with diethylstilbestrol (DES) during pregnancy. We present an 8-year-old girl with a history of severe vaginal bleeding who was diagnosed with cervical CCAC. She underwent fertility-sparing surgery and radiotherapy. No sign of recurrence was detected throughout a 10-year follow-up. Her grandmother had received DES therapy during pregnancy with the patient’s mother. Although no direct causal link is demonstrated, this case raises for the first time, the hypothesis of multigenerational effects of DES in girls and strongly suggests the need to follow the granddaughters of DES-treated women.

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