Unusual Cases of Pure Malignant Germ Cell Tumors of the Ovary: A Case Series on 10 Years Experience at a Tertiary Care Center

Background: Malignant ovarian germ cell tumors (MOGCTs) are rare female cancers, constituting up to 10% of ovarian cancers. Dysgerminoma is the most common histological variant. Surgical removal of the tumor with optimal debulking is the treatment of choice. Multidrug chemotherapy following surgery offers high remission rates. Considering the prevalence of these tumors in adolescent and young females, fertility-sparing treatment is of paramount importance. Methods: The data of all patients with ovarian malignancy admitted at a tertiary-care-teaching hospital from September 2009-March 2019 were analyzed. Ten patients of MOGCTs were treated in this period. The clinical features, radiological and biochemical findings, and management and treatment outcome were evaluated. Results: The median age of patients was 23 years. Histological subtypes included immature teratoma (n=3), endodermal sinus tumor (n=4), and dysgerminoma (n=3). Tumor markers namely AFP, βHCG, and LDH increased in all except the patients with immature teratoma. Two patients with dysgerminoma were in the second trimester of pregnancy. All patients except one underwent surgery followed by BEP chemotherapy. Two patients had developed metastasis within six months of treatment and died. In seven patients, no evidence of disease was reported till date. Conclusion: Management of antenatal patients with dysgerminoma by surgery followed by BEP chemotherapy has favorable prognosis. Fertility-sparing surgery with adjuvant chemotherapy offers great advantage in young girls. However, risk stratification based on prognostic factors should be implemented in order to individualize the treatment for achieving higher survival rates. The option for oocyte-cryopreser-vation prior to surgery must be discussed with patients desiring future fertlity.

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Are omentectomy and lymphadenectomy necessary in patients with apparently early-stage malignant ovarian germ cell tumors?

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2018-000078 ◽

2019 ◽

Vol 29 (2) ◽

pp. 398-403 ◽

Cited By ~ 4

Author(s):

Beijiao Qin ◽

Wenyan Xu ◽

Yanfang Li

Keyword(s):

Prognostic Factors ◽

Germ Cell ◽

Early Stage ◽

Survival Rates ◽

Germ Cell Tumors ◽

Yolk Sac ◽

Immature Teratoma ◽

Yolk Sac Tumor ◽

Cancer Center ◽

Early Stage Disease

ObjectiveTo evaluate the role of omentectomy and lymphadenectomy in the treatment of clinically apparent early-stage malignant ovarian germ cell tumors.MethodsWe 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).ResultsSixty 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.ConclusionsOmentectomy and lymphadenectomy do not appear to improve survival and may be omitted in patients with clinically apparent early-stage malignant ovarian germ cell tumors.

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Histopathological profile of ovarian tumors in a tertiary care center- a descriptive study

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20211342 ◽

2021 ◽

Vol 9 (4) ◽

pp. 1010

Author(s):

Anitha Pallikkara V. ◽

Shameem K. Ummer Ali

Keyword(s):

Germ Cell ◽

Malignant Tumors ◽

Care Center ◽

Tertiary Care ◽

Age Groups ◽

Germ Cell Tumors ◽

Ovarian Tumors ◽

Benign Tumors ◽

Medical College ◽

Epithelial Tumors

Background: Ovarian neoplasms are a heterogeneous group of tumors with varied clinical, morphological and histological features. Ovarian cancer accounts for about 3% of all cancer in females and is the 5th most common cause of death due to cancer because most ovarian tumors spread beyond ovary by the time of diagnosis. The objective of the study was to document the histological pattern and prevalence of ovarian tumors in specimens received at department of pathology government medical college Alappuzha.Methods: This was a prospective study of 18 months duration which comprised of 245 cases of ovariectomy and ovariotomy specimens received in the department of pathology, govt. T.D medical college Alappuzha, Kerala. After detailed and thorough gross examination of the specimens, bits from representative areas were routinely processed and stained with H and E. Tumors were classified as per WHO classification. Appropriate immunohistochemical studies were performed wherever required.Results: Out of 245 cases studied, majority were benign tumors (78.36%), followed by malignant tumors (15. 11%). Borderline tumors comprised (6.53%) of the total cases. Age groups studied ranged from 11-70 years. Epithelial tumors were the most common (76.32%) followed by germ cell tumors (17.55%), sex cord stromal tumors (5.03%) and carcinoma arising in germ cell tumors (0.81%). Serous cystadenoma was found to be the commonest benign tumor and serous cystadenocarcinoma was the commonest malignant ovarian neoplasm.Conclusions: Surface epithelial tumors were the most common ovarian tumors. The maximum number of tumors were noted in the age group 21-40 years. Malignant tumors were common above 40 years.

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Pure Immature Teratoma of the Ovary in Adults: Thirty-Year Experience of a Single Tertiary Care Center

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000000541 ◽

2015 ◽

Vol 25 (9) ◽

pp. 1616-1622 ◽

Cited By ~ 13

Author(s):

Ahmad Bakr Alwazzan ◽

Shaundra Popowich ◽

Erin Dean ◽

Christine Robinson ◽

Robert Lotocki ◽

...

Keyword(s):

Histological Grade ◽

Care Center ◽

Tertiary Care ◽

Immature Teratoma ◽

Clinicopathologic Characteristics ◽

Gynecology And Obstetrics ◽

Primary Treatment Modality ◽

Fertility Sparing ◽

Chemotherapy Regime ◽

Grade Iii

ObjectiveThe aim of this study was to evaluate clinicopathologic characteristics, treatment outcome, and reproductive function in women diagnosed with ovarian immature teratoma (IT). Our standard chemotherapy regime is currently etoposide/cisplatin (EP), creating a unique opportunity to evaluate this protocol in ovarian ITs.Materials and MethodsThis study is a retrospective analysis. Twenty-seven women older than 18 years with ovarian IT stages IA to IIIC were identified and included in this study. Patients were treated at 1 institution, Health Sciences Center, Women’s Hospital, Winnipeg, Manitoba, Canada, between 1983 and 2013.ResultsThe median age at diagnosis was 27.0 years (range, 18–36 years). Twenty-two (82%) presented with an International Federation of Gynecology and Obstetrics stage I disease, 3 (11%) had stage II, and 2 patients (7%) had stage III disease. The histologic grade distribution was grade I in 9 patients (33%), grade II in 3 patients (11%), and grade III in 15 patients (56%). Initial management was surgical for all patients: 3 (11%) hysterectomy and bilateral salpingo-oophorectomy, 1 (4%) cystectomy only, and 23 (85%) unilateral salpingo-oophorectomy. Twenty-one patients (78%) received adjuvant therapy. The median follow-up was 60 months (range, 36–72 months). One patient recurred (histological grade III) 6 months after surgery and had a complete clinical response to 4 cycles of EP chemotherapy. Twelve patients reported an attempt to conceive resulting in 10 pregnancies (8 after chemotherapy).ConclusionsOvarian IT is a curable disease. Fertility-sparing surgery should be offered. Adjuvant treatment with cisplatinum-based chemotherapy, typically with bleomycin, etoposide, and cisplatin, is still considered the standard in stages greater than stage IA grade I. Etoposide/cisplatin as a primary chemotherapy regime for early- or advanced-stage disease is an effective treatment with minimal adverse effects and high tolerability. This is the first published study examining EP as a primary treatment modality for IT. Further studies are needed to strengthen these findings.

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Impact of the modified bleomycin, etoposide and cisplatinum chemotherapy regimen on the outcome of testicular germ cell tumor: a tertiary care institute experience

International Surgery Journal ◽

10.18203/2349-2902.isj20194070 ◽

2019 ◽

Vol 6 (9) ◽

pp. 3305 ◽

Cited By ~ 1

Author(s):

Renu Madan ◽

Niketa Thakur ◽

Sakshi Rana ◽

Narendra Kumar ◽

Budhi Singh Yadav ◽

...

Keyword(s):

Germ Cell ◽

Care Center ◽

Tertiary Care ◽

Germ Cell Tumors ◽

Testicular Germ Cell Tumor ◽

Good Alternative ◽

Stage I ◽

Comparable Efficacy ◽

Testicular Germ Cell Tumors ◽

Testicular Germ Cell

Background: Bleomycin, cisplatin and etoposide (BEP) based combination chemotherapy is established as standard treatment for testicular germ cell tumors. As these tumors are highly curable, so management is crucial in terms of long-term toxicity particularly lung toxicity. With standard BEP there is increased toxicity which leads to poor compliance. So, we at a tertiary care center assessed modified BEP regimen in such patients and evaluated its effectiveness in terms of response and toxicity as compared to standard BEP.Methods: Forty-nine patients of testicular germ cell tumors were enrolled in this study from January 2012 to December 2016. The modified BEP regimen consisted of bleomycin 30 IU day 1, cisplatin 20 mg/m2 day 1-5 and etoposide 100 mg/m2 day 1 to 5, given every three weeks. The planned drug intensities were 33.3 mg/m2/week for cisplatin, 166.7 mg/m2 week for etoposide and 10 IU/body/week for bleomycin. The schedule for chemotherapy was as follows: four courses of modified BEP for stage I patients and six courses of modified BEP for stage I S, II and III patients.Results: Overall response rate in our study was seen to be 81.2% which was comparable with the available evidence. Five (10.4%) patients developed febrile neutropenia. Two (4.1%) patients showed clinically evident bleomycin induced pulmonary toxicity. Lower toxicity seen in these patients led to better overall compliance.Conclusions: Modified BEP protocol is a good alternative to standard BEP with comparable efficacy and reduced toxicity.

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THE CLINICOPATHOLOGICAL PATTERN OF TESTICULAR TUMORS A 3-YEARS EXPERIENCE AT A TERTIARY CARE UROLOGY CENTER

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v71i2.3516 ◽

2021 ◽

Vol 71 (2) ◽

pp. 517-21

Author(s):

Badar Murtaza ◽

Muhammad Rafiq Zafar ◽

Zahoor Iqbal Mirza ◽

Muhammad Akmal ◽

Hussain Ahmad ◽

...

Keyword(s):

Germ Cell ◽

Hodgkin Lymphoma ◽

Clinical Presentation ◽

Operative Procedure ◽

Tertiary Care ◽

Germ Cell Tumors ◽

Case Series ◽

Armed Forces ◽

Testicular Tumors ◽

Non Hodgkin Lymphoma

Objective: To evaluate the clinical presentation of testicular tumors and their histological pattern present in our setup. Study Design: Case series. Place and Duration of Study: Armed Forces Institute of Urology (AFIU) Rawalpindi, from Jul 2016 to Jun 2019. Methodology: The documents of all the cases of testicular tumors presenting in the last 3 years were retrieved and their relevant clinical detail: age, clinical presentation, side of involvement, operative procedure conducted and the histopathology report were documented. Results: Thirty two patients of testicular tumors were documented over a period of three years, making 10.66 cases reporting per year. The mean age was 30.10 ± 15.42 years, with the youngest 3 months old infant and the eldest being 58 years of age. The tumors were commonest on the right (59.3%) with 81.2% presentation as swelling of testis. Radical orchiectomy was performed in 90.6% of the cases and retro peritoneal lymph node dissection (RPLND) in 6.2%. Germ cell tumors were found in 71.8% cases with mixed germ cell tumorbeing the commonest histopathology seen in 31.2% of the cases followed by the seminoma (25%) and non-Hodgkin lymphoma (12.5%). Conclusion: Testicular tumors were relatively uncommon in our part of the world with a limited number of cases presenting to a tertiary care urology center. The presentation was variable but a rising trend in non-Hodgkin lymphoma results in a decrease in the overall number of germ cell tumors.

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Primary intracranial germ cell tumors: a clinical analysis of 153 histologically verified cases

Journal of Neurosurgery ◽

10.3171/jns.1997.86.3.0446 ◽

1997 ◽

Vol 86 (3) ◽

pp. 446-455 ◽

Cited By ~ 468

Author(s):

Masao Matsutani ◽

Keiji Sano ◽

Kintomo Takakura ◽

Takamitsu Fujimaki ◽

Osamu Nakamura ◽

...

Keyword(s):

Radiation Therapy ◽

Germ Cell ◽

Malignant Tumors ◽

Survival Rates ◽

Germ Cell Tumors ◽

Surgical Removal ◽

Content Type ◽

Intracranial Germ Cell Tumors ◽

Mixed Tumors ◽

Fine Print

✓ The authors analyzed 153 cases of histologically verified intracranial germ cell tumors. The histological diagnosis was germinoma in 63 patients (41.2%), teratoma in 30 (19.6%), and other types of tumors in 60 patients (39.2%). The patients were treated by a consistent policy of surgical removal with histological verification followed by radiation therapy with or without chemotherapy. The 10- and 20-year survival rates of patients with pure germinoma were 92.7% and 80.6%, respectively. The 10-year survival rates of patients with mature teratoma and malignant teratoma were 92.9% and 70.7%, respectively. Patients with pure malignant germ cell tumors (embryonal carcinoma, yolk sac tumor, or choriocarcinoma) had a 3-year survival rate of 27.3%. The mixed tumors were divided into three subgroups: 1) mixed germinoma and teratoma; 2) mixed tumors whose predominant characteristics were germinoma or teratoma combined with some elements of pure malignant tumors; and 3) mixed tumors with predominantly pure malignant elements. The 3-year survival rates were 94.1% for the first group, 70% for the second group, and 9.3% for the third group, and the differences were statistically significant. Twenty-six patients with malignant tumors received chemotherapy that consisted of cisplatin and carboplatin combinations with or without radiation therapy. However, chemotherapy was not significantly more effective than radiation therapy alone. From these treatment results, the authors classified tumors into three groups with different prognoses and proposed a treatment guideline appropriate for the subgroups.

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Multimodality treatment for Central Nervous System Germ Cell Tumors: Disease spectrum and management strategies - A tertiary care center experience from India

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2021.106481 ◽

2021 ◽

Vol 202 ◽

pp. 106481

Author(s):

Narendra Kumar ◽

Renu Madan ◽

Chinna Babu Dracham ◽

Divya Khosla ◽

Namrata Das ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Germ Cell ◽

Care Center ◽

Tertiary Care ◽

Management Strategies ◽

Germ Cell Tumors ◽

Multimodality Treatment ◽

Tertiary Care Center ◽

Disease Spectrum

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Complications of intravascular intrauterine transfusion for Rh alloimmunization

Annals of Saudi Medicine ◽

10.5144/0256-4947.2021.313 ◽

2021 ◽

Vol 41 (6) ◽

pp. 313-317

Author(s):

Asma Alkhaibary ◽

Mohannad Ali ◽

Maha Tulbah ◽

Maha Al-Nemer ◽

Rubina M. Khan ◽

...

Keyword(s):

Care Center ◽

Tertiary Care ◽

Survival Rates ◽

Case Series ◽

Intrauterine Fetal Death ◽

High Survival ◽

Safe Procedure ◽

Fetal Bradycardia ◽

Intrauterine Transfusion ◽

Record Review

BACKGROUND: Intravascular intrauterine transfusion (IUT) is considered a safe procedure, but complications still occur, including fatalities. OBJECTIVE: Review the outcomes of Rh alloimmunization, including indications and possible complications. DESIGN: Retrospective cohort (medical record review). SETTING: Tertiary care center. PATIENTS AND METHODS: We retrieved the records for all mothers who had an IUT for Rh alloimmunization between January 2009 and August 2019. We collected data on complications, post-transfusion hemoglobin and antibody combinations. MAIN OUTCOME MEASURE: Complications of IUT. SAMPLE SIZE: 119 mothers with 154 fetuses (154 different pregnancies). RESULTS: The 154 fetuses had 560 intrauterine transfusions. The median pre-IUT hemoglobin was a median of 8.0 g/dL while the median post-IUT hemoglobin 16 g/dL. Immediate procedure-related complications included fetal bradycardia in 2.7%, significant bleeding from the cord puncture site (for more than 2 minutes in 0.9%), and contractions in 0.9%. Eight (5.2%) were delivered by cesarean delivery due to IUT-specific complications such as post-procedure fetal bradycardia. Intrauterine fetal death complicated 8.4% of the pregnancies (13 fetuses). Phototherapy was required in 76 (49.4%), postnatal blood transfusions in 17 (11%), and exchange transfusion in 11 (7.1%). Neonatal death occurred 8 (5.2%). Data were insufficient to assess associations of complications with antibody combinations. CONCLUSIONS: Intrauterine transfusion is an effective treatment with high survival rates (around 90% for cases of Rh alloimmunization). LIMITATIONS: Case series. CONFLICT OF INTEREST: None.

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Left Pulmonary Artery Sling: Postoperative Outcomes for Patients at a Single Center

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/21501351211040741 ◽

2021 ◽

Vol 12 (6) ◽

pp. 715-727

Author(s):

Laura Carlson ◽

Mahwish Haider ◽

Hua Liu ◽

Christopher Baird ◽

John E. Mayer ◽

...

Keyword(s):

Pulmonary Artery ◽

Care Center ◽

Tertiary Care ◽

Survival Rates ◽

Left Lung ◽

Case Series ◽

Left Pulmonary Artery ◽

Retrospective Case ◽

Tracheal Surgery ◽

Intracardiac Repair

Background Left pulmonary artery (LPA) sling is a rare anomaly characterized by the origin of the LPA from the right pulmonary artery with a course between the trachea and esophagus. It is often associated with airway and cardiac anomalies. Methods This is a retrospective case series of consecutive patients who underwent LPA sling repair (LPASR) at a tertiary care center over a 35-year period with a focus on tracheal and/or LPA reinterventions and survival. Results Between June 1983 and July 2018, 42 patients were identified: isolated LPASR was performed in 16 (38%), LPASR/intracardiac repair in 10 (24%), and LPASR/tracheal repair in 16 (38%). There were 5 (12%) in-hospital and 4 (10%) late deaths. Survival rates (15 years) were as follows: 100% (isolated LPASR), 65% (concomitant intracardiac repair), and 52% (concomitant tracheal surgery). Preoperative intensive care unit (ICU) hospitalization was associated with future intervention on the LPA/trachea (61%, 11/18). The median distribution of blood flow to the left lung post-index surgery was 38%. Freedom from isolated LPA intervention was 100% after isolated LPASR, 93% after LPASR/tracheal surgery, and 69% after LPASR/intracardiac repair. Freedom from isolated tracheal intervention was 92% after isolated LPASR, 73% after LPASR/tracheal surgery, and 78% after LPASR/intracardiac repair. Conclusions ICU hospitalization prior to index surgery may indicate the severity of associated cardiac/tracheal abnormalities as this is associated with increased morbidity and mortality. Patients who underwent LPASR/intracardiac surgery were more likely to undergo isolated LPA intervention and those who underwent LPASR/tracheal surgery were more likely to undergo isolated tracheal intervention.

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