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

Goyal, Lajya; Kaur, Balpreet; Goyal, Gitanjali; Rajora, Parveen

doi:10.18502/jri.v22i4.7652

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

Authors

Lajya Goyal ¹

Balpreet Kaur ¹

Gitanjali Goyal ²

Parveen Rajora ³

¹ Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Punjab, India

² Department of Biochemistry, Guru Gobind Singh Medical College and Hospital, Punjab, India

³ Department of Obstetrics and Gynaecology, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India

10.18502/jri.v22i4.7652

Abstract

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-cryopreservation prior to surgery must be discussed with patients desiring future fertlity.

Keywords

Dysgerminoma

platinum

based chemotherapy

Yolk sac tumor

Zhang Y, Luo G, Li M, Guo P, Xiao Y, Ji H, et al. Global patterns and trends in ovarian cancer incidence: age, period and birth cohort analysis. BMC Cancer. 2019;19(1):984.

Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, et al. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11. Lyon, France: International Agency for Research on Cancer, 2013[2016-09-09]. http://globocan.iarc.fr.

Chen VW, Ruiz B, Killeen JL, Coté TR, Wu XC, Correa CN, et al. Pathology and classification of ovarian tumors. Cancer. 2003;97(10 Suppl):2631-42.

Pectasides D, Pectasides E, Kassanos D. Germ cell tumors of ovary. Cancer Treat Rev. 2008;34(5):427-41.

Bhurgri Y, Shaheen Y, Kayani N, Nazir K, Ahmed R, Usman A, et al. Incidence, trends and morphology of ovarian cancer in Karachi (1995-2002). Asian Pac J Cancer Prev.2011;12(6):1567-71.

Goyal LD, Kaur B, Badyal RK. Malignant mixed germ cell yumors of the ovary: a series of rare cases. J Reprod Infertil. 2019;20(4):231-6.

Low JJ, Ilancheran A, Ng JS. Malignant ovarian germ-cell tumours. Best Pract Res Clin Obstet Gynaecol. 2012;26(3):347-55.

Zhao T, Zhang H, Liu Y, Jiang H, Wang X, Lu Y. The role of staging surgery in the treatment of apparent early-stage malignant ovarian germ cell tumours. Aust N Z J Obstet Gynaecol. 2016;56(4):398-402.

Bilici A, Inanc M, Ulas A, Akman T, Seker M, Babacan NA, et al. Clinical and pathologic features of patients with rare ovarian tumors: multi-center review of 167 patients by the Anatolian society of medical oncology. Asian Pac J Cancer Prev. 2013;14(11):6439-9.

Koshy M, Vijayananthan A, Vadiveloo V. Malignant ovarian mixed germ cell tumour: a rare combination. Biomed Imaging Interv J. 2005;1(2):e10.

Gershensom DM. Treatment of ovarian cancer in young women. Clin Obstet Gynecol. 2012;55(1):65-74.

Parkinson CA, Hatcher HM, Ajithkumar TV. Management of malignant ovarian germ cell tumors. Obstet Gynecol Surv. 2011;66(8):507-14.

Vazquer I, Rustin GJ. Current controversies in the management of germ cell ovarian tumours. Curr Opin Oncol. 2013;25(5):539-45.

Solheim O, Kærn J, Tropé CG, Rokkones E, Dahl AA, Nesland JM, et al. Malignant ovarian germ cell tumors: presentation, survival and second cancer in a population based Norwegian cohort (1953–2009). Gynecol Oncol. 2013;131(2):330-5.

Royal College of Obstetricians and Gynaecologists. Management of suspected ovarian masses in premenopausal women. Green-top Guideline No. 62. London: RCOG; 2011. 1-14.

Sturgeon CM, Duffy MJ, Stenman UH, Lilja H, Brünner N, Chan DW, et al.; National academy of clinical biochemistry laboratory medicine practice guidelines for use of tumor markers in testicular, prostate, colorectal, breast, and ovarian cancers. Clin Chem. 2008;54(12):e11-79.

Mazumdar M, Bajorin DF, Bacik J, Higgins G, Motzer RJ, Bosl GJ. Predicting outcome to chemotherapy in patients with germ cell tumors: the value of the rate of decline of human chorionic gonadotrophin and alpha-fetoprotein during therapy. J Clin Oncol. 2001;19(9):2534-41.

Chan JK, Tewari KS, Waller S, Cheung MK, Shin JY, Osann K, et al. The influence of conservative surgical practices for malignant ovarian germ cell tumors. J Surg Oncol. 2008;98(2):111-6.

Gershenson DM. Management of ovarian germ cell tumors. J Clin Oncol. 2007;25(20):2938-43.

Khi C, Low JJ, Tay EH, Chew SH, Ho TH. Malignant ovarian germ cell tumors: the KK hospital experience. Eur J Gynaecol Oncol. 2002;23(3):251-6.

Morice P, Denschlag D, Rodolakis A, Reed N, Schneider A, Kesic V, et al. Recommendations of the fertility task force of the European society of gynecologic oncology about the conservative management of ovarian malignant tumors. Int J Gynecol Cancer. 2011;21(5):951-63.

Royal College of Obstetricians and Gynaecologists. Management of female malignant ovarian germ cell tumours. Scientific Impact Paper No. 52. London: RCOG; 2016. 1-10.

Mahdi H, Swensen RE, Hanna R, Kumar S, Ali-Fehmi R, Semaan A, et al. Prognostic impact of lymphadenectomy in clinically early stage malignant germ cell tumour of the ovary. Br J Cancer. 2011;105(4):493-7.

Akhtar K, Ahmad SS, Kumar A, Afshan N. Dysgerminoma with pregnancy and viable baby: a case report. Oman Med J. 2011;26(3):198-200.

Matsuyama T, Tsukamoto N, Matsukuma K, Kamura T, Kaku T, Saito T. Malignant ovarian tumors associated with pregnancy: report of six cases. Int J Gynaecol Obstet. 1989;28(1):61-6.

Patterson DM, Murugaesu N, Holden L, Seckl MJ, Rustin GJ. A review of the close surveillance policy for stage I female germ cell tumors of the ovary and other sites. Int J Gynecol Cancer. 2008;18(1):43-50.

Kim DS, Park MI. Maternal and fetal survival following surgery and chemotherapy of endodermal sinus tumor of the ovary during pregnancy: a case report. Obstet Gynecol. 1989;73(3 Pt 2):503-7.

Ghaemmaghami F, Hasanzadeh M, Zarchi MK, Fallahi A. Nondysgerminomatous ovarian tumors: clinical characteristics, treatment, and outcome: a case-controlled study. Int J Surg. 2008;6(5):382-6.

Weinberg LE, Lurain JR, Singh DK, Schink JC. Survival and reproductive outcomes in women treated for malignant ovarian germ cell tumors. Gynecol Oncol. 2011;121(2):285-9.

Colombo N, Peiretti M, Castiglione M, ESMO Guidelines working group. Non-epithelial ovarian cancer: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol. 2009;20 Suppl 4:24-6.

Mangili G, Scarfone G, GadducciA, Sigismondi C, Ferrandina G, Scibilia G, et al. Is adjuvant chemotherapy indicated in stage I pure immature ovarian teratoma (IT)? a multicentre Italian trial in ovarian cancer (MITO-9). Gynecol Oncol. 2010;119(1):48-52.

Kumar RB. Treatment outcomes in malignant ovarian germ cell tumors. Int J Reprod Contracept Obstet Gynecol. 2017;6(12):5256-60.

Neeyalavira V, Suprasert P. Outcomes of malignant ovarian germ cell tumours treated in Chiang Mai University hospital over a nine year period. Asian Pac J Cancer Prev. 2014;15(12):4909-13.

Low JJ, Perrin LC, Crandon AJ, Hacker NF. Conservative surgery to preserve ovarian function in patients with malignant ovarian germ cell tumors. a review of 74 cases. Cancer. 2000;89(2):391-8.