Ovarian germ cell tumor natural history: Difference between revisions

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__NOTOC__
__NOTOC__
{{Ovarian germ cell tumor}}
{{Ovarian germ cell tumor}}
{{CMG}}; {{AE}}{{Sahar}}
{{CMG}}; {{AE}} {{Sahar}} {{MD}}


==Overview==
==Overview==
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*[[Rupture]] in < 4% of the affected individuals.<ref name="AyhanBukulmez2000">{{cite journal|last1=Ayhan|first1=Ali|last2=Bukulmez|first2=Orhan|last3=Genc|first3=Cuneyt|last4=Karamursel|first4=Burcu S.|last5=Ayhan|first5=Ayse|title=Mature cystic teratomas of the ovary: case series from one institution over 34 years|journal=European Journal of Obstetrics & Gynecology and Reproductive Biology|volume=88|issue=2|year=2000|pages=153–157|issn=03012115|doi=10.1016/S0301-2115(99)00141-4}}</ref>
*[[Rupture]] in < 4% of the affected individuals.<ref name="AyhanBukulmez2000">{{cite journal|last1=Ayhan|first1=Ali|last2=Bukulmez|first2=Orhan|last3=Genc|first3=Cuneyt|last4=Karamursel|first4=Burcu S.|last5=Ayhan|first5=Ayse|title=Mature cystic teratomas of the ovary: case series from one institution over 34 years|journal=European Journal of Obstetrics & Gynecology and Reproductive Biology|volume=88|issue=2|year=2000|pages=153–157|issn=03012115|doi=10.1016/S0301-2115(99)00141-4}}</ref>
**[[Rupture]] may be associated with leakage of [[sebaceous]] contents of the [[tumor]] into the [[peritoneal cavity]] and leads to [[granulomatous]] [[peritonitis]].<ref name="pmid8008317">{{cite journal |vauthors=Comerci JT, Licciardi F, Bergh PA, Gregori C, Breen JL |title=Mature cystic teratoma: a clinicopathologic evaluation of 517 cases and review of the literature |journal=Obstet Gynecol |volume=84 |issue=1 |pages=22–8 |date=July 1994 |pmid=8008317 |doi= |url=}}</ref>
**[[Rupture]] may be associated with leakage of [[sebaceous]] contents of the [[tumor]] into the [[peritoneal cavity]] and leads to [[granulomatous]] [[peritonitis]].<ref name="pmid8008317">{{cite journal |vauthors=Comerci JT, Licciardi F, Bergh PA, Gregori C, Breen JL |title=Mature cystic teratoma: a clinicopathologic evaluation of 517 cases and review of the literature |journal=Obstet Gynecol |volume=84 |issue=1 |pages=22–8 |date=July 1994 |pmid=8008317 |doi= |url=}}</ref>
***This [[complication]] is very [[rare]] and happens in less than 1% of the affected individuals.
**This [[complication]] is very [[rare]] and happens in less than 1% of the affected individuals.
*This [[tumor]] may be [[bilateral]] in 8% to 15% of cases.
*[[Malignant transformation]] of the [[tumor]] may also happen in approximately 2% of affected individuals.<ref name="pmid2841767">{{cite journal |vauthors=Singh P, Yordan EL, Wilbanks GD, Miller AW, Wee A |title=Malignancy associated with benign cystic teratomas (dermoid cysts) of the ovary |journal=Singapore Med J |volume=29 |issue=1 |pages=30–4 |date=February 1988 |pmid=2841767 |doi= |url=}}</ref>
*[[Malignant transformation]] of the [[tumor]] may also happen in approximately 2% of affected individuals.<ref name="pmid2841767">{{cite journal |vauthors=Singh P, Yordan EL, Wilbanks GD, Miller AW, Wee A |title=Malignancy associated with benign cystic teratomas (dermoid cysts) of the ovary |journal=Singapore Med J |volume=29 |issue=1 |pages=30–4 |date=February 1988 |pmid=2841767 |doi= |url=}}</ref>
**The [[tumor]] undergoes [[malignant transformation]] to [[squamous cell carcinoma]] in 80% of them and to [[adenocarcinoma]] in the rest of the cases.
**The [[tumor]] undergoes [[malignant transformation]] to [[squamous cell carcinoma]] in 80% of them and to [[adenocarcinoma]] in the rest of the cases.
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*** Part of a mixed [[germ cell]] [[tumor]]
*** Part of a mixed [[germ cell]] [[tumor]]


===Mature teratoma===
{| class="wikitable"
*[[Prognosis]] is generally excellent in the [[Mature cystic teratoma|mature teratoma]], but in case of simultaneous [[malignant transformation]], the 5-year [[survival rate]] of patients is approximately [15-30]%.<ref name="ParkKim2008">{{cite journal|last1=Park|first1=Jeong-Yeol|last2=Kim|first2=Dae-Yeon|last3=Kim|first3=Jong-Hyeok|last4=Kim|first4=Yong-Man|last5=Kim|first5=Young-Tak|last6=Nam|first6=Joo-Hyun|title=Malignant transformation of mature cystic teratoma of the ovary: Experience at a single institution|journal=European Journal of Obstetrics & Gynecology and Reproductive Biology|volume=141|issue=2|year=2008|pages=173–178|issn=03012115|doi=10.1016/j.ejogrb.2008.07.032}}</ref>
|+
===Immature teratoma===
! colspan="2" |Prognosis of ovarian germ cell tumors
The [[prognosis]] of immature [[teratoma]] is favorable.<ref name="urlHarvardKey Login">{{cite web |url=https://www-sciencedirect-com.ezp-prod1.hul.harvard.edu/book/9780323447324/diagnostic-gynecologic-and-obstetric-pathology |title=HarvardKey Login |format= |work= |accessdate=}}</ref>
|-
|Mature teratoma
|[[Prognosis]] is generally excellent in the [[Mature cystic teratoma|mature teratoma]], but in case of simultaneous [[malignant transformation]], the 5-year [[survival rate]] of patients is approximately [15-30]%.<ref name="ParkKim2008">{{cite journal|last1=Park|first1=Jeong-Yeol|last2=Kim|first2=Dae-Yeon|last3=Kim|first3=Jong-Hyeok|last4=Kim|first4=Yong-Man|last5=Kim|first5=Young-Tak|last6=Nam|first6=Joo-Hyun|title=Malignant transformation of mature cystic teratoma of the ovary: Experience at a single institution|journal=European Journal of Obstetrics & Gynecology and Reproductive Biology|volume=141|issue=2|year=2008|pages=173–178|issn=03012115|doi=10.1016/j.ejogrb.2008.07.032}}</ref>
|-
|Immature teratoma
|The [[prognosis]] of immature [[teratoma]] is favorable.<ref name="urlHarvardKey Login">{{cite web |url=https://www-sciencedirect-com.ezp-prod1.hul.harvard.edu/book/9780323447324/diagnostic-gynecologic-and-obstetric-pathology |title=HarvardKey Login |format= |work= |accessdate=}}</ref>
*The overall 5-year [[survival rate]] is 90%.
*The overall 5-year [[survival rate]] is 90%.
*The 5-year [[Survival rate|survival]] for stages III and IV is 75%.
*The 5-year [[Survival rate|survival]] for stages III and IV is 75%.
*[[Relapse|Relapse rate]] is 20% for grade III [[Tumor|tumors]].
*[[Relapse|Relapse rate]] is 20% for grade III [[Tumor|tumors]].
===Dysgerminoma===
|-
|Dysgerminoma
|
*Depending on the stage of the [[tumor]] at the time of [[diagnosis]], the [[prognosis]] may vary. However, the [[prognosis]] is generally regarded as good.<ref name="VicusBeiner2010">{{cite journal|last1=Vicus|first1=Danielle|last2=Beiner|first2=Mario E.|last3=Klachook|first3=Shany|last4=Le|first4=Lisa W.|last5=Laframboise|first5=Stephane|last6=Mackay|first6=Helen|title=Pure dysgerminoma of the ovary 35 years on: A single institutional experience|journal=Gynecologic Oncology|volume=117|issue=1|year=2010|pages=23–26|issn=00908258|doi=10.1016/j.ygyno.2009.12.024}}</ref>
*Depending on the stage of the [[tumor]] at the time of [[diagnosis]], the [[prognosis]] may vary. However, the [[prognosis]] is generally regarded as good.<ref name="VicusBeiner2010">{{cite journal|last1=Vicus|first1=Danielle|last2=Beiner|first2=Mario E.|last3=Klachook|first3=Shany|last4=Le|first4=Lisa W.|last5=Laframboise|first5=Stephane|last6=Mackay|first6=Helen|title=Pure dysgerminoma of the ovary 35 years on: A single institutional experience|journal=Gynecologic Oncology|volume=117|issue=1|year=2010|pages=23–26|issn=00908258|doi=10.1016/j.ygyno.2009.12.024}}</ref>
*The 5-year [[survival rate]] of the patient even with disseminated [[disease]] at the time of [[diagnosis]] is above 90%.
*The 5-year [[survival rate]] of the patient even with disseminated [[disease]] at the time of [[diagnosis]] is above 90%.
*Recurrence of the [[tumor]] may occur within 2-years of [[diagnosis]] and is curable.
*Recurrence of the [[tumor]] may occur within 2-years of [[diagnosis]] and is curable.
**For stage A1 the recurrence rate is approximately 20% in 2-years.
**For stage A1 the recurrence rate is approximately 20% in 2-years.
*Poor [[prognosis]] is associated with the following factors:<ref name="ChenRuiz2003">{{cite journal|last1=Chen|first1=Vivien W.|last2=Ruiz|first2=Bernardo|last3=Killeen|first3=Jeffrey L.|last4=Cot�|first4=Timothy R.|last5=Wu|first5=Xiao Cheng|last6=Correa|first6=Catherine N.|last7=Howe|first7=Holly L.|title=Pathology and classification of ovarian tumors|journal=Cancer|volume=97|issue=S10|year=2003|pages=2631–2642|issn=0008-543X|doi=10.1002/cncr.11345}}</ref>
*Poor [[prognosis]] is associated with the following factors:<ref name="pmid12733128" />
**Large [[tumor]] size
**Large [[tumor]] size
**[[Bilateral]] involvement
**[[Bilateral]] involvement
**Age< 20 or > 40 years
**Age< 20 or > 40 years
**Presence of other [[germ cell]] [[neoplasms]]
**Presence of other [[germ cell]] [[neoplasms]]
 
|-
===Yolk sac tumor===
|Yolk sac tumor
*These [[Tumor|tumors]] are highly [[malignant]] and tend to spread early.<ref name="pmid12733128">{{cite journal |vauthors=Chen VW, Ruiz B, Killeen JL, Coté TR, Wu XC, Correa CN |title=Pathology and classification of ovarian tumors |journal=Cancer |volume=97 |issue=10 Suppl |pages=2631–42 |date=May 2003 |pmid=12733128 |doi=10.1002/cncr.11345 |url=}}</ref>
|
*These [[Tumor|tumors]] are highly [[malignant]] and tend to spread early.<ref name="pmid12733128" />
*The [[survival rate]] depends on the stage of the [[tumor]]:
*The [[survival rate]] depends on the stage of the [[tumor]]:
**For Stage I–II is 60–100%
**For Stage I–II is 60–100%
**For Stage III–IV disease is 50–75% after appropriate [[chemotherapy]].
**For Stage III–IV disease is 50–75% after appropriate [[chemotherapy]].
*The overall 5-year [[survival rate]] is 80%.<ref name="urlHarvardKey Login">{{cite web |url=https://www-sciencedirect-com.ezp-prod1.hul.harvard.edu/book/9780323447324/diagnostic-gynecologic-and-obstetric-pathology |title=HarvardKey Login |format= |work= |accessdate=}}</ref>
*The overall 5-year [[survival rate]] is 80%.<ref name="urlHarvardKey Login" />
*[[Relapse]] rate is 20% overall.
*[[Relapse]] rate is 20% overall.
 
|-
===Embryonal carcinoma===
|Embryonal carcinoma
*These [[Tumor|tumors]] tend to [[metastasize]] early.<ref name="ChenRuiz2003">{{cite journal|last1=Chen|first1=Vivien W.|last2=Ruiz|first2=Bernardo|last3=Killeen|first3=Jeffrey L.|last4=Cot�|first4=Timothy R.|last5=Wu|first5=Xiao Cheng|last6=Correa|first6=Catherine N.|last7=Howe|first7=Holly L.|title=Pathology and classification of ovarian tumors|journal=Cancer|volume=97|issue=S10|year=2003|pages=2631–2642|issn=0008-543X|doi=10.1002/cncr.11345}}</ref>
|
*These [[Tumor|tumors]] tend to [[metastasize]] early.<ref name="pmid12733128" />
*The [[survival rate]] is similar to [[yolk sac tumor]].
*The [[survival rate]] is similar to [[yolk sac tumor]].
===Choriocarcinoma===
|-
*These [[tumors]] are highly [[malignant]] and tend to spread locally and within the [[abdominal cavity]].<ref name="ChenRuiz2003">{{cite journal|last1=Chen|first1=Vivien W.|last2=Ruiz|first2=Bernardo|last3=Killeen|first3=Jeffrey L.|last4=Cot�|first4=Timothy R.|last5=Wu|first5=Xiao Cheng|last6=Correa|first6=Catherine N.|last7=Howe|first7=Holly L.|title=Pathology and classification of ovarian tumors|journal=Cancer|volume=97|issue=S10|year=2003|pages=2631–2642|issn=0008-543X|doi=10.1002/cncr.11345}}</ref>
|Choriocarcinoma
|
*These [[tumors]] are highly [[malignant]] and tend to spread locally and within the [[abdominal cavity]].<ref name="pmid12733128" />
*They [[Spread of the cancer|spread]] early in the course of the [[tumor]].
*They [[Spread of the cancer|spread]] early in the course of the [[tumor]].
*[[Survival rate]] is improved with combination [[chemotherapy]].
*[[Survival rate]] is improved with combination [[chemotherapy]].
*The majority of patients do not experience the recurrence except those with non-[[Gestation period|gestational]] [[choriocarcinoma]].
*The majority of patients do not experience the recurrence except those with non-[[Gestation period|gestational]] [[choriocarcinoma]].
*The overall 5-year [[survival rate]] is 80%.<ref name="urlHarvardKey Login">{{cite web |url=https://www-sciencedirect-com.ezp-prod1.hul.harvard.edu/book/9780323447324/diagnostic-gynecologic-and-obstetric-pathology |title=HarvardKey Login |format= |work= |accessdate=}}</ref>
*The overall 5-year [[survival rate]] is 80%.<ref name="urlHarvardKey Login" />
*[[Relapse]] rate is 20% overall.
*[[Relapse]] rate is 20% overall.
|}


==References==
==References==

Latest revision as of 13:50, 22 April 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sahar Memar Montazerin, M.D.[2] Monalisa Dmello, M.B,B.S., M.D. [3]

Overview

The prognosis of germ cells of the ovary depends on the type of the tumor and its malignant potentials. Possible complications of benign teratomas are a rupture and ovarian torsion also malignant transformation. Prognosis is generally excellent in the mature teratoma, but in case of simultaneous malignant transformation, the 5-year survival rate of patients is approximately [15-30]%. The 5-year survival rate of the patient even with disseminated dysgerminoma at the time of diagnosis is above 90%. The overall 5-year survival rate for yolk sac tumor, embryonal carcinoma and choriocarcinoma are approximately 80%.

Natural History, Complications, and Prognosis

Natural History

Dysgerminomas

Yolk sac tumor

Embryonal carcinoma

Choriocarcinoma

Complications

Mature teratoma

Common complications of mature teratoma include:[7]

Dysgerminoma

Prognosis

Prognosis of ovarian germ cell tumors
Mature teratoma Prognosis is generally excellent in the mature teratoma, but in case of simultaneous malignant transformation, the 5-year survival rate of patients is approximately [15-30]%.[13]
Immature teratoma The prognosis of immature teratoma is favorable.[14]
Dysgerminoma
Yolk sac tumor
Embryonal carcinoma
Choriocarcinoma

References

  1. Low, Jeffrey J.H.; Ilancheran, Arunachalam; Ng, Joseph S. (2012). "Malignant ovarian germ-cell tumours". Best Practice & Research Clinical Obstetrics & Gynaecology. 26 (3): 347–355. doi:10.1016/j.bpobgyn.2012.01.002. ISSN 1521-6934.
  2. Rozenholc A, Abdulcadir J, Pelte MF, Petignat P (2012). "A pelvic mass on ultrasonography and high human chorionic gonadotropin level: not always an ectopic pregnancy". BMJ Case Rep. 2012. doi:10.1136/bcr.01.2012.5577. PMC 4543203. PMID 22669919.
  3. Shaaban, Akram M.; Rezvani, Maryam; Elsayes, Khaled M.; Baskin, Henry; Mourad, Amr; Foster, Bryan R.; Jarboe, Elke A.; Menias, Christine O. (2014). "Ovarian Malignant Germ Cell Tumors: Cellular Classification and Clinical and Imaging Features". RadioGraphics. 34 (3): 777–801. doi:10.1148/rg.343130067. ISSN 0271-5333.
  4. Stein, Erica B.; Wasnik, Ashish P.; Sciallis, Andrew P.; Kamaya, Aya; Maturen, Katherine E. (2017). "MR Imaging–Pathologic Correlation in Ovarian Cancer". Magnetic Resonance Imaging Clinics of North America. 25 (3): 545–562. doi:10.1016/j.mric.2017.03.004. ISSN 1064-9689.
  5. Kurman RJ, Norris HJ (December 1976). "Endodermal sinus tumor of the ovary: a clinical and pathologic analysis of 71 cases". Cancer. 38 (6): 2404–19. PMID 63318.
  6. 6.0 6.1 6.2 6.3 6.4 6.5 Chen VW, Ruiz B, Killeen JL, Coté TR, Wu XC, Correa CN (May 2003). "Pathology and classification of ovarian tumors". Cancer. 97 (10 Suppl): 2631–42. doi:10.1002/cncr.11345. PMID 12733128.
  7. 7.0 7.1 Ayhan, Ali; Bukulmez, Orhan; Genc, Cuneyt; Karamursel, Burcu S.; Ayhan, Ayse (2000). "Mature cystic teratomas of the ovary: case series from one institution over 34 years". European Journal of Obstetrics & Gynecology and Reproductive Biology. 88 (2): 153–157. doi:10.1016/S0301-2115(99)00141-4. ISSN 0301-2115.
  8. Kim, Min Jae; Kim, Na Young; Lee, Dong-Yun; Yoon, Byung-Koo; Choi, DooSeok (2011). "Clinical characteristics of ovarian teratoma: age-focused retrospective analysis of 580 cases". American Journal of Obstetrics and Gynecology. 205 (1): 32.e1–32.e4. doi:10.1016/j.ajog.2011.02.044. ISSN 0002-9378.
  9. Comerci JT, Licciardi F, Bergh PA, Gregori C, Breen JL (July 1994). "Mature cystic teratoma: a clinicopathologic evaluation of 517 cases and review of the literature". Obstet Gynecol. 84 (1): 22–8. PMID 8008317.
  10. Singh P, Yordan EL, Wilbanks GD, Miller AW, Wee A (February 1988). "Malignancy associated with benign cystic teratomas (dermoid cysts) of the ovary". Singapore Med J. 29 (1): 30–4. PMID 2841767.
  11. AL Husaini, Hamed; Soudy, Hussein; Darwish, Alaa El Din; Ahmed, Mohamed; Eltigani, Amin; AL Mubarak, Mustafa; Sabaa, Amal Abu; Edesa, Wael; AL-Tweigeri, Taher; Al-Badawi, Ismail A. (2012). "Pure dysgerminoma of the ovary: a single institutional experience of 65 patients". Medical Oncology. 29 (4): 2944–2948. doi:10.1007/s12032-012-0194-z. ISSN 1357-0560.
  12. Smith, Harriet O.; Berwick, Marianne; Verschraegen, Claire F.; Wiggins, Charles; Lansing, Letitia; Muller, Carolyn Y.; Qualls, Clifford R. (2006). "Incidence and Survival Rates for Female Malignant Germ Cell Tumors". Obstetrics & Gynecology. 107 (5): 1075–1085. doi:10.1097/01.AOG.0000216004.22588.ce. ISSN 0029-7844.
  13. Park, Jeong-Yeol; Kim, Dae-Yeon; Kim, Jong-Hyeok; Kim, Yong-Man; Kim, Young-Tak; Nam, Joo-Hyun (2008). "Malignant transformation of mature cystic teratoma of the ovary: Experience at a single institution". European Journal of Obstetrics & Gynecology and Reproductive Biology. 141 (2): 173–178. doi:10.1016/j.ejogrb.2008.07.032. ISSN 0301-2115.
  14. 14.0 14.1 14.2 "HarvardKey Login".
  15. Vicus, Danielle; Beiner, Mario E.; Klachook, Shany; Le, Lisa W.; Laframboise, Stephane; Mackay, Helen (2010). "Pure dysgerminoma of the ovary 35 years on: A single institutional experience". Gynecologic Oncology. 117 (1): 23–26. doi:10.1016/j.ygyno.2009.12.024. ISSN 0090-8258.