Ovarian germ cell tumor natural history
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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]
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. If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
OR
Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
OR
Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.
Natural History, Complications, and Prognosis
Natural History
- The symptoms of ovarian germ cell tumors usually develop in the teenage years with abdominal pain or fullness, and palpable pelvic/abdominal mass.[1]
Dysgerminomas
- These tumors tend to spread late and do so through lymphatic system primarily.[2]
Yolk sac tumor
- These tumors tend to grow rapidly and spread to abdominopelvic cavity in early stages.[3]
- They are mostly affects women in theie second or third decade of life.[4]
Embryonal carcinoma
- These tumors tend to metastasize early.[5]
- They spread through the lymphatic system.
Choriocarcinoma
- These tumors are highly malignant and tend to spread locally and within the abdominal cavity.[5]
- They spread early in the course of the tumor.
- Non-gestational choriocarcinomas spread through lymphatic system.
- Gestational choriocarcinomas spread through Bloodstream.
Complications
Mature teratoma
Common complications of mature teratoma include:[6]
- Ovarian torsion is the most common complication and affects 5% to 10% of the individuals.
- It happens at a greater extent in:[7]
- Younger age (10-19 years)
- Larger tumors
- It happens at a greater extent in:[7]
- Rupture in < 4% of the affected individuals.[6]
- Rupture may be associated with leakage of sebaceous contents of the tumor into the peritoneal cavity and leads to granulomatous peritonitis.[8]
- This complication is very rere and happens in less than 1% of the affected individuals.
- Rupture may be associated with leakage of sebaceous contents of the tumor into the peritoneal cavity and leads to granulomatous peritonitis.[8]
- 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.[9]
- The tumor undergoes malignant transformation to squamous cell carcinma in 80% of them and to adenocarcinoma in the rest of the cases.
Dysgerminoma
- Ovarian torsion and acute abdominal pain may occur in < 10% of the cases.[10]
Prognosis
- Only 3% to 5% of ovarian germ cell tumors are malignant which the majority include:[11]
- Dysgerminomas
- Immature teratomas
- Yolk sac tumors
- Pure form
- Part of a mixed germ cell tumor
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]%.[12]
Immature teratoma
The prognosis of immature teratoma is favorable.[13]
- The overall 5-year survival rate is 90%.
- The 5-yr survival for stages III and IV is 75%.
- Relapse rate is 20% for grade III tumors.
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.[14]
- The 5-year survival rate of the patient even with disseminated disease at the time of diagnosis is above 90%.
- Reoccurence 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.
- Poor prognosis is associated with the following factors:[5]
- Large tumor size
- Bilateral involvement
- Age< 20 or > 40 years
- Presence of other germ cell neoplasms
Yolk sac tumor
- These tumors are highly malignant and tend to spread early.[5]
- The survival rate depends on the stage of the tumor:
- For Stage I–II is 60–100%
- For Stage III–IV disease is 50–75% after appropriate chemotherapy.
- The overall 5-year survival rate is 80%.[13]
- Relapse rate is 20% overall.
Embryonal carcinoma
- These tumors tend to metastasize early.[5]
- The survival rate is simmilar to yolk sac tumor.
Choriocarcinoma
- These tumors are highly malignant and tend to spread locally and within the abdominal cavity.[5]
- They spread early in the course of the tumor.
- Survival rate is improved with combination chemotheraspy.
- The majority of patients do not experience the reocurrence except those with non-gestational choriocarcinoma.
- The overall 5-year survival rate is 80%.[13]
- Relapse rate is 20% overall.
References
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 5.0 5.1 5.2 5.3 5.4 5.5 Chen, Vivien W.; Ruiz, Bernardo; Killeen, Jeffrey L.; Cot�, Timothy R.; Wu, Xiao Cheng; Correa, Catherine N.; Howe, Holly L. (2003). "Pathology and classification of ovarian tumors". Cancer. 97 (S10): 2631–2642. doi:10.1002/cncr.11345. ISSN 0008-543X. replacement character in
|last4=at position 4 (help) - ↑ 6.0 6.1 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ A L Husaini H, Soudy H, El Din Darwish A, Ahmed M, Eltigani A, A L Mubarak M, Sabaa AA, Edesa W, A L-Tweigeri T, Al-Badawi IA (December 2012). "Pure dysgerminoma of the ovary: a single institutional experience of 65 patients". Med. Oncol. 29 (4): 2944–8. doi:10.1007/s12032-012-0194-z. PMID 22407668. Vancouver style error: missing comma (help)
- ↑ 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.
- ↑ 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.
- ↑ 13.0 13.1 13.2 "HarvardKey Login".
- ↑ 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.