Oncology and reproductive outcomes over 16 years of malignant ovarian germ cell tumors treated by fertility sparing surgery

BACKGROUND Malignant ovarian germ cell tumors(MOGCT)are rare and frequently occur in women of young and reproductive age and the oncologic and reproductive outcomes after fertility-sparing surgery(FSS)for this disease are still limited.AIM To evaluate the oncology and reproductive outcomes of MOGCT patients who underwent FSS.METHODS All MOGCT patients who underwent FSS defined as the operation with a preserved uterus and at least one side of the ovary at our institute between January 2005 and December 2020 were retrospectively reviewed.RESULTS Sixty-two patients were recruited for this study.The median age was 22 years old and over 77%were nulliparous.The three most common histology findings were immature teratoma(32.2%),dysgerminoma(24.2%),and yolk sac tumor(24.2%).The distribution of stage was as follows;Stage I,74.8%;stage II,9.7%;stage III,11.3%;and stage IV,4.8%.Forty-three(67.7%)patients received adjuvant chemotherapy.With a median follow-up time of 96.3 mo,the 10-year progressionfree survival and overall survival were 82.4%and 91%,respectively.For reproductive outcomes,of 43 patients who received adjuvant chemotherapy,18(41.9%)had normal menstruation,and 17(39.5%)resumed menstruation with a median time of 4 mo.Of about 14 patients who desired to conceive,four were pregnant and delivered good outcomes.Only one case was aborted.Therefore,the successful pregnancy rate was 28.6%CONCLUSION The oncology and reproductive outcomes of MOGCT treated by FSS are excellent.Many patients show a long survival time with normal menstruation.However,the obstetric outcome is not quite satisfactory.

Postmenopausal women with hyperandrogenemia:Three case reports

BACKGROUND Diagnosing hyperandrogenemia in postmenopausal women is very difficult.It occasionally manifests as excessive hair growth or with no clinical manifestations,and is therefore often misdiagnosed or missed altogether.Ovarian steroid cell tumors that cause hyperandrogenemia in women account for approximately 0.1%of all ovarian tumors.Due to the low incidence,corresponding imaging reports are rare,so ovarian steroid cell tumors lacks typical imaging findings to differ-entiate it from other ovarian tumors.Therefore,we summarized its clinical and imaging characteristics through this case series,and elaborated on the differential diagnosis of steroid cell tumors.CASE SUMMARY We report three cases of postmenopausal women with hyperandrogenemia.Only 1 patient showed virilization symptoms,the other two patients were completely asymptomatic.All patients underwent total hysterectomy+bilateral adnexe-ctomy.Histological results showed one case of Leydig cell tumor and two cases of benign,non-specific steroid cell tumor.After the operation,the androgen levels of all patients returned to normal,and there was no clinical recurrence since follow-up.CONCLUSION Although virilization caused by increased serum testosterone levels is an important clinical feature of ovarian steroid cell tumors,it is often asymptomatic.A solid,slightly hypoechoic,round or oval mass with uniform internal echo,richer blood flow in the solid part,and low resistance index are typical imaging features of ovarian steroid cell tumors.Diagnosis of ovarian steroid cell tumors after menopause is challenging,but surgery can be used for both diagnosis and clear treatment.

Swyer＇s Syndrome with Mixed Ovarian Malignant Germ Cell Tumor and Ovarian Gonadoblastoma

A 16-year-old girl was administered to our hospital because of primary amenorrhea and solid pelvic mass. She was 158 cm tall and weighed 55 kg. There was no evidence ofacanthosis nigricans, acne, hirsutism, goiter, cushingoid features, or Turners stigmata. Examination of secondary sexual characteristics revealed that the breast was small and poorly developed （Tanner＇s Stage II）. Pubic hair was absent while the external genitalia was of female type and had no evidence of clitoromegaly. Ultrasonography of the pelvis showed a solid mass diameter about 9 cm in right adnexal area, a normal uterus with endometrium of 3 ram, and left ovary 1.5 cm x1.0 cm. Her serum hormonal assay revealed a low estradiol level of 0.155 nmol/L （normal range： 0.200-0.790 nmol/L in follicular phase） in the background of elevated luteinizing hormone level of 25.47 U/L （normal range： 2.12-10.89 U/L in follicular phase）, follicle-stimulating hormone level of 51.36 U/L （normal range： 3.85-8.78 U/L in follicular phase）, and testosterone level of 3.97 nmol/L （normal range： 0.35-2.60 nmol/L）. She was found to have normal progesterone level of 3.77 nmol/L （0.98-4.83 nmol/L in follicular phase） and serum prolactin level of 12.47 ng/ml （3.34-26.72 ng/ml）.

Clinicopathological Evaluation of Ovarian Juvenile Granulosa Cell Tumor: Is Fertility-Sparing Surgery Safe?

Objective:To retrospectively investigate the clinicopathological characteristics of ovarian juvenile granulosa cell tumors(JGCTs)and to evaluate the safety of fertility-sparing surgery.Methods:In this study,surgically treated patients with JGCTs diagnosed between January 2004 and October 2018 in our center were identified.Clinicopathological data,survival outcomes,and recurrence rates were examined in these patients.Results:A total of 8 patients were included.All patients were premenarchal girls or young women(age range,9-32 years).Irregular vaginal bleeding was the most common presenting symptom.Of them,seven patients were classified with Stage I JGCTs,and they underwent fertility-sparing surgery.One patient who had Stage IIIC JGCT and had completed childbearing underwent complete surgery.Seven patients received adjuvant chemotherapy.The median follow-up duration in the total cohort was 64 months(range,2-117 months).The overall survival rate in the fertility-sparing group was 100%,whereas the patient with Stage IIIC JGCT died 1 month after the treatment.Conclusions:Fertility-sparing surgery might not show a negative impact on oncologic outcomes.Fertility sparing could be considered a modified option for patients with Stage I JGCTs.However,due to the limited number of patients,the conclusion must be interpreted with caution,and larger or multicenter studies are needed before conclusions can be drawn.