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Clinical and radiologic signs of relapsed ovarian germ cell tumor: tissue is the issue.

Homs MY, Schreuder HW, Jonges GN, Witteveen PO - Case Rep Obstet Gynecol (2013)

Bottom Line: In retrospect, the ascites was false positive.This case shows that current diagnostic tools are not sufficient to distinguish between vital tumor and mature teratoma and can be misleading.Tumor biopsy and/or laparoscopic inspection are therefore indicated.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical Oncology, University Medical Center, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.

ABSTRACT
Malignant ovarian germ cell tumor is a rare disease, but with current treatment strategies including surgery and platinum based chemotherapy survival is excellent. After treatment, intensive followup is indicated to encounter tumor relapse at an early stage. This case describes a 22-year-old female with a history of common variable immune deficiency (CVID) who underwent a resection of a large ovarian germ cell tumor followed by 4 cycles of cisplatin and etoposide resulting in clinical complete remission. During followup, she developed a mass at the umbilicus and ascites. Initially, the cytology of the ascites was interpreted as tumor positive, suspicious of relapse of the disease, but tumor markers remained negative. However, during laparoscopy it turned out to be a mature teratoma, which can develop after chemotherapy, the so called growing teratoma syndrome. In retrospect, the ascites was false positive. This case shows that current diagnostic tools are not sufficient to distinguish between vital tumor and mature teratoma and can be misleading. Tumor biopsy and/or laparoscopic inspection are therefore indicated.

No MeSH data available.


Related in: MedlinePlus

Germ cell tumor.
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fig1: Germ cell tumor.

Mentions: A 22-year-old female presented with abdominal pain and distension of the abdomen, weight loss, constipation, and fatigue. Her medical history reported a common variable immune deficiency (CVID) with a deficiency of IgG2 subclasses, which was discovered after several pulmonary infections during childhood, resulting in bronchiectasis of the lungs. Since diagnosis she regularly receives immune globulins. An abdominal CT scan identified a mass in the pelvis, likely ovarian origin, and a large amount of ascites (Figure 1). Laboratory results showed an alpha fetoprotein (AFP) of 5300 μg/L (normal range 0.0–9.0), beta human chorionic gonadotropin (B-HCG) of 5800 IU/L (normal range 0.0–3.0), lactic dehydrogenase of 2055 U/L (normal range 0–250), and CA 125 of 136 U/mL (normal range 0–35). She underwent a laparotomy with drainage of 7 liters of ascites, resection of the left ovary with a large tumor that ruptured during surgery, resection of the right fallopian tube, and omentectomy. Inspection of the abdomen showed no signs of residual disease. Pathology showed a mixed germ cell tumor of 25 cm with dysgerminoma, yolk sac tumor, choriocarcinoma, mature teratoma, immature teratoma, and possibly embryonal cell carcinoma. The right fallopian tube contained a cyst and localization of germ cell tumor;the omentectomy showed only reactive changes. In conclusion, she was diagnosed with a mixed germ cell tumor, minimal stage IC. A secondary laparotomy for complete staging was not performed because full macroscopic examination during the first procedure did not show other macroscopic abnormalities, and CT scan performed after surgery showed ascites but no residual tumor. Furthermore, the indication for adjuvant chemotherapy was already there. Because of the preexisting bronchiectasis which has led to reduced lung capacity, bleomycin was contraindicated, and she received 4 cycles of cisplatin and etoposide. At the start of the chemotherapy AFP was 150 ug/L and B-HCG 9.8 IU/L, with still a large amount of ascites. During chemotherapeutic treatment, tumor markers normalized after the third course of chemotherapy and the ascites disappeared without additional paracentesis. Abdominal CT scan 6 weeks after the last chemotherapy showed a minimal amount of free fluid with no signs of residual disease; lymph nodes were all less than 1 cm. Clinical complete remission was concluded and followup started.


Clinical and radiologic signs of relapsed ovarian germ cell tumor: tissue is the issue.

Homs MY, Schreuder HW, Jonges GN, Witteveen PO - Case Rep Obstet Gynecol (2013)

Germ cell tumor.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3814044&req=5

fig1: Germ cell tumor.
Mentions: A 22-year-old female presented with abdominal pain and distension of the abdomen, weight loss, constipation, and fatigue. Her medical history reported a common variable immune deficiency (CVID) with a deficiency of IgG2 subclasses, which was discovered after several pulmonary infections during childhood, resulting in bronchiectasis of the lungs. Since diagnosis she regularly receives immune globulins. An abdominal CT scan identified a mass in the pelvis, likely ovarian origin, and a large amount of ascites (Figure 1). Laboratory results showed an alpha fetoprotein (AFP) of 5300 μg/L (normal range 0.0–9.0), beta human chorionic gonadotropin (B-HCG) of 5800 IU/L (normal range 0.0–3.0), lactic dehydrogenase of 2055 U/L (normal range 0–250), and CA 125 of 136 U/mL (normal range 0–35). She underwent a laparotomy with drainage of 7 liters of ascites, resection of the left ovary with a large tumor that ruptured during surgery, resection of the right fallopian tube, and omentectomy. Inspection of the abdomen showed no signs of residual disease. Pathology showed a mixed germ cell tumor of 25 cm with dysgerminoma, yolk sac tumor, choriocarcinoma, mature teratoma, immature teratoma, and possibly embryonal cell carcinoma. The right fallopian tube contained a cyst and localization of germ cell tumor;the omentectomy showed only reactive changes. In conclusion, she was diagnosed with a mixed germ cell tumor, minimal stage IC. A secondary laparotomy for complete staging was not performed because full macroscopic examination during the first procedure did not show other macroscopic abnormalities, and CT scan performed after surgery showed ascites but no residual tumor. Furthermore, the indication for adjuvant chemotherapy was already there. Because of the preexisting bronchiectasis which has led to reduced lung capacity, bleomycin was contraindicated, and she received 4 cycles of cisplatin and etoposide. At the start of the chemotherapy AFP was 150 ug/L and B-HCG 9.8 IU/L, with still a large amount of ascites. During chemotherapeutic treatment, tumor markers normalized after the third course of chemotherapy and the ascites disappeared without additional paracentesis. Abdominal CT scan 6 weeks after the last chemotherapy showed a minimal amount of free fluid with no signs of residual disease; lymph nodes were all less than 1 cm. Clinical complete remission was concluded and followup started.

Bottom Line: In retrospect, the ascites was false positive.This case shows that current diagnostic tools are not sufficient to distinguish between vital tumor and mature teratoma and can be misleading.Tumor biopsy and/or laparoscopic inspection are therefore indicated.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical Oncology, University Medical Center, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.

ABSTRACT
Malignant ovarian germ cell tumor is a rare disease, but with current treatment strategies including surgery and platinum based chemotherapy survival is excellent. After treatment, intensive followup is indicated to encounter tumor relapse at an early stage. This case describes a 22-year-old female with a history of common variable immune deficiency (CVID) who underwent a resection of a large ovarian germ cell tumor followed by 4 cycles of cisplatin and etoposide resulting in clinical complete remission. During followup, she developed a mass at the umbilicus and ascites. Initially, the cytology of the ascites was interpreted as tumor positive, suspicious of relapse of the disease, but tumor markers remained negative. However, during laparoscopy it turned out to be a mature teratoma, which can develop after chemotherapy, the so called growing teratoma syndrome. In retrospect, the ascites was false positive. This case shows that current diagnostic tools are not sufficient to distinguish between vital tumor and mature teratoma and can be misleading. Tumor biopsy and/or laparoscopic inspection are therefore indicated.

No MeSH data available.


Related in: MedlinePlus