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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

Umbilical swelling.
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fig2: Umbilical swelling.

Mentions: Only two months later, she developed a swelling at her umbilicus (Figure 2(a)) and regained ascites. She was clinically fit, with no rise in tumor markers. CT scanning confirmed the increased ascites and showed a 4.5 cm lesion at the umbilicus with a similar density to the ascites but with a solid part (Figure 2(b)). FDG-PET scanning showed diffuse moderate uptake in the pelvis next to the uterus and slight lymphadenopathy, mainly mesenterial and inguinal. A biopsy of the lesion at the umbilicus showed fat tissue and connective tissue with reactive changes, no malignancy. Cytology of the ascites was reported to show atypical cells resembling the original germ cell tumor, confirmed by 2 experienced pathologists. The unusual aspects of this case were the negative tumor markers and a clinically fit patient. We considered the diagnosis mature teratoma, but this normally does not present with a large amount of apparently malignant ascites. Due to doubts on the diagnosis we asked our pathologists again for a revision of the cytological material, this time with an immunomarker profile. This showed atypical cells, but immunologic tests on epithelial cell markers (MoC31, Epcam) or germ cell carcinoma (bHCG and aFP) were negative, concluding that this was not enough evidence for relapse of the disease.


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)

Umbilical swelling.
© Copyright Policy
Related In: Results  -  Collection

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

fig2: Umbilical swelling.
Mentions: Only two months later, she developed a swelling at her umbilicus (Figure 2(a)) and regained ascites. She was clinically fit, with no rise in tumor markers. CT scanning confirmed the increased ascites and showed a 4.5 cm lesion at the umbilicus with a similar density to the ascites but with a solid part (Figure 2(b)). FDG-PET scanning showed diffuse moderate uptake in the pelvis next to the uterus and slight lymphadenopathy, mainly mesenterial and inguinal. A biopsy of the lesion at the umbilicus showed fat tissue and connective tissue with reactive changes, no malignancy. Cytology of the ascites was reported to show atypical cells resembling the original germ cell tumor, confirmed by 2 experienced pathologists. The unusual aspects of this case were the negative tumor markers and a clinically fit patient. We considered the diagnosis mature teratoma, but this normally does not present with a large amount of apparently malignant ascites. Due to doubts on the diagnosis we asked our pathologists again for a revision of the cytological material, this time with an immunomarker profile. This showed atypical cells, but immunologic tests on epithelial cell markers (MoC31, Epcam) or germ cell carcinoma (bHCG and aFP) were negative, concluding that this was not enough evidence for relapse of the disease.

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