Clinical Case Analysis And Literature Review Of Malignant Ovarian Germ Cell Tumors

Objectives:Malignant ovarian germ cell tumors(MOGCTs)is mainly happen in the young female.This study was aimed to analyze the clinical characteristics,the survival outcome and prognosis of malignant ovarian germ cell tumors,and explore the ovarian endocrine function and pregnancy outcomes of fertility-sparing patients.Methods:1.In our study,65 cases MOGCTs patients were admitted to Tianjin Medical University General Hospital,since January 1996 to September 2019.We analyzed the clinical characteristics,pathology types,FIGO stage,surgery method,intraoperative exploration of ascites,chemotherapy,survival outcome and prognosis factors of MOGCTs.2.Aanaly the 57 cases of MOGCTs patients received the fertility-preserving surgery and search 12 cases of literatures about the fertility-preserving surgery since January 1991 to February 2020 which has published on the Pub Med、CNKI、Wan Fang and Wei Pu database.To analy and and explore the ovarian endocrine function and obstetric outcomes of fertility-sparing patients.Results:The first part: Patients aged range since 11 to 47 years old,and the median age was 24 years old.The usual clinical symptoms were abdominal pain(49.2%)or abdominal bloating(16.9%).Pathological types includes immature teratoma 30 cases,dysgerininoma 16 cases,yolk sac tumor 12 cases,malignant mixed germ cell tumor 6 cases,Non-pregnant choriocarcinoma 1 case.According to the FIGO 50 cases,stage I;3 cases,stage II;9 cases,stage III;3 cases,stage IV.All MOGCTs patients received the detected of serum CA125,CA199,AFP,LDH,β-HCG.And the detected of serum CA125 elevated 39 cases.The serum of CA199 elevated 10 cases.The serum of AFP elevated 29 cases.The serum of LDH elevated 12 cases.The serum of β-HCG elevated 11 cases.All patiens have received surgery treatment,and 57 cases of them received fertility-reserving surgery.14 cases received comprehensive staging sugery(ipsilateral/bilateral ovarian salpingectomy+omentum resection+ pelvic lymph node dissection/biopsy+appendectomy)treatment.Received noncomprehensive stage surgery 13 cases,received ipsilateral ovarian salpingectomy 28 cases,receive ipsilateral ovarian salpingectomy contralateral+ contralateral ovarian biopsy 2 cases(2 cases were yolk sac tumor).52 cases of MOGCTs patients received chemotherapy after the surgery.Most patients given BEP(Bleomycin,Etoposide,Cisplatinum)regimen chemotherapy(46.2%).The others were given PVB(Cisplatin+Vincristine+Bleomycin)、VAC(Vincristine+ Actinomycin+ Cyclophosphamide)and TC(Carboplatin+Paclitaxel)chemotherapy.Patients given 3 to 6 courses have 48 cases(92.3%),more than 6 courses have 4 cases(7.7%).It is no need to receive chemotherapy after surgery were 6 cases,which includes immature teratoma 5 cases,stage I,G1 and dysgerininoma,stage Ia was 1 case.The follow-up time was since 2 to 281 months,uncontrolled 10 cases,relapsed 2 cases,died 12 cases.The overal five year survival rate was 84.7%.The second part: 57 cases received fertility-sparing surgery treatment,and 48 cases were given chemotherapy after the surgery,follwed-up the patient during the childbearing age in 37 cases.During the chemotherapy,35 cases had menstrual disorder(94.6%),and 34 cases the menstruation recover normal after the chemotherapy finished within the 1 to 6 month.The 36 cases who desire for pregnancy,31 cases had pregnant for 38 times,33 cases were delivery at term,spontaneous abortions for 3 times.The pregnancy rate was 86.1%.And there was no statistic difference between the obstetric outcome and surgery methods,chemotherapy,FIGO stage,and histological type(P=0.670、P=0.394、P=0.129、P=0.297).And all 390 cases of MOGCTs patients received the fertility-sparing surgery from 11 case of literatures,and 278 of them received the chemotherapy treatment after the surgery(71.3%).And the rate of menstrual disorder was 61.5%,and the failure of ovarian function of 4 cases(1.4%).And rang from the chemotherapy finished and to recover the normal menstrual,the time is 2 months and over 24 months.In 390 cases patients,129 cases had plan of pregnancy,108 cases pregnancy and delivery at term of 104 times,the overall pregnancy rate was 83.7%.And 2 cases study from the 11 cases of literatures,totally includes 58 cases of MOGCTs who received the ipsilateral ovarian salpingectomy and uncomprehensive stage surgery and post-chemotherapy,the menstrual disorder rate was 50.9%,and the pregnancy rate was 59.1%.Conclusion: 1.MOGCTs usually happens in the young female.The usual clinical manifestations were abdominal pain、abdominal bloating and pelvic mass,and always accompanied with the specific tumor markers increased.2.Most patients in the early stage during the initial diagnosis,and the FIGO stage,histological type and chemotherapy as the independent factors that have influences on MOGCTs patients.3.Fertility-sparing surgery is safety for MOGCTs patients with fertility needs.And the FIGO staging,histological type,surgery methods,chemotherapy has no relationships with obstetric outcome.