ABSTRACT
Os disgerminomas são tumores malignos de células germinativas ovarianas, são raros, geralmente acometem mulheres em idade fértil e têm bom prognóstico e sobrevida elevada. Paciente de 20 anos, primigesta com 26 semanas de gestação, foi admitida no centro obstétrico da Fundação Hospitalar Santo Antônio em Blumenau- SC com quadro de dor abdominal intensa refratária à analgesia e desconforto respiratório. Ressonância magnética demonstrou derrame pleural, moderada ascite e volumosa lesão expansiva de aspecto sólido-cístico em anexo direito. Foram realizadas salpingo-oforectomia à direita e omentectomia parcial e coletado lavado peritoneal. Anatomopatológico evidenciou disgerminoma. A paciente seguiu acompanhamento gestacional nos serviços de pré-natal de alto risco e oncologia. Devido à imaturidade fetal, manteve-se conduta expectante e, após o parto normal com 37 semanas, foi realizado estadiamento e iniciada quimioterapia adjuvante. Devido à baixa incidência e à raridade de tumores de células malignas ovarianas, relatos de casos como este são importantes para discutir as melhores estratégias de manejo clínico.(AU)
Dysgerminomas are rare malignant ovarian germ cell tumors that generally affect adolescence and early adulthood, have a good prognosis and high survival. Patient 20 years old, gestation 1, at 26 weeks of gestation, was hospitalized at the obstetric center of Fundação Hospitalar Santo Antônio in Blumenau-SC, with severe abdominal pain refractory to analgesia and respiratory discomfort. Magnetic resonance showed pleural effusion, moderate ascites and a massive expansive lesion with a solid cystic aspect in the right ovary. Right salpingoophorectomy, partial omentectomy and peritoneal lavage were collected. Anatomopathological evidence showed dysgerminoma. Patient followed gestational follow-up at high-risk prenatal and oncology services. Due to fetal immaturity, expectant management was maintained and after vaginal delivery at 37 weeks, staging was performed and adjuvant chemotherapy was started. Due to the low incidence and rarity of ovarian malignant cell tumors, case reports such as this one are important to discuss the best clinical management strategies.(AU)
Subject(s)
Humans , Female , Pregnancy , Adult , Prenatal Care , Pregnancy, High-Risk , Dysgerminoma , Dysgerminoma/surgery , Dysgerminoma/drug therapy , Pain , Pleural Effusion , Prognosis , Ascites , Survival , Brazil , Magnetic Resonance Spectroscopy , Risk , Chemotherapy, Adjuvant , Labor, InducedABSTRACT
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Subject(s)
Humans , Female , Child , Dysgerminoma/drug therapy , Dysgerminoma , Intracranial Embolism and Thrombosis , Intracranial Thrombosis/drug therapy , Intracranial Thrombosis , Tomography, Emission-Computed/methods , Headache/complications , Headache/etiology , Venous Thrombosis/complications , Risk Factors , Paresis/complications , Papilledema/complications , EchoencephalographyABSTRACT
Germinal cell tumours represent only 2-5% of all cancers of the ovary. However, the characteristics of the tumour and the patients have some special qualities as high rates of healing goes together with a strong desire to keep fertility intact because this condition occurs in female children and adolescent girls. Neither the prognosis nor the treatment of these tumours is homogeneous; the low incidence is the reason it is hard to develop prospective studies for establishing prognostic factors and specific treatments. The introduction of adjuvant chemotherapy into initial surgery has improved the prognosis of these patients. The BEP scheme has proved to be equally efficient and less toxic than PVB, and for this reason it has become the standard scheme despite the fact that no randomised studies have been carried out. The surgical treatment demands the application of the same principles seen in cytoreduction surgery of epithelial cancers of the ovary (maximum possible cytoreduction), though in many cases hysterectomy and double adnexectomy may be obviated. In view of the rarity of these tumours, it is advisable to work within cooperative groups that may have subgroups for the treatment of rare tumours. This will probably be the only way to move forward in the prospective knowledge of prognostic factors for these tumours (AU)
Subject(s)
Humans , Female , Child , Adolescent , Young Adult , Adult , Antineoplastic Agents/therapeutic use , Carcinoma, Embryonal/diagnosis , Carcinoma, Embryonal/drug therapy , Choriocarcinoma/drug therapy , Neoplasms, Germ Cell and Embryonal/diagnosis , Neoplasms, Germ Cell and Embryonal/drug therapy , Neoplasms, Germ Cell and Embryonal/surgery , Ovarian Neoplasms/diagnosis , Ovarian Neoplasms/drug therapy , Ovarian Neoplasms/surgery , Carcinoma, Embryonal/pathology , Choriocarcinoma/pathology , Choriocarcinoma/diagnosis , Chorionic Gonadotropin, beta Subunit, Human , Dysgerminoma/diagnosis , Dysgerminoma/drug therapy , Neoplasms, Germ Cell and Embryonal/pathology , Ovarian Neoplasms/pathology , alpha-Fetoproteins , Biomarkers, TumorABSTRACT
Planteamos a partir de un caso clínico, cuáles son las opciones actuales para el tratamiento de los tumores de células germinales del ovario, en concreto del disgerminoma y el gonadoblastoma, su asociación y nuestra experiencia clínica en una paciente. Se realiza una revisión bibliográfica mediante búsqueda informática en el sistema Medline de aquellos trabajos publicados al respecto, desde 1987 hasta 2001, y concluimos con la posibilidad de preservar la fertilidad en mujeres jóvenes con disgerminoma, sin que ello repercuta en su pronóstico a largo plazo, así como la pauta de conservar el útero en pacientes con gonadoblastoma
This case report describes the current options in the management of ovarian germ cell tumors, specifically dysgerminoma and gonadoblastoma, their association, and our clinical experience in a patient. A Medline search was performed to identify relevant studies published from 1987 to 2001. We conclude that it is possible to preserve fertility in young women with dysgerminoma, without consequences for their long-term prognosis, and to preserve the uterus in patients with gonadoblastoma
Subject(s)
Female , Adult , Humans , Germinoma/pathology , Dysgerminoma/drug therapy , Gonadoblastoma/drug therapy , Ovarian Neoplasms/pathology , Cisplatin/therapeutic useABSTRACT
Entre 1986 y 1990 se estudió un grupo de 51 enfermos con tumores germinales del testículo, tratados con etoposide y cisplatino, con el propósito de conocer la reacción tumoral a este esquema de tratamiento y establecer que factores clínicos e histopatológicos influyen en ella
Subject(s)
Humans , Male , Adult , Middle Aged , Testicular Neoplasms/classification , Testicular Neoplasms/drug therapy , Cisplatin/administration & dosage , Cisplatin/pharmacology , Dysgerminoma/physiopathology , Dysgerminoma/drug therapy , Etoposide/administration & dosage , Etoposide/pharmacology , Neoplasm Staging/adverse effects , Neoplasm StagingABSTRACT
De 1965 al 1990 se estudian 33 casos de cáncer embrionario de ovario en los hospitales Belén y Regional de Trujillo, con la finalidad de determinar su incidencia y complicaciones. Este grupo de tumores representó el 17.6 por ciento de todas las neoplasias ováricas malignas, siendo el disgerminoma el tumor más frecuentemente encontrado (16 casos). Se apreció un predominio en las pacientes menores de 30 años (29 casos), que acudieron por dolor y tumoración abdominal (33 casos), presentando 25 de ellas un tiempo de evolución menor de 7 meses. Asimismo, 23 llegaron en estadíos III y IV. Todas fueron operadas a excepción de una que falleció el día de su ingreso al Hospital. La complicación más frecuente fué la anemia (15 casos), habiéndose registrado un caso con perforación de colon. Fueron derivadas al INEN 25 pacientes, 6 no regresaron a su control y 2 fallecieron víctimas de la enfermedad
Subject(s)
Neoplasms, Germ Cell and Embryonal/classification , Neoplasms, Germ Cell and Embryonal/diagnosis , Peru , Teratoma/diagnosis , Teratoma/therapy , Dysgerminoma/diagnosis , Dysgerminoma/drug therapy , Dysgerminoma/therapy , Antigens, NeoplasmABSTRACT
Eighteen ppatients with advanced seminoma (stages IIc-III) were with: cytoxan 600 mg/m2, vinblastine 4 mg/m2, actinomycin D 1 mg/m2, bleomycin 30 mg, i. v. on day 1, followed by bleomycin 30 mg/day by infusion, days 1-3, and cis-platinum 120 mg/m2 on day 4. 9/18 pts. achieved complete remission and have been followed clinically; no recurrences have occurred in this group. The other 9 pts. had residual masses after 3 cycles of chemotherapy; they were taken to surgery and no viable tumor was found on surgical specimens. Thera were 3 recurrences in this group, always distant from the site of original disease. These patients were successfully treated with salvage chemotherapy and radiotherapy. One of these patients died of hepatic failure un related to his seminoma. All the other patients are alive, at a median follow-up of 50 months. This chemotherapy regimen is effective in curing advanced seminoma
Subject(s)
Humans , Male , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Dysgerminoma/drug therapy , Bleomycin/administration & dosage , Cisplatin/administration & dosage , Cyclophosphamide/administration & dosage , Dactinomycin/administration & dosage , Vinblastine/administration & dosageABSTRACT
Treze pacientes portadores de tumores germinativos avançados foram tratados nos últimos três anos no Hospital de Oncologia - INAMPS com esquema quimioterápico PVB. Destes, um paciente näo é avaliavel visto ter recebido dois ciclos incompletos e somente um tem apresentaçäo extragonadal, sendo os demais primitivos do testículo. Oito pacientes apresentaram RC (66,7%) e quatro RP (33,3%). Duas recidivas ocorreram 12 e 16 meses após início da quimioterapia. Houve três óbitos, após RP, dois por falha ao esquema de 2ª linha (VP16 + CCDP) e um por evoluçäo de doença após abandono de tratamento durante esquema de 2ª linha. Somente um paciente recebeu dois ciclos de quimioterapia que corresponde a um tumor metacrônico. O período médio de acompanhamento é de 21 meses (oito a 39 meses). A média de ciclos é 3,8. O esquema é eficaz, a tolerabilidade muito boa, porém é necessário maior para confirmarmos o percentual de remissäo
Subject(s)
Adult , Humans , Male , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Dysgerminoma/drug therapy , Testicular Neoplasms/drug therapy , Bleomycin/administration & dosage , Brazil , Cisplatin/administration & dosage , Vinblastine/administration & dosageABSTRACT
El tratamiento médico de los tumores de células germinales (TCG) en general y de los testiculares en particular supone uno de los más importantes logros de la moderna Oncología. Aunque ha sido el desarrollo de la quimioterapia la principal causa de este avance, la práctica oncológica multidisciplinaria que agrupa a la cirugía y a la radioterapia junto con la quimioterapia, es al igual que sucede con otors tumores curables, la base fundamental de estos logros
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Dysgerminoma/drug therapy , Testicular Neoplasms/drug therapyABSTRACT
O prognóstico dos pacientes com câncer disseminado do testículo melhorou de forma significativa com o advento de esquemas de quimioterapia citotóxica contendo cis-platinum, vinblastina e bleomicina. O objetivo do presente trabalho foi o de avaliar a eficiência desta abordagem em pacientes com tumores germinativos metastáticos do testículo em estádios IIc e III. Quarenta pacientes, 14 portadores de seminoma e 26 portadores de tumores näo-seminomatosos, foram tratados com quimioterapia sistêmica seguida de cirurgia cito-redutiva. Nestes casos foi empregado o esquema VAB6, representado pela administraçäo de vinblastina, actinomicina-D, bleomicina, cis-platinum e ciclofosfamida por 3 ou 4 ciclos de 21 dias. Nos pacientes com persistência ou recorrência posterior da neplasia foram feitas novas reinduçöes com esquemas contendo VP-16-213 e cis-platinum. A análise deste material, após um período de seguimento que variou de 8 a 46 meses (mediana = 29 meses) em seminomas e de 3 a 64 meses (mediana = 33 meses) em tumores näo-seminomatosos, evidenciou remissäo completa e prolongada da neoplasia em 34 dos 40 pacientes (85%), incluindo todos os 14 pacientes com seminoma (100%) e 20 dos 26 pacientes com tumores näo-seminomatosos (77%). Os dados do presente estudo demostram que o cancêr do testículo representa doença consistentemente curável, mesmo em fases de apresentaçäo mais avançada