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CC BY 4.0 · Indian J Med Paediatr Oncol 2025; 46(03): 269-277
DOI: 10.1055/s-0044-1796674
Original Article

Germ Cell Tumors in Children: A Retrospective Review of a 04-Year Single-Center Experience

Kanwal Aftab 
1   Department of Histopathology, Indus Hospital & Health Network, Karachi, Pakistan
,
Fatima Ambreen
2   Department of Pediatric Oncology, Indus Hospital & Health Network, Karachi, Pakistan
,
Sidra Maqsood 
3   Department of Research, Innovation and Commercialization, Indus Hospital & Health Network, Karachi, Pakistan
,
Nausheen Yaqoob
1   Department of Histopathology, Indus Hospital & Health Network, Karachi, Pakistan
,
Saba Jamal
1   Department of Histopathology, Indus Hospital & Health Network, Karachi, Pakistan
› Author Affiliations
Funding None.
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Abstract

Introduction Pediatric germ cell tumors (GCTs) are rare neoplasms that can be benign or malignant and occur in children and adolescents. They can arise from germ cells in the extragonadal or gonadal sites and have numerous histologic subtypes. The International Germ Cell Cancer Cooperative Group classification is used to guide treatment, with most children experiencing excellent overall survival (OS). Chemotherapy is historically recommended for all malignant GCTs. Nevertheless, surgery and observation alone may be sufficient for stage I gonadal GCTs. Using chemotherapy can lead to successful salvage of relapses..

Objectives Our institute has conducted a study with the objective of evaluating a group of 97 patients diagnosed with GCTs, who received treatment within the past 4 years.

Materials and Methods From January 2018 to April 2022, a total of 97 pediatric patients diagnosed with GCTs underwent surgical treatment at Indus Hospital & Health Network. The diagnosis was established by considering clinical features, tumor marker levels, imaging, and histology. Treatment was determined based on the risk stratification utilizing the United Kingdom Children's Cancer Study Group GC 2005–04 protocol. Patients classified as LR (low-risk) received chemotherapy only if a recurrence occurred after the initial surgery. On the other hand, IR (intermediate-risk) and HR (high-risk) patients received four and six cycles of JEB (chemotherapy regimen), respectively, followed by surgery. Recurrence was closely monitored through suspicion, tumor marker levels, or imaging. Patients experiencing a recurrence after JEB chemotherapy were treated with TIP (paclitaxel, ifosfamide, and cisplatin) chemotherapy and subsequently underwent surgery.

Results In this retrospective study, a group of 97 patients diagnosed with GCTs was analyzed. The cohort included 59 gonadal tumors and 38 extragonadal tumors. The most common histopathological types observed were yolk sac tumor and dysgerminoma. Out of the patients, 33 (34%) were classified as HR, 35 (36.1%) as IR, and 29 (29.9%) as LR. Among the patients, 16 experienced recurrence, while the remaining 90 patients (92.8%) were alive at the time of the analysis. The study determined the 5-year event-free survival (EFS) rate as 83.5% and the OS rate as 92.8%. The presence of residual disease was found to be the only significant factor that influenced EFS.

Conclusion To manage GCTs in children, a multidisciplinary approach involving surgeons, oncologists, and radiation therapists is required. Surgery and chemotherapy have improved outcomes for children with GCTs, but personalized treatment planning is crucial. With advancements in pediatric oncology care, the prognosis for children with GCT in Pakistan has improved, providing hope for better outcomes in the future.

Keywords

germ cell tumors (GCT) - children - gonadal - yolk sac tumor - overall survival - event-free survival

Patient Consent

Informed patient consent was obtained for this study.




Publication History

Article published online:
24 February 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Cecchetto G. Gonadal germ cell tumors in children and adolescents. J Indian Assoc Pediatr Surg 2014; 19 (04) 189-194
    CrossrefPubMedSearch in Google Scholar
  • 2 Pierce JL, Frazier AL, Amatruda JF. Pediatric germ cell tumors: a developmental perspective. Adv Urol 2018; 2018: 9059382
    CrossrefPubMedSearch in Google Scholar
  • 3 Rescorla FJ. Pediatric germ cell tumors. Semin Pediatr Surg 2012; 21 (01) 51-60
    CrossrefPubMedSearch in Google Scholar
  • 4 Schneider DT, Terenziani M, Cecchetto G. et al. Gonadal and extragonadal germ cell tumors, sex cord stromal and rare gonadal tumors. Chapter 39. In: Rare Tumors in Children and Adolescents. Germany: Springer Berlin Heidelberg; 2012: 327-402
    Search in Google Scholar
  • 5 Parida L. Nonurological malignancies in children. J Indian Assoc Pediatr Surg 2014; 19 (01) 31-37
    CrossrefPubMedSearch in Google Scholar
  • 6 Panteli C, Curry J, Kiely E. et al. Ovarian germ cell tumours: a 17-year study in a single unit. Eur J Pediatr Surg 2009; 19 (02) 96-100
    Thieme ConnectPubMedSearch in Google Scholar
  • 7 İncesoy-Özdemir S, Ertem U, Şahin G. et al. Clinical and epidemiological characteristics of children with germ cell tumors: a single center experience in a developing country. Turk J Pediatr 2017; 59 (04) 410-417
    CrossrefPubMedSearch in Google Scholar
  • 8 International Germ Cell Cancer Collaborative Group. International Germ Cell Consensus Classification: a prognostic factor-based staging system for metastatic germ cell cancers. J Clin Oncol 1997; 15 (02) 594-603
    CrossrefPubMedSearch in Google Scholar
  • 9 Frazier AL, Hale JP, Rodriguez-Galindo C. et al. Revised risk classification for pediatric extracranial germ cell tumors based on 25 years of clinical trial data from the United Kingdom and United States. J Clin Oncol 2015; 33 (02) 195-201
    CrossrefPubMedSearch in Google Scholar
  • 10 Billmire DF, Cullen JW, Rescorla FJ. et al. Surveillance after initial surgery for pediatric and adolescent girls with stage I ovarian germ cell tumors: report from the Children's Oncology Group. J Clin Oncol 2014; 32 (05) 465-470
    CrossrefPubMedSearch in Google Scholar
  • 11 Rescorla FJ, Ross JH, Billmire DF. et al. Surveillance after initial surgery for Stage I pediatric and adolescent boys with malignant testicular germ cell tumors: report from the Children's Oncology Group. J Pediatr Surg 2015; 50 (06) 1000-1003
    CrossrefPubMedSearch in Google Scholar
  • 12 Goldman S, Bouffet E, Fisher PG. et al. Phase II trial assessing the ability of neoadjuvant chemotherapy with or without second-look surgery to eliminate measurable disease for non-germinomatous germ cell tumors: a Children's Oncology Group study. J Clin Oncol 2015; 33 (22) 2464-2471
    CrossrefPubMedSearch in Google Scholar
  • 13 Fresneau B, Orbach D, Faure-Conter C. et al. Sex-cord stromal tumors in children and teenagers: results of the TGM-95 study. Pediatr Blood Cancer 2015; 62 (12) 2114-2119
    CrossrefPubMedSearch in Google Scholar
  • 14 Islam Nasir IU, Ashraf MI, Ahmed N. et al. Clinical profile, treatment and survival outcomes of peadiatric germ cell tumours: a Pakistani perspective. J Pak Med Assoc 2016; 66 (10) S119-S121
    Search in Google Scholar
  • 15 Kaatsch P, Häfner C, Calaminus G, Blettner M, Tulla M. Pediatric germ cell tumors from 1987 to 2011: incidence rates, time trends, and survival. Pediatrics 2015; 135 (01) e136-e143
    CrossrefPubMedSearch in Google Scholar
  • 16 Kumar H, Saju SV, Radhakrishnan V. et al. Analysis of extra-cranial germ cell tumors in male children: experience from a single centre in India. Pediatric Hematology Oncology Journal 2020; 5 (02) 37-42
    CrossrefSearch in Google Scholar
  • 17 Marina N, London WB, Frazier AL. et al. Prognostic factors in children with extragonadal malignant germ cell tumors: a pediatric intergroup study. J Clin Oncol 2006; 24 (16) 2544-2548
    CrossrefPubMedSearch in Google Scholar
  • 18 Lorch A, Bascoul-Mollevi C, Kramar A. et al. Conventional-dose versus high-dose chemotherapy as first salvage treatment in male patients with metastatic germ cell tumors: evidence from a large international database. J Clin Oncol 2011; 29 (16) 2178-2184
    CrossrefPubMedSearch in Google Scholar
  • 19 Rescorla FJ. Pediatric germ cell tumors. Semin Surg Oncol 1999; 16 (02) 144-158
    CrossrefPubMedSearch in Google Scholar
  • 20 PDQ Pediatric Treatment Editorial Board. Childhood Extracranial Germ Cell Tumors Treatment (PDQ®): Health Professional Version. 2023 Feb 10. In: PDQ Cancer Information Summaries [Internet]. Bethesda, MD: National Cancer Institute (US); 2002
    Search in Google Scholar
  • 21 Wollner N, Ghavimi F, Wachtel A, Luks E, Exelby P, Woodruff J. Germ cell tumors in children: gonadal and extragonadal. Med Pediatr Oncol 1991; 19 (04) 228-239
    CrossrefPubMedSearch in Google Scholar
  • 22 Depani S, Stoneham S, Krailo M, Xia C, Nicholson J. Results from the UK Children's Cancer and Leukaemia Group study of extracranial germ cell tumours in children and adolescents (GCIII). Eur J Cancer 2019; 118: 49-57
    CrossrefPubMedSearch in Google Scholar
  • 23 Akyüz C, Varan A, Büyükpamukçu N, Kutluk T, Büyükpamukçu M. Malignant ovarian tumors in children: 22 years of experience at a single institution. J Pediatr Hematol Oncol 2000; 22 (05) 422-427
    CrossrefPubMedSearch in Google Scholar
  • 24 Feltbower RG, Siller C, Woodward E. et al. Treatment and survival patterns for germ cell tumors among 13- to 24-year olds in Yorkshire, UK. Pediatr Blood Cancer 2011; 56 (02) 282-288
    CrossrefPubMedSearch in Google Scholar
  • 25 Mann JR, Raafat F, Robinson K. et al. The United Kingdom Children's Cancer Study Group's second germ cell tumor study: carboplatin, etoposide, and bleomycin are effective treatment for children with malignant extracranial germ cell tumors, with acceptable toxicity. J Clin Oncol 2000; 18 (22) 3809-3818
    CrossrefPubMedSearch in Google Scholar
  • 26 Kaatsch P, Häfner C, Calaminus G, Blettner M, Tulla M. Pediatric germ cell tumors from 1987 to 2011: incidence rates, time trends, and survival. Pediatrics 2015; 135 (01) e136-e143
    CrossrefPubMedSearch in Google Scholar
  • 27 Bhuta R, Shah R, Gell JJ. et al. Children's Oncology Group's 2023 blueprint for research: Germ cell tumors. Pediatr Blood Cancer 2023; 70 (suppl 6, suppl 6): e30562
    CrossrefPubMedSearch in Google Scholar
  • 28 Mason JB, Srivastava A, Lanzotti NJ. et al. Variations in germ cell tumor histology by age and implications for cancer-specific survival among pediatric and adult males: a population-based study. Urol Oncol 2024; 42 (09) 292.e17-292.e26
    CrossrefPubMedSearch in Google Scholar