Subscribe to RSS
DOI: 10.1055/a-1112-0506
Management Unterbauchraumforderungen in der Schwangerschaft – Fallbeschreibung eines extraovariell-intraabdominalen Dysgerminoms mit Überblick über die Literatur
Management of intra-abdominal dysgerminoma During pregnancy – A Case Report and Literature Review
Zusammenfassung
Einleitung Dysgerminome sind seltene maligne Keimzelltumoren des Ovars und in der Schwangerschaft eine Rarität. Neben ovariellen sind außerhalb der Schwangerschaft auch primär extraovarielle Dysgerminome des Mediastinums und Retroperitoneums beschrieben. Nach adäquater chirurgischer und systemischer Therapie besteht eine gute Prognose.
Methodik Bericht eines primär extraovariell-intraabdominalen Dysgerminoms in der Schwangerschaft, systematische Literaturrecherche.
Fallbericht Bei einer 35-jährigen II Gravida wird in der 20. Schwangerschaftswoche ein suspekter intraabdominaler Tumor festgestellt. Bei der folgenden Explorativlaparotomie wird bei unauffälligen Ovarien ein Tumorkonglomerat mit Darminfiltration reseziert und ein Dysgerminom diagnostiziert. In der 34. SSW wird eine primäre Sectio Caesarea durchgeführt, erneuter Tumorbefall komplett reseziert und folgend systemisch Bleomycin, Etoposid und Cisplatin appliziert. Nach 12 Monaten erfolgt bei zystischen Adnexen eine erneute Exploration mit Hysterektomie und Adnexektomie beidseits ohne Nachweis von Malignität. Nach nun 16 Monaten besteht weiter eine Komplettremission.
Zusammenfassung Präsentiert wird die Erstbeschreibung eines primär extraovariell-intraabdominalen Dysgerminoms in der Schwangerschaft. Durch die Entscheidung, die zytoreduktive Operation während und die Systemtherapie erst nach Prolongation der Schwangerschaft durchzuführen, konnte größtmöglicher Benefit für das Kind mit der günstigen Prognose der Mutter vereint werden. Angesichts limitierter Datenlage müssen bei Dysgerminomen in der Schwangerschaft individuelle, interdisziplinäre Konzepte erstellt werden.
Abstract
Introduction Dysgerminomas are rare malignant germ cell tumors. They usually arise from the ovary, but case reports describing extraovarian dysgerminomas do exist. When treated adequately the disease has a good prognosis. Dysgerminomas diagnosed during pregnancy are very rare.
Methodology Report of extraovarian intra-abdominal dysgerminoma during pregnancy. Systematic literature review.
Case report A 35-year-old second gravida was diagnosed with a suspected intra-abdominal mass at 20 gestational weeks. During an exploratory laparotomy, a tumor infiltrating the transverse colon and histologically identified as a dysgerminoma was resected. Ovaries were clinically unremarkable. The induction of chemotherapy was postponed until after delivery. At 34 gestational weeks the patient underwent cesarean section and tumor debulking. Four cycles of bleomycin, etoposide and cisplatin were administered. After 12 months, cystic ovaries were found. Hysterectomy with bilateral adnexectomy was performed but no malignancy found. After 16 months, the patient was still in complete remission.
Conclusion We describe the first-ever published dysgerminoma in gravida primarily evolving intraabdominally and not affecting the ovaries. The decision for cytoreductive surgery, prolongation of pregnancy and postponing chemotherapy until after delivery combined the best benefit for the baby with a good maternal prognosis. Due to limited data regarding dysgerminomas in pregnancy, individual interdisciplinary concepts are mandatory.
Publication History
Received: 09 November 2019
Accepted: 26 January 2020
Article published online:
02 April 2020
© 2020. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
Literatur
- 1 Van Calsteren K. Chemotherapy during pregnancy: pharmacokinetics and impact on foetal neurological development. Facts, views & vision in ObGyn 2010; 2: 278-286
- 2 Cardonick EH, Gringlas MB, Hunter K. et al. Development of children born to mothers with cancer during pregnancy: comparing in utero chemotherapy-exposed children with nonexposed controls. American journal of obstetrics and gynecology 2015; 212: 658.e651-658 DOI: 10.1016/j.ajog.2014.11.032.
- 3 Bundesamt S. Durchschnittliches Alter der Mutter bei der Geburt des Kindes 2017. https://www.destatis.de/DE/ZahlenFakten/GesellschaftStaat/Bevoelkerung/Geburten/Tabellen/GeburtenMutterBiologischesAlter.html;jsessionid=55FEE50C682AE6F72163A49B2403E511.InternetLive2 Zugriff am 06.01.2019
- 4 Runowicz C, Brewer M. Chemotherapy of ovarian cancer in pregnancy. www.uptodate.com Zugriff am 22.01.2019
- 5 Gershenson D. Ovarian germ cell tumors: Pathology, clinical manifestations and diagnosis. www.uptodate.com Zugriff am 19.12.2018
- 6 Shaaban AM, Rezvani M, Elsayes KM. et al. Ovarian malignant germ cell tumors: cellular classification and clinical and imaging features. Radiographics: a review publication of the Radiological Society of North America, Inc 2014; 34: 777-801 DOI: 10.1148/rg.343130067.
- 7 Husaini HAL, Soudy H, Din Darwish AEl. et al. Pure dysgerminoma of the ovary: a single institutional experience of 65 patients. Medical oncology (Northwood, London, England) 2012; 29: 2944-2948 DOI: 10.1007/s12032-012-0194-z.
- 8 Zogbi L, Goncalves CV, Tejada VF. et al. Treatment of bilateral ovarian dysgerminoma with 11-year follow-up: A case report. Annals of medicine and surgery (2012) 2018; 33: 50-52 DOI: 10.1016/j.amsu.2018.08.009.
- 9 Manikandan K, Veena P, Elamurugan S. et al. Mediastinal dysgerminoma complicating pregnancy. Obstetric medicine 2012; 5: 135-137 DOI: 10.1258/om.2011.110066.
- 10 Chen Y, Luo Y, Han C. et al. Ovarian dysgerminoma in pregnancy: A case report and literature review. Cancer biology & therapy 2018; 19: 649-658 DOI: 10.1080/15384047.2018.1450118.
- 11 Kantoff P. Extragonadal germ cell tumors involving the mediastinum and retroperitoneum. www.uptodate.com Zugriff am 19.12.2018
- 12 Yoo SH, Kim KR, Hong SJ. et al. Primary retroperitoneal dysgerminoma presenting as an adrenal tumor: a case report and literature review. Pathology international 2011; 61: 248-251 DOI: 10.1111/j.1440-1827.2010.02640.x.
- 13 Rath W, Gembruch U, Schmidt S. Geburtshilfe und Perinatalmedizin: Pränataldiagnostik, Erkrankungen, Entbindung. 2. Aufl. Thieme; 2010
- 14 Amant F, Brepoels L, Halaska MJ. et al. Gynaecologic cancer complicating pregnancy: an overview. Best practice & research Clinical obstetrics & gynaecology 2010; 24: 61-79 DOI: 10.1016/j.bpobgyn.2009.08.001.
- 15 Ray JG, Vermeulen MJ, Bharatha A. et al. Association Between MRI Exposure During Pregnancy and Fetal and Childhood Outcomes. Jama 2016; 316: 952-961 DOI: 10.1001/jama.2016.12126.
- 16 Runowicz C, Brewer M. Adnexal mass in pregnacny. www.uptodate.com Zugriff am 28.3.2019
- 17 Ercan S, Kaymaz O, Yucel N. et al. Serum concentrations of CA 125, CA 15-3, CA 19-9 and CEA in normal pregnancy: a longitudinal study. Archives of gynecology and obstetrics 2012; 285: 579-584 DOI: 10.1007/s00404-011-2025-4.
- 18 Han SN, Lotgerink A, Gziri MM. et al. Physiologic variations of serum tumor markers in gynecological malignancies during pregnancy: a systematic review. BMC medicine 2012; 10: 86 DOI: 10.1186/1741-7015-10-86.
- 19 Kodama M, Grubbs BH, Blake EA. et al. Feto-maternal outcomes of pregnancy complicated by ovarian malignant germ cell tumor: a systematic review of literature. European journal of obstetrics, gynecology, and reproductive biology 2014; 181: 145-156 DOI: 10.1016/j.ejogrb.2014.07.047.
- 20 Wallwiener D, Grischke EM, Brucker SY. et al. Gynäkologische. Onkologie: Schattauer GmbH. 2017
- 21 [Anonym] Committee Opinion No. 696: Nonobstetric Surgery During Pregnancy. Obstetrics and gynecology 2017; 129: 777-778 DOI: 10.1097/aog.0000000000002014.
- 22 Norwitz E, Shin Park J, Snegovskikh D. Management oft the pregnant patient undergoing nonobstetric surgery. www.uptodate.com Zugriff am 31.3.2019
- 23 Cardonick E, Usmani A, Ghaffar S. Perinatal outcomes of a pregnancy complicated by cancer, including neonatal follow-up after in utero exposure to chemotherapy: results of an international registry. American journal of clinical oncology 2010; 33: 221-228 doi:10.1097/COC.0b013e3181a44ca9
- 24 Gershenson D. Treatment of malignant germ cell tumor of the ovary. www.uptodate.com Zugriff am 19.12.2018
- 25 Shah R, Xia C, Krailo M. et al. Is carboplatin-based chemotherapy as effective as cisplatin-based chemotherapy in the treatment of advanced-stage dysgerminoma in children, adolescents and young adults?. Gynecologic oncology 2018; 150: 253-260 DOI: 10.1016/j.ygyno.2018.05.025.
- 26 Kumar S, Shah JP, Bryant CS. et al. The prevalence and prognostic impact of lymph node metastasis in malignant germ cell tumors of the ovary. Gynecologic oncology 2008; 110: 125-132 DOI: 10.1016/j.ygyno.2008.04.022.
- 27 Krebsgesellschaft D, Krebshilfe D, AWMF S3-Leitlinie Diagnostik, Therapie und Nachsorge maligner Ovarialtumoren, Langversion 2.0 2016 AWMF-Registernummer: 032/035OL. http://leitlinienprogramm-onkologie.de/Ovarialkarzinom.61.0.html Zugriff am 18.02.2019.
- 28 Li J, Wu X. Current Strategy for the Treatment of Ovarian Germ Cell Tumors: Role of Extensive Surgery. Current treatment options in oncology 2016; 17: 44 doi:10.1007/s11864-016-0416-2
- 29 Cheng L, Thomas A, Roth LM. et al. OCT4: a novel biomarker for dysgerminoma of the ovary. The American journal of surgical pathology 2004; 28: 1341-1346 DOI: 10.1097/01.pas.0000135528.03942.1f.
- 30 Reichardt P. DGHO Leitlinie Gastrointestinale Stromatumore (GIST). In. https://www.onkopedia.com/de/onkopedia/guidelines/gastrointestinale-stromatumore-gist/@@view/pdf/20180918-051944.pdf Zugriff am 19.12.2018