Sigismondi Cristina, Scollo Paolo, Ferrandina Gabriella, Candiani Massimo, Angioli Roberto, Viganò Riccardo, Scarfone Giovanna, Mangili Giorgia
*Department of Gynecology, IRCCS Ospedale San Raffaele, Milan; †Department of Obstetrics and Gynecology, Cannizzaro Hospital, Catania; ‡Department of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome; §Department of Gynecology, University Campus Bio-Medico of Rome, Rome; and ∥Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico Mangiagalli Regina Elena Hospital, Milan, Italy.
Int J Gynecol Cancer. 2015 Feb;25(2):203-7. doi: 10.1097/IGC.0000000000000358.
Bilaterality is rare in malignant ovarian germ cell tumors (MOGTs). The bilateral ovarian involvement represents a critical issue when diagnosed in young women desiring to preserve fertility. The aim of this study was to evaluate clinical characteristic and management of patients bilateral MOGTs.
Patients affected by bilateral MOGT and treated at MITO group centers were reviewed.
In 145 patients with MOGTs, 5.5% were bilateral. Three patients were affected by dysgerminoma (associated with bilateral gonadoblastoma in 1), 2 by immature teratoma, 2 by mixed germ cell tumors, and 1 by embryonal carcinoma. International Federation of Gynecology and Obstetrics stage was 3 IB, 1 IC, 3 IIIC, and 1 IV. Three patients received radical surgery, and the patient with dysgerminoma associated with gonadoblastoma received bilateral adnexectomy. Four patients received fertility-sparing surgery; 2 patients received unilateral salpingo-oophorectomy and contralateral cystectomy; in 2 patients, the ovaries were completely transformed in neoplastic tissue; suspecting a contralateral dysgerminoma histology, a unilateral salpingo-oophorectomy and contralateral biopsy were performed, and the contralateral neoplastic ovary was left unresected. Six patients received adjuvant chemotherapy. Seven patients are disease free after a median follow-up of 54 months. The patient affected by embryonal carcinoma died of disease. Two patients resumed menstruation, and one had a pregnancy. A compromised ovarian function was found in 2 patients, and they were addressed to oocyte cryopreservation.
Bilateral MOGTs have a good prognosis. In dysgerminoma histology, residual disease could be left to spare fertility. An oncological and reproductive function follow-up is recommended.
双侧性在恶性卵巢生殖细胞肿瘤（MOGTs）中较为罕见。当在渴望保留生育能力的年轻女性中诊断出双侧卵巢受累时，这是一个关键问题。本研究的目的是评估双侧MOGTs患者的临床特征及治疗方法。
对在MITO组中心接受治疗的双侧MOGTs患者进行回顾性分析。
在145例MOGTs患者中，5.5%为双侧性。3例为无性细胞瘤（其中1例伴有双侧性腺母细胞瘤），2例为未成熟畸胎瘤，2例为混合性生殖细胞肿瘤，1例为胚胎性癌。国际妇产科联盟（FIGO）分期为3例IB期、1例IC期、3例IIIC期和1例IV期。3例患者接受了根治性手术，伴有性腺母细胞瘤的无性细胞瘤患者接受了双侧附件切除术。4例患者接受了保留生育功能的手术；2例患者接受了单侧输卵管卵巢切除术和对侧囊肿切除术；2例患者的卵巢完全被肿瘤组织取代；怀疑对侧为无性细胞瘤组织学，进行了单侧输卵管卵巢切除术和对侧活检，对侧肿瘤性卵巢未切除。6例患者接受了辅助化疗。中位随访54个月后，7例患者无疾病复发。胚胎性癌患者死于疾病。2例患者恢复月经，1例患者怀孕。2例患者出现卵巢功能受损，对其进行了卵母细胞冷冻保存。
双侧MOGTs预后良好。对于无性细胞瘤组织学类型，可保留残留病灶以保留生育功能。建议进行肿瘤学和生殖功能随访
