title: Ovarian small cell carcinoma of the hypercalcemic type in children and adolescents: a prognostically unfavorable but curable disease.
abstract: BACKGROUND
  Ovarian small cell carcinoma of the hypercalcemic type is a rare neoplasm that is associated with a poor prognosis. The objective of the current study was to investigate the clinicopathologic features of this tumor and to develop preliminary diagnostic and therapeutic guidelines.
  
  
  METHODS
  Between 1994 and 2005, 11 girls (ages 9-22 years) who were registered on the German Maligne Keimzelltumoren studies and the Kiel Pediatric Tumor Registry were analyzed. Prior to histopathologic review, 8 patients had been misdiagnosed with either germ cell tumor or juvenile granulosa cell tumor.
  
  
  RESULTS
  According to the International Federation of Gynecologic Oncology, 4 patients had Stage IA disease, 3 patients had Stage IC disease, and 4 patients had Stage III disease. After resection, 4 patients were followed without additional therapy, and all 4 patients developed recurrent disease after 3 to 11 months. Seven patients received adjuvant chemotherapy during first-line treatment. One patient with Stage III disease received additional regional deep hyperthermia. During first-line treatment, high-dose chemotherapy was received by 4 patients who achieved a complete response (CR) after conventional chemotherapy. All 4 of those patients remained in CR for 7 to 73 months, whereas the other 3 patients developed recurrent disease. Salvage treatment after recurrence or tumor progression consisted of surgery and chemotherapy. One patient received high-dose chemotherapy in 2nd CR and remained in 2nd CR. In total, 5 patients remained alive with no evidence of disease.
  
  
  CONCLUSIONS
  Patients with ovarian small cell carcinoma of the hypercalcemic type require multiagent chemotherapy during first-line treatment. High-dose chemotherapy may be used to consolidate the therapeutic success.
authors.affiliation: Clinic of Pediatric Oncology, Hematology, and Immunology, Heinrich-Heine University, Duesseldorf, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Distelmaier
authors.forename: Gabriele
authors.initials: G
authors.lastname: Calaminus
authors.forename: Dieter
authors.initials: D
authors.lastname: Harms
authors.forename: Ronald
authors.initials: R
authors.lastname: Sträter
authors.forename: Uwe
authors.initials: U
authors.lastname: Kordes
authors.forename: Gudrun
authors.initials: G
authors.lastname: Fleischhack
authors.forename: Ulrich
authors.initials: U
authors.lastname: Göbel
authors.forename: Dominik T
authors.initials: DT
authors.lastname: Schneider
mesh_terms: D000293:Adolescent; D000328:Adult; D018288:Carcinoma, Small Cell / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D002648:Child; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome