Pure Immature Teratoma of the Ovary in Adults: Thirty-Year Experience of a Single Tertiary Care Center.
OBJECTIVE
The aim of this study was to evaluate clinicopathologic characteristics, treatment outcome, and reproductive function in women diagnosed with ovarian immature teratoma (IT). Our standard chemotherapy regime is currently etoposide/cisplatin (EP), creating a unique opportunity to evaluate this protocol in ovarian ITs.


METHODS
This study is a retrospective analysis. Twenty-seven women older than 18 years with ovarian IT stages IA to IIIC were identified and included in this study. Patients were treated at 1 institution, Health Sciences Center, Women's Hospital, Winnipeg, Manitoba, Canada, between 1983 and 2013.


RESULTS
The median age at diagnosis was 27.0 years (range, 18-36 years). Twenty-two (82%) presented with an International Federation of Gynecology and Obstetrics stage I disease, 3 (11%) had stage II, and 2 patients (7%) had stage III disease. The histologic grade distribution was grade I in 9 patients (33%), grade II in 3 patients (11%), and grade III in 15 patients (56%). Initial management was surgical for all patients: 3 (11%) hysterectomy and bilateral salpingo-oophorectomy, 1 (4%) cystectomy only, and 23 (85%) unilateral salpingo-oophorectomy. Twenty-one patients (78%) received adjuvant therapy. The median follow-up was 60 months (range, 36-72 months). One patient recurred (histological grade III) 6 months after surgery and had a complete clinical response to 4 cycles of EP chemotherapy. Twelve patients reported an attempt to conceive resulting in 10 pregnancies (8 after chemotherapy).


CONCLUSIONS
Ovarian IT is a curable disease. Fertility-sparing surgery should be offered. Adjuvant treatment with cisplatinum-based chemotherapy, typically with bleomycin, etoposide, and cisplatin, is still considered the standard in stages greater than stage IA grade I. Etoposide/cisplatin as a primary chemotherapy regime for early- or advanced-stage disease is an effective treatment with minimal adverse effects and high tolerability. This is the first published study examining EP as a primary treatment modality for IT. Further studies are needed to strengthen these findings.
*Division of Gynecologic Oncology, Department of Obstetrics and Gynecology and Reproductive Sciences, Winnipeg Health Sciences Centre and CancerCare Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada; and †Division of Gynecology Oncology, Department of Obstetrics and Gynecology, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia.
Ahmad Bakr
AB
Alwazzan
Shaundra
S
Popowich
Erin
E
Dean
Christine
C
Robinson
Robert
R
Lotocki
Alon D
AD
Altman
D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D003520:Cyclophosphamide / Q000008:administration & dosage; D003609:Dactinomycin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D059247:Fertility Preservation; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D059351:Organ Sparing Treatments; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery; D010052:Ovariectomy; D011247:Pregnancy; D018873:Pregnancy Rate; D012189:Retrospective Studies; D058994:Salpingectomy; D015996:Survival Rate; D013724:Teratoma / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery; D014750:Vincristine / Q000008:administration & dosage; D055815:Young Adult
D003609:Dactinomycin; D014750:Vincristine; D005047:Etoposide; D003520:Cyclophosphamide; D002945:Cisplatin