Gonadal germ cell tumors in children

Abstract

Background:The true incidence of gonadal germ cell tumors (GCTs) in children is unknown. Few studies have been published concerning about pediatric gonadal GCTs. The aim of this study is to review and analyze clinical data on the diagnosis and management of gonadal GCTs in children.Methods:Between 2005 and 2015, 127 pediatric patients (<14 years old) with gonadal GCTs admitted to our institute were reviewed. Clinical features, imaging and laboratory studies, surgical approaches, as well as pathological diagnoses were recorded.Results:The series comprised 53 males with testicular GCTs and 74 females with ovarian GCTs. Their median age was 5.8 years old. Palpable mass was the main clinical manifestation of testicular GCTs, while abdominal pain and abdominal distention were the most frequent presenting symptoms of ovarian GCTs. Both computed tomography and magnetic resonance imaging showed a high diagnostic yield. AFP levels were elevated in most malignant GCTs, markedly elevated in yolk sac tumors. All patients were treated surgically. Mature teratoma was the most common type of benign GCTs, while yolk sac tumor was the most common type of malignant GCTs.Conclusion:Gonadal GCTs in children have various of pathological types, as well as clinical manifestations. Imaging and laboratory data could be useful for differentiation of malignant from benign tumors. Final diagnosis depends on pathology. Surgical excision of the gonadal GCTs is the prior option.

Germ Cell Tumors in Dysgenetic Gonads

“…The true incidence of gonadal GCTs in children is unknown, and few studies have been published on the incidence of this tumor in pediatric populations. When the correct diagnosis and proper treatment occur during the early stage, most gonadal tumors are curable (30).…”

“…This neoplasm may manifest in childhood when it has a soft consistency and is more sensitive to chemotherapy. During adulthood, tumors have a mixed appearance and a less favorable chemotherapeutic response (30). These tumors can be found either on dysgenetic gonads or on other body parts, such as the testes, vagina, ovaries, urachus, retroperitoneum, or mediastinum.…”

“…Nasioudis et al analyzed 561 women with this neoplasia and determined that the median age was 23 years and that the majority of tumors, namely, 58.5%, were stage I or stage II disease, while 29.6% and 11% of tumors were stage III and stage IV disease, respectively. These patients were treated by hysterectomy, lymphadenectomy and omentectomy, and those who received chemotherapy achieved an increased survival rate compared with the group that did not receive chemotherapy (30).…”

Pediatric and Adolescent Gynecology: Treatment Perspectives in Minimally Invasive Surgery

“…Malignant ovarian tumors in the pediatric age are rare, accounting for only 1.1% of all malignancies in female patients less than 15 years of age. 25,32,33 Oltman et al ., 34 reported the best predictive preoperative indicators of an ovarian malignancy: complaint of a mass or precocious puberty, mass exceeding 8 cm or a mass with solid imaging characteristics. Patients aged 1 to 8 years have the greatest incidence of malignancy.…”

“…15,17,37,39 Tumor markers, including cancer antigen- 125, α-fetoprotein, lactate dehydrogenase, human chorionic gonadotropin, inhibin, Mullerian inhibiting substance, and carcinoembryonic antigen, can be obtained preoperatively if there is a suspicion of malignancy. 19,27,32,37…”