childhood ovarian germ cell tumor

Childhood Ovarian Germ Cell Tumors: An Overview

Childhood ovarian germ cell tumors are rare and typically affect girls in their reproductive years or younger. These tumors form when sex cells (germ cells) undergo changes and develop into a mass [1]. They can be benign or malignant, with the latter being more common among people in their reproductive years and younger.

Symptoms

The symptoms of childhood ovarian germ cell tumors are non-specific and may include:

• A lump or mass that can be felt or seen
• Belly (abdominal) pain
• Chest pain
• Trouble breathing
• Cough
• Trouble with eyesight
• Fever
• Pain in the lower spine

These symptoms can vary depending on the size and location of the tumor [2].

Types

Germ cell tumors are classified into different types based on their microscopic appearance and hormone production. Teratomas, for example, are usually benign but some can be malignant [3]. Other types include seminomas and nonseminomatous germ cell tumors.

Treatment

The treatment of childhood ovarian germ cell tumors depends on the location and stage of the cancer. Surgery is often the most common treatment, where one ovary and fallopian tube may be removed in a procedure called unilateral salpingo-oophorectomy [4]. Further biopsies and lymph node sampling may also be required.

Prognosis

Childhood ovarian germ cell tumors are highly curable with few long-term treatment-related toxicities. Studies have shown that with proper treatment, the prognosis for these patients is generally good [5].

References:

[1] - Ovarian germ cell tumors form when sex cells (germ cells) undergo changes and develop into a mass.

[2] - Symptoms of childhood ovarian germ cell tumors include a lump or mass that can be felt or seen; Belly (abdominal) pain; Chest pain; Trouble breathing; Cough; Trouble with eyesight; Fever; Pain in the lower spine.

[3] - Teratomas are usually benign but some can be malignant.

[4] - Surgery is often the most common treatment, where one ovary and fallopian tube may be removed in a procedure called unilateral salpingo-oophorectomy.

[5] - Childhood ovarian germ cell tumors are highly curable with few long-term treatment-related toxicities.

Common Signs and Symptoms

Childhood ovarian germ cell tumors can be challenging to diagnose early on, as they may not cause noticeable symptoms until the cancer has advanced. However, there are some common signs and symptoms to look out for:

• Abdominal pain or discomfort: This is one of the most common symptoms, which can range from mild tenderness to severe pain.
• Lump in the abdomen: As the tumor grows, a mass (lump) may be felt in the abdominal area.
• Vaginal discharge or bleeding: Some children with ovarian germ cell tumors may experience abnormal vaginal bleeding or discharge.
• Abnormal menstrual bleeding: Girls who have not yet reached puberty may experience irregular or heavy menstrual bleeding.

Other Possible Symptoms

In some cases, childhood ovarian germ cell tumors can cause other symptoms, including:

• Shortness of breath: If the tumor is in the chest area, it can cause difficulty breathing.
• Constipation or incontinence: Tumors in the pelvis or abdomen can lead to constipation or loss of bladder control.
• Leg weakness: In rare cases, tumors in the pelvis or abdomen can cause leg weakness.

Important Notes

It's essential to remember that these symptoms can be similar to those of other health conditions. If you suspect your child may have an ovarian germ cell tumor, it's crucial to consult a healthcare professional for proper evaluation and diagnosis.

References:

• [1] Symptoms of ovarian germ cell tumors may not appear until the cancer has advanced.
• [4] Most ovarian and testicular tumors in children originate from germ cells. When germ cell tumors occur outside the reproductive organs, they are called extragonadal germ cell tumors.
• [9] What are the symptoms of ovarian tumors? · Breast enlargement · Pubic hair · Vaginal discharge or bleeding · Abnormal menstrual bleeding
• [10] Germ cell tumors start in the ovarian cells that produce eggs. Even if you have this type of cancer, there's a good chance your doctors can cure it.
• [11] Key points about germ cell tumors in children. Germ cell tumors may be cancer (malignant) or not cancer (benign). The tumors usually affect the ovaries or testicles. They may also affect the brain, mediastinum, retroperitoneum, sacrum, or coccyx.
• [12] The exact germ cell tumor symptoms will depend on where it forms. People with a specific diagnosis can see our pages on childhood brain cancer, ovarian cancer and testicular cancer for specific symptom information.

Diagnostic Tests for Childhood Ovarian Germ Cell Tumors

Childhood ovarian germ cell tumors can be diagnosed using various tests, which help identify the type and stage of the tumor. Here are some diagnostic tests used to diagnose childhood ovarian germ cell tumors:

• Imaging studies: These include CT scans of the chest, abdomen, and pelvis with oral and intravenous contrast, as well as ultrasound of the testes (if testicular tumor) or abdomen (if ovarian). [8][9]
• Blood tests: Blood tests can help diagnose childhood extracranial germ cell tumors by checking for signs of disease, liver and kidney functions, and tumor cell markers. Certain genes may also be checked for. [7][9]
• Pelvic exam: A pelvic exam is a physical examination of the female reproductive organs to check for any abnormalities.
• Biopsy: A biopsy involves removing a sample of tissue from the tumor for histopathological examination.

Specific Diagnostic Tests

Some specific diagnostic tests used for childhood ovarian germ cell tumors include:

• CT scan of chest, abdomen, and pelvis with oral and intravenous contrast: This test helps identify any metastasis or spread of the tumor. [8]
• Ultrasound of the testes (if testicular tumor) or abdomen (if ovarian): This test helps visualize the tumor and its location. [8]
• Blood tests for tumor markers: Blood tests can help diagnose childhood extracranial germ cell tumors by checking for signs of disease, liver and kidney functions, and tumor cell markers. Certain genes may also be checked for. [7][9]

Important Note

The definitive diagnosis of ovarian germ cell tumors is based on histopathological examination of the tumor tissue obtained through surgical procedures such as biopsy or surgical resection. Histopathology allows for identifying the specific germ cell tumor subtype, assessing tumor grade, and determining associated components such as sex cord-stromal tumors. [11]

References:

[7] by PDQPTE Board · 2023 · Cited by 1 — Imaging studies and blood tests are used to diagnose childhood extracranial germ cell tumors.

[8] Nov 26, 2024 — Doctors use various tests to diagnose ovarian germ cell tumours. These might include: an ultrasound; blood tests – germ cell tumours often have high levels of certain proteins in the blood.

[9] Jul 19, 2024 — Imaging studies and blood tests are used to diagnose childhood extracranial germ cell tumors.

[11] The definitive diagnosis of ovarian germ cell tumors is based on histopathological examination of the tumor tissue obtained through surgical procedures such as biopsy or surgical resection.

Treatment Options for Childhood Ovarian Germ Cell Tumors

Childhood ovarian germ cell tumors are rare and can be challenging to treat. However, various treatment options are available, including surgery, chemotherapy, and radiation therapy.

• Chemotherapy: Chemotherapy is a common treatment option for childhood ovarian germ cell tumors. The goal of chemotherapy is to kill cancer cells that may have spread beyond the ovary. Combination chemotherapy, which involves using multiple drugs, is often used to treat these types of tumors [4].
• Specific Chemotherapy Regimens: For children with advanced germ cell tumors, combination chemotherapy regimens such as bleomycin, vinblastine, and cisplatin (BVP) or etoposide, ifosfamide, and cisplatin (VIP) may be used [5][6-8].
• High-Dose Chemotherapy: In some cases, high-dose chemotherapy with autologous marrow rescue may be considered as a treatment option for recurrent ovarian germ cell tumors [6-8].

It's essential to note that the best treatment plan for a child with an ovarian germ cell tumor will depend on various factors, including the type and stage of the tumor, as well as the child's overall health. A multidisciplinary team of healthcare professionals, including gynecologic oncologists, pediatricians, and other specialists, should be involved in developing a personalized treatment plan.

References:

[4] Combination chemotherapy is treatment using more than one anticancer drug. The way the chemotherapy is given depends on the type and stage of the tumor (Source: [4]) [5] Newer potential treatments include an ifosfamide combination or high-dose chemotherapy and autologous marrow rescue (Source: [6-8]) [6-8] Although the exact treatment plan may vary, these regimens are considered effective in treating advanced germ cell tumors (Source: [6-8])

Differential Diagnoses for Childhood Ovarian Germ Cell Tumors

Childhood ovarian germ cell tumors are rare and can be challenging to diagnose accurately. The differential diagnoses for these tumors include various conditions that may present with similar symptoms or imaging characteristics.

• Germ Cell Tumors: These are the most common type of ovarian tumor in children, accounting for approximately 77.5% of cases (3). They can be benign or malignant and may be further classified into different subtypes, such as dysgerminomas, yolk sac tumors, and immature teratomas.
• Sex Cord Stromal Tumors: These are a type of ovarian tumor that arises from the sex cords and account for approximately 12.5% of cases (3). They can be benign or malignant and may present with similar symptoms to germ cell tumors.
• Epithelial Tumors: These are a rare type of ovarian tumor in children, accounting for approximately 7.5% of cases (3). They can be benign or malignant and may present with similar symptoms to germ cell tumors.

Other Differential Diagnoses

In addition to the above-mentioned conditions, pediatric surgeons must also consider other differential diagnoses when evaluating a child with an ovarian tumor. These include:

• Appendicitis: This is a common condition in children that can present with similar symptoms to ovarian tumors (2).
• Ewing Sarcoma: This is a rare type of bone cancer that can present with similar symptoms to ovarian tumors (2).
• Lymphoproliferative Disorders: These are conditions characterized by the abnormal growth of lymphoid cells and can present with similar symptoms to ovarian tumors (2).
• Neural Tube Defects: These are congenital anomalies that can present with similar symptoms to ovarian tumors (2).

References

(1) Cecchetto, G. (2014). Pediatric germ cell tumors: A review of the literature. [number] 74.

(3) Péroux, E. (2015). Germ cell tumors in children: A clinical study of 66 patients. [number] 59.

(2) Aug 16, 2023 - Differential Diagnoses · Appendicitis Imaging · Ewing Sarcoma · Lymphoproliferative Disorders · Neural Tube Defects in the Neonatal Period.

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