Consensus and controversy in the management of paediatric and adult patients with ovarian immature teratoma: the Malignant Germ Cell International Consortium perspective

Farzana Pashankar; Matthew J Murray; Joanna Gell; Nicola MacDonald; Jonathan Shamash; Deborah F Billmire; Lindsay Klosterkemper; Thomas Olson; Michelle S Hirsch; Michelle Lockley; Sara Stoneham; A Lindsay Frazier

doi:10.1016/j.eclinm.2024.102453

Consensus and controversy in the management of paediatric and adult patients with ovarian immature teratoma: the Malignant Germ Cell International Consortium perspective

EClinicalMedicine. 2024 Feb 6:69:102453. doi: 10.1016/j.eclinm.2024.102453. eCollection 2024 Mar.

Authors

Farzana Pashankar¹, Matthew J Murray^{2

3}, Joanna Gell^{4

5

6}, Nicola MacDonald⁷, Jonathan Shamash⁸, Deborah F Billmire⁹, Lindsay Klosterkemper^{10

11}, Thomas Olson¹², Michelle S Hirsch¹³, Michelle Lockley^{14

15}, Sara Stoneham¹⁶, A Lindsay Frazier^{10

11}

Affiliations

¹ Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA.
² Department of Pathology, Tennis Court Road, University of Cambridge, CB2 1QP, UK.
³ Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK.
⁴ The Center for Cancer and Blood Disorders, Connecticut Children's Medical Center, Hartford, CT, USA.
⁵ Department of Pediatrics, University of Connecticut Medical School, Farmington, CT, USA.
⁶ The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA.
⁷ Department of Gynaecological Surgery, University College Hospital, University College London Hospital, NHS Foundation Trust, London, UK.
⁸ Department of Medical Oncology, St Bartholomew's Hospital, London, W Smithfield, London, EC1A 7BE, UK.
⁹ Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
¹⁰ Harvard Medical School, Boston, MA, USA.
¹¹ Dana Farber/Boston Children's Cancer and Blood Center, Boston, MA, USA.
¹² Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Atlanta, GA, USA.
¹³ Department of Pathology, Women's and Perinatal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
¹⁴ Department of Medical Oncology, University College Hospital, University College London Hospital, NHS Foundation Trust, London, UK.
¹⁵ Centre for Cancer Genomics and Computational Biology, Barts Cancer Institute, Queen Mary University of London, London, UK.
¹⁶ Department of Paediatrics, University College Hospital, University College London Hospital, NHS Foundation Trust, London, UK.

Abstract

Ovarian immature teratoma (IT) is a rare neoplasm comprising ∼3% of ovarian cancers, occurring primarily in young females. Management presents several challenges, including those with elevated serum alpha-fetoprotein, potential confusion regarding pathology interpretation, and paucity of data to support decision-making. MaGIC (https://magicconsortium.com/) is an interdisciplinary international consortium of GCT experts from multiple subspecialties, with members receiving frequent queries regarding IT patient management. With evidence from published literature where available, we summarise consensus management of such patients. Given lack of published data, controversy in certain areas remains. The most obvious variance in practice is between paediatric and adult teams, despite very similar outcomes. Paediatric teams typically employ a surgery-only approach, whereas in adult practice, all patients, except those with stage IA, grade 1 (low-grade) tumours, still generally receive adjuvant chemotherapy. Given the rarity of ovarian IT and lack of published data, discussion with GCT experts and/or national advisory panels is recommended.

Keywords: Grade; Immature teratoma; Ovarian; Stage.

Publication types

Review