Imaging Appearance of Nongerminoma Pediatric Ovarian Germ Cell Tumors Does Not Discriminate Benign from Malignant Histology

Self Cite

Extracranial germ cell tumors (GCT) are a biologically diverse group of tumors occurring in children, adolescents, and young adults. The majority of patients have excellent outcomes, but treatment‐related toxicities impact their quality of survivorship. A subset of patients succumbs to the disease. Current unmet needs include clarifying which patients can be safely observed after initial surgical resection, refinement of risk stratification to reduce chemotherapy burden in patients with standard‐risk disease, and intensify therapy for patients with poor‐risk disease. Furthermore, enhancing strategies for detection of minimal residual disease and early detection of relapse, particularly in serum tumor marker‐negative histologies, is critical. Improving the understanding of the developmental and molecular origins of GCTs may facilitate discovery of novel targets. Future efforts should be directed toward assessing novel therapies in a biology‐driven, biomarker‐defined, histology‐specific, risk‐stratified patient population. Fragmentation of care between subspecialists restricts the unified study of these rare tumors. It is imperative that trials be conducted in collaboration with national and international cooperative groups, with harmonized data and biospecimen collection. Key priorities for the Children's Oncology Group (COG) GCT Committee include (a) better understanding the biology of GCTs, with a focus on molecular targets and mechanisms of treatment resistance; (b) strategic development of pediatric and young adult clinical trials; (c) understanding late effects of therapy and identifying individuals most at risk; and (d) prioritizing diversity, equity, and inclusion to reduce cancer health disparities and studying the impacts of social determinants of health on outcomes.

Section: Strategic Approach To Therapymentioning

confidence: 99%

Section: Surgical Guidelinesmentioning

confidence: 99%

Children's Oncology Group's 2023 blueprint for research: Germ cell tumors

Bhuta

Shah

Gell

et al. 2023

Self Cite

“…Neither preoperative imaging features nor frozen section analysis accurately discriminate between benign and malignant pathologies in ovarian GCTs, and comprehensive surgical staging remains essential for risk stratification. 20,21 Collaboration with the Malignant Germ Cell International Consortium (MaGIC) to standardize the care of GCTs across age groups is an essential element of current research. Future investigations will better define the role of retroperitoneal lymph node dissection (RPLND) in testicular GCTs; evaluate the outcome of observation only, without adjuvant therapy, after surgical resection of low-risk GCTs; and study the epidemiology and treatment of growing teratoma syndrome.…”

Section: Germ Cell and Rare Tumorsmentioning

confidence: 99%

“…Surgical guidelines emphasize accurate intraoperative staging, complete resection without violation of the tumor capsule, and preservation of fertility. Neither preoperative imaging features nor frozen section analysis accurately discriminate between benign and malignant pathologies in ovarian GCTs, and comprehensive surgical staging remains essential for risk stratification 20,21 . Collaboration with the Malignant Germ Cell International Consortium (MaGIC) to standardize the care of GCTs across age groups is an essential element of current research.…”

Section: Areas Of Surgical Research For Solid Tumorsmentioning

confidence: 99%

Children's Oncology Group's 2023 blueprint for research: Surgery

Gow,

Lautz,

Malek

et al. 2023

Surgery plays a crucial role in the treatment of children with solid malignancies. A well‐conducted operation is often essential for cure. Collaboration with the primary care team is important for determining if and when surgery should be performed, and if performed, an operation must be done in accordance with well‐established standards. The long‐term consequences of surgery also need to be considered. Indications and objectives for a procedure vary. Providing education and developing and analyzing new research protocols that include aims relevant to surgery are key objectives of the Surgery Discipline of the Children's Oncology Group. The critical evaluation of emerging technologies to ensure safe, effective procedures is another key objective. Through research, education, and advancing technologies, the role of the pediatric surgeon in the multidisciplinary care of children with solid malignancies will continue to evolve.

“…reported that in a cohort of 30 females with ovarian lesions who underwent MRI, all lesions were accurately characterized as benign or malignant 39 . One notable limitation of MRI is that it cannot be relied on for differentiation of mature versus immature teratomas 40 . Indeed, a teratoma may potentially harbor more aggressive elements such as yolk sac tumor without any imaging manifestations, and reliance on tumor markers and complete surgical staging is needed in many cases 41 .…”

Section: Imaging At Diagnosismentioning

confidence: 99%

Imaging of pediatric ovarian tumors: A COG Diagnostic Imaging Committee/SPR Oncology Committee White Paper

Behr

Morani

Artunduaga

et al. 2022

Ovarian tumors in children are uncommon. Like those arising in the adult population, they may be broadly divided into germ cell, sex cord, and surface epithelium subtypes; however, germ cell tumors comprise the majority of lesions in children, whereas tumors of surface epithelial origin predominate in adults. Diagnostic workup, including the use of imaging, requires an approach that often differs from that required in an adult. This paper offers consensus recommendations for imaging of pediatric patients with a known or suspected primary ovarian malignancy at diagnosis and during follow‐up.