Ahmed abu zaid (final)

1. Incidence of Malignant Ovarian
Germ Cell Tumors (MOGCTs) in
Saudi Arabia
Ahmed Abu-Zaid, MBBS
Alfaisal University―College of Medicine
King Faisal Specialist Hospital & Research Centre
Riyadh, Saudi Arabia
Hematol Oncol Stem Cell Ther. 2014 Mar;7(1):41-3

2. INTRODUCTION
 Ovarian Germ Cell Tumors (OGCT)
– Originate from primitive ovarian germ cells
– Rapidly growing tumors
– Frequent in young women and adolescent girls
– Uncommon, 20-25% of all ovarian tumors
– Pathologically: benign or malignant
Gershenson DM. Cancer. 1993;71(4 Suppl):1581-90
Siegel R, et al. CA Cancer J Clin. 2013; 63:11–30

3. INTRODUCTION
 Malignant Ovarian Germ Cell Tumors (MOGCTs)
―Uncommon, 5% of all malignant ovarian tumors
―Histopathological classification
Gershenson DM. Cancer. 1993;71(4 Suppl):1581-90
Dysgerminoma Yolk Sac Tumor
Germinoma Malignant Teratoma
Polyembryoma Ovarian Choriocarcinoma
Embryonal Carcinoma Mixed Germ Cell Tumor
Siegel R, et al. CA Cancer J Clin. 2013; 63:11–30

4. OBJECTIVE
 Define the population-based incidence and
histopathological types of MOGCTs in the Saudi
Arabian population from 1999 to 2008

5. MATERIALS AND METHODS
 Saudi Cancer Registry (SCR)
—Cross-sectional study
—Jan. 1999 to Dec. 2008
—MOGCT epidemiological data
o Histopathological types
o Frequency of cases
o Crude Incidence Rates (CIRs)
o Age-Standardized Incidence Rates (ASIRs)
SCR. https://scr.clearvision.com.sa
Freedman D, et al. Statistics. 1997. ISBN-10: 0393970833

6. RESULTS
 Figure 1
Incidence of Female, Ovarian and MOGCTs
All Female Tumors = 30,720
All Ovarian Tumors = 1,271
Incidence = 4.1% (n= 1,271/30,720)
All MOGCTs = 175
Incidence = 13.8% (n= 175/1,271)

7. RESULTS
 Figure 2
Histopathological types of MOGCTs
41%
25%
19%
14%
1%
Dysgerminoma
Malignant Teratoma
Yolk Sac Tumor
Mixed Germ Cell Tumor
Embryonal Carcinoma

8. RESULTS
 Table 1
Incidence of MOGCTs per year
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Total (%)
10 7 5 5 8 4 9 8 10 6 72 (41.1)
0 0 0 2 0 0 0 0 0 0 2 (1.1)
2 2 3 6 4 4 2 1 2 6 32 (18.3)
5 7 5 5 6 3 1 2 6 4 44 (25.1)
4 2 1 1 4 2 4 4 1 2 25 (14.3)
21
(12)
18
(10.3)
14
(8.0)
19
(10.9)
22
(12.6)
13
(7.4)
16
(9.1)
15
(8.6)
19
(10.9)
18
(10.3)
175 (100)

9. RESULTS
 Table 2
Total number of cases, CIRs and world ASIRs
Year All Ages 0-24 25-39 40+ CIR ASIR p
1999 21 14 6 1 0.3 0.3 NS
2000 18 13 3 2 0.2 0.2 NS
2001 14 9 3 2 0.2 0.2 NS
2002 19 13 2 4 0.2 0.2 NS
2003 22 17 5 0 0.3 0.2 NS
2004 13 9 2 2 0.2 0.1 NS
2005 16 14 2 0 0.2 0.1 NS
2006 15 10 4 1 0.2 0.2 NS
2007 19 17 1 1 0.2 0.2 NS
2008 18 14 5 0 0.2 0.2 NS
Total (%) 175 (100) 130 (74.3) 33 (18.9) 12 (6.9)

10. DISCUSSION
 Incidence of All Ovarian Tumors
Siegel R, et al. CA Cancer J Clin. 2013; 63: 11–30
Saudi Arabia West
All Female-Related Tumors 4.1% 3%

11. DISCUSSION
 Incidence of All MOGCTs
Saudi Arabia West Asia and Africa
13.8% 5% 15%
Low JJ, et al. Best Pract Res Clin Obstet Gynaecol. 2012; 26: 347–55

12. DISCUSSION
 Incidence of Dysgerminoma
―Most frequent histopathological type
Saudi Arabia Worldwide
All Ovarian Tumors 5.7% 2%
All MOGCTs 41.1% 35-50%
Gershenson DM. Cancer. 1993; 71: 1581–90
Chen VW, et al. Cancer. 2003; 97: 2631–42

13. DISCUSSION
 Incidence of Malignant Teratomas
―Second most frequent histopathological type
Saudi Arabia Worldwide
All Ovarian Tumors 3.5% < 1%
All MOGCTs 25.1% 20%
Deodhar KK, et al. Indian J Pathol Microbiol. 2011; 54: 730–5

14. DISCUSSION
 Incidence of Yolk Sac Tumors
―Third most frequent histopathological type
Saudi Arabia Worldwide
All MOGCTs 18.3% 20%
Gershenson DM. Cancer. 1993; 71: 1581–90

15. DISCUSSION
 Incidence of Mixed Germ Cell Tumors
―Fourth most frequent histopathological type
Saudi Arabia Worldwide
All MOGCTs 14.3% 10%
Gershenson DM. Cancer. 1993; 71: 1581–90

16. DISCUSSION
 Incidence of Polyembryoma & Primary Ovarian
Choriocarcinomas
―Mostly exist in admixed forms
Saudi Arabia Worldwide
All MOGCTs 0% < 1%
Gershenson DM. Cancer. 1993; 71: 1581–90
Tewari K, et al. Obstet Gynecol. 2000; 95: 128–33

17. DISCUSSION
 Median age of MOGCTs
― 74% of cases occurred between 0 and 25 years
― Younger age group of Saudi population
― Fertility and its challenge to gynecologic oncologists
Saudi Arabia Worldwide
Median Age (years) 18 18
Williams SD, et al. Principles and practice of gynecologic oncology. 1997: 987–1002
Gershenson DM. Gynecol Oncol. 1994; 55: S62–S72

18. STUDY LIMITATIONS
 Clinico-Pathological details are not explored
― Beyond the scope of study
― Will be Addressed in a future study

19. CONCLUSION
 First Saudi study exploring incidence of MOGCTs
 MOGCTs
― Common tumors (15.8%)
― Mostly in child-bearing women
― Incidence rates and histopathological types are
similar to international populations with few
differences

20. Future Studies
 Detailed Single-Center Experience at KFSH&RC
― Epidemiology/Risk factors
― Clinical Presentation
― Tumor biological behavior
― Blood markers/Imaging modalities
― Management modalities
― Prognosis

21. AKNOLWEDGMENT
 Ahmed Nazer, MD
 Osama AlOmar, MD
 Ayman Azzam, MD, PhD
 Haya S. Al-Eid, MD
 Tusneem A. Elhassan, PhD
 Ismail A. Al-Badawi, MD, FRCSC

22. THANK YOU
THANK YOU