Search

Summary: Aneuploidy is the most common chromosomal abnormality and also is the leading cause of early fetal loss and serious mental retardations. Except for the advanced maternal age, there is no clearly established factor for the development of aneuploidy. On the other hand, advanced maternal age is well characterized with elevated gonadotropin levels due to the decreased ovarian reserve. Such high level gonadotropins are also seen physiologically in the adolescent period. Both age groups may have an increased risk for having a baby with chromosomal abnormality. On the other hand, high doses of gonadotropins are widely used in artificial reproductive technologies (ART). Low pregnancy and high abortion rates in ART practices may be explained by higher incidence of chromosomal abnormalities in the unfertilized oocytes maturated by high dose gonadotropins. Gonadotropins are also found to induce congenital malformations and chromosomal abnormalities in some animal studies. From this point of view, we hypothesized that gonadotropins might have a role in the development of aneuploidy. If this hypothesis is true, basal serum FSH levels may be used as a screening test in preconceptional period for assessment of the aneuploidy risk in low risk population. Furthermore, new ART protocols using low dose gonadotropins should be developed in order to improve pregnancy outcomes and possibly to prevent aneuploidy. [Copyright &y& Elsevier]

Abstract: Objective: The purpose of this study was to evaluate the treatment regimens used for patients with endodermal sinus tumors (EST), and also to examine the prognostic value of surgicopathological variables. Study design: Twenty-two patients treated for pure EST, and seven patients who had mixed germ cell tumors with EST components were included. Initial surgery consisting of surgical staging to achieve optimal debulking was the principal mode of therapy. Data were obtained from patients’ files, a special gynecologic oncology database, and pathology records. Results: The median age at the time of diagnosis was 18 (range 8–45). Sixteen patients had stage I (55%), and 13 (45%) had stage II–IV disease. As an adjuvant therapy 18 patients (62%) received platin-based chemotherapy, three patients (10%) had non-platin-based chemotherapy, four patients (14%) had radiotherapy, and four patients (14%) had combined radiotherapy plus non-platin-based chemotherapy. The 5-year disease-free and overall survival rates were 47 and 48%, respectively. Survival rates were dismal in patients with stage II–IV disease (P <0.001). Platin-based chemotherapy achieved significant survival benefit (P =0.03 and P <0.001, respectively). Fertility-saving surgery had an overall survival no worse than those who underwent more extensive surgery. There was no significant survival difference with respect to age, histology, and tumor size. Conclusion: Fertility-sparing surgery with a postoperative platin-based combination chemotherapy should be the selected mode of treatment. [Copyright &y& Elsevier]