From: State of the art review in gonadal dysgenesis: challenges in diagnosis and management
Study | Type of study | Diagnoses | Location of gonads that show malignancy: if specified | Conclusions from each study regarding timing of gonadectomy | Design limitations |
---|---|---|---|---|---|
Wunsch, et al. 2012 [33] | Observational Cohort study | 8 patients with CGD underwent gonadectomy: | All patients with CGD had intra-abdominal gonads | Early gonadectomy for patients with CGD | Small sample size, lack of blinding, lack of allocation concealment |
-Ages ranged from 1–25 years | All patients with PGD had intra-abdominal streak gonads. | For patients with PGD and non-scrotal gonads, early gonadectomy may be warranted | |||
-3 patients (37.5%) had evidence of in situ neoplasia (ages 3, 12, 18); | |||||
-2 of these patients also had dysgerminoma. 12 patients with PGD had gonadal tissue evaluation: | |||||
1 patient (8.3%) had gonadoblastoma at age 6 | |||||
Johansen, et al. 2012 [34] | Observational Retrospective study | 15 patients with PGD (45X/46,XY and variants) had gonadal samples for review: | 14 year old male had left inguinal dysgenetic testis with CIS | No specific recommendations for timing, does indicate that CIS originates before puberty | Small sample size, lack of blinding, lack of allocation concealment, ascertainment bias |
-3 patients (20%) had evidence of In situ Neoplasia: | 2 year old male with right inguinal dysgenetic testis | ||||
 | 4 year old female with left inguinal dysgenetic testis | ||||
-2 males (ages 2 and 14) and 1 female (age 4) had CIS | |||||
Martinerie, et al. 2012 [35] | Observational Retrospective Study | 20 boys with PGD (45,X/46,XY) were studied | 13 year old with intra-abdominal streak gonad | No specific recommendations for timing of gonadectomy. | Small sample size, lack of blinding, lack of allocation concealment |
-2 patients (10%) had evidence of malignancy: | 23 year old with intrascrotal dysgenetic testis (inguinal at birth with orchidopexy at 9 years of age). | Recommend strict surveillance of gonads and testicular function in patients with PGD raised as males | |||
Dysgerminoma found in a 13 year old male. | |||||
Seminoma found in a 23 year old male. | |||||
Rocha, et al. 2011[20] | Observational Retrospective study | 9 patients with XY CGD who had histology available. | Abdominal | Recommend gonadectomy at diagnosis | Limited sample size, lack of blinding, lack of allocation concealment |
-Gonadoblastoma in 4 patients (44%) ages 14–17, Two of which also had dysgerminoma (22%) | |||||
Cools, et al. 2011[36] | Observational study | Obtained 84 gonadal samples from 39 patients with PGD who were 45,X/46, XY: | 1 patient with mild undervirilization had right abdominal gonad with gonadoblastoma (age not specified) | In females with PGD, tumor risk is limited but gonads are not functional, making gonadectomy the most reasonable option. | Small sample size, lack of blinding, lack of allocation concealment, selection bias (no gonadal tissue from undiagnosed 45,X/46,XY males). |
-In Situ Neoplasia found in 4 different patients (10.2%). | 1 patient with ambiguous phenotype had left abdominal gonad with gonadoblastoma (age 1) | Malignancy risk in males appears inversely related to degree of virilization (more virilized, less risk). | |||
-3 patients had gonadoblastoma, 1 had CIS. | 1 patient with ambiguous phenotype had dysgenetic inguinal testis with gonadoblastoma (age 1) | Low threshold for gonadectomy in males with ambiguous genitalia. | |||
1 patient with female phenotype had right abdominal gonad with CIS (age 16) | For mildly undervirilized males: 1 prepubertal biopsy and 1 post-pubertal biopsy | ||||
Michala, et al. 2008 [37] | Observational Retrospective study | Gonadal histology reviewed in 22 patients with Swyer syndrome: | Abdominal | Recommend bilateral gonadectomy as soon as diagnosis is made | Limited sample size, retrospective study |
-45% with germ cell tumors; | |||||
-32% with dysgerminoma (ages 10–31 years) | |||||
-14% with gonadoblastoma (ages 17, 19, and 27 yrs) | |||||
Cools, et al. 2006 [14] | Observational Retrospective Study | 60 gonadectomy samples from 43 patients with gonadal dysgenesis (included CGD and PGD): | Did not specify gonadal location | Gonadal histology revealing undifferentiated gonadal tissue or testicular tissue staining positive for OCT3/4 on the basal lamina contains high risk for gonadal tumors and should lead to immediate gonadectomy. | Small sample size, lack of blinding, lack of allocation concealment |
-35% incidence of germ cell tumors in patients with GD (n = 16), ages ranging from 4 months-25 yrs). | Testicular tissue displaying maturation delay of germ cells can be left in situ, given that its localization allows for adequate follow-up. | ||||
-All but 1 patient with malignancy had Y chromosome material. | Ovarian tissue can be safely left in place | ||||
-Invasive germ cell tumors found in 13% (n = 6) | Streak is not functional, making its preservation controversial | ||||
Mazzanti, et al. 2005 [38] | Observational Study | Identified 14 Turner patients with Y-chromosome material: | Abdominal | Recommend bilateral gonadectomy for all Turner patients with Y chromosome material | Limited sample size, lack of blinding, lack of allocation concealment. |
-12 out of 14 patients consented to gonadectomy: | |||||
33% of gonadectomized patients had gonadoblastoma (ages 2,7,11, 15 yrs) | |||||
The 15 year-old patient also had a immature teratoma, and a endodermal sinus tumor | |||||
Slowikowska-Hilczer, et al. 2003 [39] | Observational Study | Gonadal histology reviewed in 40 cases of gonadal dysgenesis: | All gonads were located in the abdomen or upper segment of the inguinal canal | No specific recommendations for timing of gonadectomy | Limited sample size, lack of blinding, lack of allocation concealment |
-67.5% had 46,XY Karyotype and the remainder had numerical and structural abberations of sex chromosomes. | |||||
One patient with 46,XY karyotype had seminoma from abdominal gonad (age 17) | |||||
CIS present in 14 patients (35%) with GD | |||||
Sex cord-derived tumors including gonadoblastoma nests and unclassified mixed germ cell-sex cord-stromal tumors were present in 11 patients (27.5%) with GD | |||||
Ages of malignancy ranged from 7 months to 19 years | |||||
Mendes, et al. 1999 [40] | Observational study | 36 patients with Turner syndrome were studied: | Abdominal | Recommend gonadectomy in Turner Syndrome patients who are Y positive | Limited sample size, lack of blinding, lack of allocation concealment |
Two patients were found to be Y positive by PCR | Â | Â | |||
Of the two Y-positive patients, one had gonadoblastoma (50%) | |||||
Gourlay, et al. 1994 [42] | Observational Retrospective Study | 11 patients with PGD had gonadal tissue for review: | All but 1 patient with PGD and malignancy had abdominal gonads | Recommend early gonadectomy in all patients with XY gonadal dysgenesis as tumors can develop at an early age | Limited sample size, lack of blinding, lack of allocation concealment |
Six patients (54%) had germ cell tumors; ages ranging from 1 month to 19 years | 1 PGD patient (age 19) with a seminoma had scrotal gonads | ||||
One patient with 46,XY CGD had a gonadoblastoma (age 17) | The patient with CGD had abdominal gonads | ||||
Robboy, et al. 1982 [43] | Observational Retrospective Study | Obtained gonadal tissue from 21 patients with PGD: | 53 year old with gonadoblastoma had abdominal gonads | Recommend early gonadectomy | Limited sample size, lack of blinding, lack of allocation concealment |
-Three patients (14.2%) with XY PGD had malignancy: | One patient had a gonadoblastoma and seminoma in a scrotal-inguinal gonad 15 years after the contralateral testis was removed (age not specified) | ||||
Two patients with XY PGD had gonadoblastomas and one of these was overgrown by a seminoma. | 2 week old with seminoma had an abdominal gonad | ||||
One patient with XY PGD had seminoma (age 2 weeks) | |||||
Scully, et al. 1970 [9] | Observational Retrospective Study | Reviewed clinical characteristics of 74 cases of gonadoblastoma: | Majority were abdominal gonads | Recommend early gonadectomy | Lack of blinding, lack of allocation concealment |
25 phenotypic females, 35 virilized females, 13 phenotypic males. | Inguinal gonadoblastomas were seen in several of the phenotypic males (exact number not specified) | ||||
43 patients had invasive germinoma | |||||
Ages ranged from 1 to 38 years | |||||
Karyotypes were available in 30/74 patients: | |||||
57% had 46,XY karyotypes | |||||
30% with 45,X/46,XY karyotype | |||||
3% (1 patient) with 45,X karyotype | |||||
10% with other forms of mosaicism |