title: Malignant ovarian germ cell tumors: a single-institution experience.
abstract: OBJECTIVE
  To evaluate the clinicopathologic prognostic factors in malignant ovarian germ cell tumors.
  
  
  METHODS
  We reviewed the medical records of 70 patients treated from 1990 to 2006 at our center. Clinical data including demographics, stage, surgery, chemotherapy, survival, menses status, and fertility were collected from patients' charts.
  
  
  RESULTS
  Median age was 22 years (range, 9-68). The histologic subtypes included 36 dysgerminomas, 11 yolk sac tumors, 3 immature teratomas, 1 embryonal carcinomas, and 19 mixed types. The most striking clinicopathologic finding was a history of concomitant immunosuppressant therapy, which was observed in 2 patients. Two patients had contralateral sex-cord tumors at presentation and follow-up. During a median follow-up period of 4.6 years, 11 patients had recurrence. The median time to recurrence was 8 months (6-28 months). Recurrences appeared in the abdominopelvic cavity in 9 out of 11 patients. Only one could be salvaged with second-line chemotherapy. Cumulative survival rate was 97% and 60% in patients with dysgerminoma and nondysgerminoma, respectively. Nondysgerminoma histology and residual tumor after surgery were unfavorable prognostic factors (P < 0.001 and P = 0.015). Fertility-sparing surgery was as effective as radical surgery among all eligible patients. Of patients with known menstrual status, 96% had regular menses. Of the 8 patients who opted for conception among these patients, 7 delivered healthy infants.
  
  
  CONCLUSIONS
  Nondysgerminomas have an aggressive clinical course. New treatment strategies are needed for eradication of abdominopelvic disease at initial diagnosis and recurrent setting. Occurrence of malignant ovarian germ cell tumors may be associated with immunosuppression in some patients. Sex-cord stromal tumors may present with bilateral involvement. It is possible to maintain fertility after fertility-sparing surgery followed by chemotherapy.
authors.affiliation: Department of Medical Oncology, Faculty of Medicine, Trakya University, Edirne; Turkey. irfancicin@hotmail.com
authors.forename: Irfan
authors.initials: I
authors.lastname: Cicin
authors.forename: Yesim
authors.initials: Y
authors.lastname: Eralp
authors.forename: Pinar
authors.initials: P
authors.lastname: Saip
authors.forename: Inci
authors.initials: I
authors.lastname: Ayan
authors.forename: Rejin
authors.initials: R
authors.lastname: Kebudi
authors.forename: Cem
authors.initials: C
authors.lastname: Iyibozkurt
authors.forename: Sitki
authors.initials: S
authors.lastname: Tuzlali
authors.forename: Omer
authors.initials: O
authors.lastname: Gorgun
authors.forename: Erkan
authors.initials: E
authors.lastname: Topuz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008499:Medical Records; D008875:Middle Aged; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D011379:Prognosis; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult