title: Management of bilateral malignant ovarian germ cell tumors: a MITO-9 retrospective study.
abstract: OBJECTIVE
  Bilaterality is rare in malignant ovarian germ cell tumors (MOGTs). The bilateral ovarian involvement represents a critical issue when diagnosed in young women desiring to preserve fertility. The aim of this study was to evaluate clinical characteristic and management of patients bilateral MOGTs.
  
  
  METHODS
  Patients affected by bilateral MOGT and treated at MITO group centers were reviewed.
  
  
  RESULTS
  In 145 patients with MOGTs, 5.5% were bilateral. Three patients were affected by dysgerminoma (associated with bilateral gonadoblastoma in 1), 2 by immature teratoma, 2 by mixed germ cell tumors, and 1 by embryonal carcinoma. International Federation of Gynecology and Obstetrics stage was 3 IB, 1 IC, 3 IIIC, and 1 IV. Three patients received radical surgery, and the patient with dysgerminoma associated with gonadoblastoma received bilateral adnexectomy. Four patients received fertility-sparing surgery; 2 patients received unilateral salpingo-oophorectomy and contralateral cystectomy; in 2 patients, the ovaries were completely transformed in neoplastic tissue; suspecting a contralateral dysgerminoma histology, a unilateral salpingo-oophorectomy and contralateral biopsy were performed, and the contralateral neoplastic ovary was left unresected. Six patients received adjuvant chemotherapy. Seven patients are disease free after a median follow-up of 54 months. The patient affected by embryonal carcinoma died of disease. Two patients resumed menstruation, and one had a pregnancy. A compromised ovarian function was found in 2 patients, and they were addressed to oocyte cryopreservation.
  
  
  CONCLUSIONS
  Bilateral MOGTs have a good prognosis. In dysgerminoma histology, residual disease could be left to spare fertility. An oncological and reproductive function follow-up is recommended.
authors.affiliation: *Department of Gynecology, IRCCS Ospedale San Raffaele, Milan; †Department of Obstetrics and Gynecology, Cannizzaro Hospital, Catania; ‡Department of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome; §Department of Gynecology, University Campus Bio-Medico of Rome, Rome; and ∥Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico Mangiagalli Regina Elena Hospital, Milan, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Sigismondi
authors.forename: Paolo
authors.initials: P
authors.lastname: Scollo
authors.forename: Gabriella
authors.initials: G
authors.lastname: Ferrandina
authors.forename: Massimo
authors.initials: M
authors.lastname: Candiani
authors.forename: Roberto
authors.initials: R
authors.lastname: Angioli
authors.forename: Riccardo
authors.initials: R
authors.lastname: Viganò
authors.forename: Giovanna
authors.initials: G
authors.lastname: Scarfone
authors.forename: Giorgia
authors.initials: G
authors.lastname: Mangili
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003131:Combined Modality Therapy / Q000706:statistics & numerical data; D005260:Female; D059247:Fertility Preservation / Q000379:methods; D006801:Humans; D007044:Hysterectomy / Q000379:methods / Q000706:statistics & numerical data; D009373:Neoplasms, Germ Cell and Embryonal / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy*; D010051:Ovarian Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy*; D010052:Ovariectomy / Q000379:methods / Q000706:statistics & numerical data; D011247:Pregnancy; D015995:Prevalence; D012189:Retrospective Studies; D055815:Young Adult