title: Immature teratoma of ovary--outcome following primary and secondary surgery: study of a single institution cohort.
abstract: OBJECTIVE
  To analyse the clinical presentation, treatment - primary and secondary debulking and outcomes with focus on recurrences in ovarian immature teratoma.
  
  
  METHODS
  This is a single institution, retrospective analysis of 24 women who presented to a gynecologic oncology unit from 1999 to 2011 with ovarian immature teratoma. Patient's clinical presentation, operative and chemotherapy details were included in a database. Follow up details regarding recurrence and management and future outcomes were also noted. Overall survival was calculated from the date of registration to last follow up or date of death. Survival curve was constructed by Kaplan-Meier method.
  
  
  RESULTS
  Immature teratoma accounted for 11% of 218 malignant germ cell tumors. Of the 24 patients, pain was the predominant symptom and abdominal mass was the commonest clinical presentation. Sixteen out of 24 patients presented in Stage I and grade 3 tumors were found in 43% of patients. Six patients had only unilateral salpingo oophorectomy and no staging procedure. Twelve patients underwent staging, with omentectomy being the commonest procedure. All but one, had cisplatin based combination chemotherapy. Six patients underwent secondary debulking of recurrence. Most recurrences were recorded in Stage III, higher grade tumors. With secondary cytoreduction and platinum based chemotherapy, it was possible to salvage most recurrences as well. Overall survival after a mean follow-up of 39 months was 91.6%.
  
  
  CONCLUSIONS
  Majority of the patients did well with conservative surgery in terms of survival, menstrual and reproductive function. Platinum based chemotherapy was indicated in higher grade and higher stage tumors as recurrences commonly occurred in this subgroup of patients. Recurrences could be salvaged with selected secondary cytoreduction and platinum based chemotherapy.
authors.affiliation: Department of Gynecologic Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India.
authors.forename: Pallavi V
authors.initials: PV
authors.lastname: Reddihalli
authors.affiliation: Department of Gynecologic Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India. Electronic address: anbu.subbian@yahoo.com.
authors.forename: Anbukkani
authors.initials: A
authors.lastname: Subbian
authors.affiliation: Department of Gynecologic Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India.
authors.forename: K
authors.initials: K
authors.lastname: Umadevi
authors.affiliation: Department of Gynecologic Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India.
authors.forename: Praveen S
authors.initials: PS
authors.lastname: Rathod
authors.affiliation: Department of Gynecologic Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India.
authors.forename: Shobha
authors.initials: S
authors.lastname: Krishnappa
authors.affiliation: Department of Gynecologic Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India.
authors.forename: Shakuntala P
authors.initials: SP
authors.lastname: Nanaiah
authors.affiliation: Department of Gynecologic Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India.
authors.forename: Uttam D
authors.initials: UD
authors.lastname: Bafna
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D002945:Cisplatin / Q000008:administration & dosage; D065426:Cytoreduction Surgical Procedures; D005260:Female; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000601:surgery*; D009367:Neoplasm Staging; D009852:Omentum / Q000601:surgery; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D010052:Ovariectomy; D012086:Reoperation; D012189:Retrospective Studies; D058994:Salpingectomy; D015996:Survival Rate; D013724:Teratoma / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D055815:Young Adult
chemical_list: D002945:Cisplatin
keywords: Immature teratoma; Ovarian germ cell tumor; Secondary debulking; Surgical staging