title: Malignant Ovarian Germ Cell Tumors in Postmenopausal Patients: The Royal Marsden Experience and Literature Review.
abstract: BACKGROUND
  Ovarian germ cell tumors (OGCT) account for 2-5% of ovarian malignancies, with an annual incidence of 1:100,000, and typically occur in young women and adolescents. The yolk sac tumor (YST) is the second most common subtype of OGCTs and has an aggressive phenotype. Their rarity in postmenopausal women has the potential to cause initial diagnostic uncertainty and lead to delayed or sub-optimal treatment. In this article, we report two cases. The first case is a 67-year-old woman with a pure YST and the second refers to a 59-year-old patient with YST with neuroendocrine differentiation. We also review and summarise the current literature.
  
  
  CONCLUSIONS
  YSTs in older women, either in association with ovarian epithelial tumors or without an identifiable epithelial precursor, are a challenging clinical situation. The disease is aggressive and the outcome remains poor. Thirty-seven cases, including the two reported in this article, have been described in the literature to date. 12/ 37 described patients with malignant OGCTs died within 8 months of diagnosis.
  
  
  CONCLUSIONS
  Ovarian cancer with a YST component in postmenopausal women has an aggressive behaviour and adjuvant platinum-based chemotherapy should be considered.
authors.affiliation: Gynaecology Unit, The Royal Marsden NHS Foundation Trust, London, U.K.
authors.forename: Stergios
authors.initials: S
authors.lastname: Boussios
authors.affiliation: Department of Histopathology, Royal Marsden Hospital, London, U.K.
authors.forename: Ayoma
authors.initials: A
authors.lastname: Attygalle
authors.affiliation: Department of Histopathology, Royal Marsden Hospital, London, U.K.
authors.forename: Steve
authors.initials: S
authors.lastname: Hazell
authors.affiliation: Gynaecology Unit, The Royal Marsden NHS Foundation Trust, London, U.K.
authors.forename: Michele
authors.initials: M
authors.lastname: Moschetta
authors.affiliation: Gynaecology Unit, The Royal Marsden NHS Foundation Trust, London, U.K.
authors.forename: Jennifer
authors.initials: J
authors.lastname: McLachlan
authors.affiliation: Gynaecology Unit, The Royal Marsden NHS Foundation Trust, London, U.K.
authors.forename: Alicia
authors.initials: A
authors.lastname: Okines
authors.affiliation: Gynaecology Unit, The Royal Marsden NHS Foundation Trust, London, U.K. susana.banerjee@rmh.nhs.uk.
authors.forename: Susana
authors.initials: S
authors.lastname: Banerjee
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008875:Middle Aged; D009373:Neoplasms, Germ Cell and Embryonal / Q000209:etiology* / Q000473:pathology; D010051:Ovarian Neoplasms / Q000209:etiology* / Q000473:pathology; D017698:Postmenopause; D011379:Prognosis
keywords: Yolk sac tumor; ovarian germ cell; postmenopausal; α-fetoprotein