Ovarian germ cell tumours: a 17-year study in a single unit

Abstract

Background/purpose: The aim of this study was to evaluate the clinical presentation, management and outcome in girls treated for ovarian germ cell tumours at a single unit.

Methods: The records of 40 girls (median age 10.5 years) with histologically proven ovarian germ cell tumours operated upon between 1990 and 2007 were reviewed.

Results: Twenty-nine patients had mature teratomas (MT), 5 patients had immature teratomas (IT) and 6 had malignant tumours: 4 malignant mixed germ cell tumours (MMGCT) and 2 germinomas (G). The median age at presentation was 11 years for the MT and IT groups and 8.5 years for the malignant group. The commonest symptoms and signs at presentation were pain (n=28), a palpable mass (n=15) and abdominal distension (n=9). Precocious puberty was noted at presentation in three patients with malignant tumours. Tumour markers were elevated at presentation in all patients with MMGCT. At operation, 14 patients with MT had ovarian torsion. Open unilateral oophorectomy was the procedure most frequently performed (n=30). Surgery alone was the treatment for all patients with MT and IT. Of the patients with malignant tumours, 1 had stage I, 2 had stage II, 1 had stage III and 1 had stage IV disease. All 40 patients are now between 8 months and 17 years post treatment with no contralateral tumours identified. There was one recurrence in a patient with IT, with raised tumour markers.

Conclusions: Ovarian germ cell tumours are uncommon in childhood. Tumour markers are valuable both pre and post-operatively. Malignancy is a risk regardless of age. Surgery is curative in the majority of cases. The overall outlook is very good. However, a close collaboration between surgeons, histologists, radiologists and oncologists is essential to achieve good outcomes.