Abstract
BackgroundThe value of this report is the identification of late recurrence with an extremely unusual combination of malignant transformation. In particular, the retroconversion of immature to mature teratoma as well as a somatic-type malignant transformation were both observed postchemotherapeutically in our case.Case presentationWe report the case of a 20-year-old girl who completed fertility-sparing surgery and chemotherapy under the diagnosis of ovarian mixed germ cell tumor (immature teratoma and yolk sac tumor) and experienced subsequent recurrence 4 years after a second debulking surgery with a somatic type malignant transformation (teratoma with melanoma and leiomyosarcoma). Multiple metastases developed after a third debulking surgery, and the patient survived for 18 additional months.ConclusionsRecurrent disease after repeated cytoreduction and chemotherapy hints a poor outcome despite a generally excellent long-term survival rate among ovarian germ cell malignancies. It is important for clinicians to distinguish those at risk of poorer outcomes and establish individualized postoperative surveillance. Fertility-compromising surgery may be considered in selected patients.
Highlights
The value of this report is the identification of late recurrence with an extremely unusual combination of malignant transformation
Fertilitycompromising surgery may be considered in selected patients
For pure form tumors or a component of mixed germ cell tumors, the prognosis of immature teratomas is greatly dependent on the initial stage and histological grading, which are determined by the levels of immature neural elements that are considered to be evoluted from a malignant clone [4, 5]
Summary
Given the generally chemo-sensitive feature and reproductive needs of these patients, optimal cytoreduction is warranted to achieve a maximum benefit from subsequent chemotherapy. Long-term survival rate is excellent among ovarian germ cell malignancies under current treatment strategies, relapsing disease after chemotherapy indicates a poor prognosis especially in cases with higher grades and stages. To the best of our knowledge, it is the first report of ovarian mixed germ cell tumor with both these two phenomenon observed at the same time. We propose that curative surgery that compromises fertility should be considered in these patients with advanced and relapsing disease. Given the rarity of the disease, it is important for clinicians to distinguish those at risk of poorer outcomes and establish individualized postoperative surveillance before the presence of more valid evidence-based guidance.
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