Tumeurs germinales malignes de l'ovaire. À propos de 36 cas

Abstract

Objective With personal results and a review of the literature, we report the eventual interest of surgical staging in malignant ovarian germ cell tumours. Patients and methods This was a retrospective study of 36 patients (21.5–[8–61]) with malignant ovarian germ cell tumours between January 1984 and December 2004. There were 4 groups: n o 1 – dysgerminoma only, n o 2 – immature teratoma, n o 3 – malignant ovarian germ cell tumours with secretion. All the patients had a minimal follow up of 18 months after treatment. We reported conservative or non-conservative surgery, if surgical staging was made and description of eventual neoadjuvant or adjuvant chemotherapies and finally the recurrences and deaths. Results Stages of FIGO were: group 1 – IA n = 2, IC n = 2, IIB n = 1, IIIA n = 2, IIIC n = 3; group 2 – IA n = 3 (G1, G2, G2), IC n = 1 (G3); group 3 – IA n = 8, IC n = 4, IIA n = 1, IIIA n = 1, IIIB n = 3, IIIC n = 5. Three patients had neoadjuvant chemotherapy. All the patients had cytoreductive surgery (conservative surgery n = 31) with staging in 15 cases. Twenty-six patients had adjuvant chemotherapy. Five years global survival was 92%. Discussion and conclusion Surgery in a young patient with malignant ovarian germ cells tumours must be conservative (adnexectomy) (preserving fertility and because of good prognostic). In case of stage IA with part of dysgerminoma and/or immature teratoma and/or embryonal carcinoma certified by surgical staging, strict follow up could be organized (clinic, radiology, AFP, HCG). In case of more than stage IA, chemotherapy is indicated after conservative surgery and surgical staging.