Malignant Mixed Germ Cell Tumor Research Articles

Component Patterns and Survival Outcomes in Patients with Mixed Malignant Ovarian Germ Cell Tumors: A Retrospective Cohort Study

AimsTo evaluate the component patterns and risk stratification in patients with mixed malignant ovarian germ cell tumors (mMOGCT). MethodsA retrospective study of 70 mMOGCT patients treated in our hospital between 2000 and 2022 was conducted. The recurrence-free survival (RFS), disease-specific survival (DSS), and risk stratification systems based on scoring the identified prognostic factors were assessed. ResultsYolk sac tumor component was the most common type (80%), followed by dysgerminoma (50%), immature teratoma (40%), embryonic carcinoma (27.1%), and chorionic carcinoma (15.7%). The 5-year RFS and DSS rates were 77.9% and 87.9%, respectively. International federation of gynecology and obstetrics (FIGO) stage III-IV (RR 3.253, P = 0.029) and normalization of tumor marker (TM) ≤ 3 cycles of chemotherapy (RR 6.249, P = 0.017) were risk factors for RFS and DSS, respectively. Significant DSS (RR 8.268, P = 0.006) was also noted between patients who had normalized TM ≤ 4 and ≥5 cycles of chemotherapy. FIGO stages I–II and stages III–IV were scored as 0 and 2, respectively. AFP normalization ≤3, 4, and ≥5 cycles of chemotherapy were scored as 0, 1, and 4, respectively. A total score of 0, 1–2, and ≥3 stratified patients into low-risk (43 patients), intermediate-risk (13 patients), and high-risk groups (14 patients), respectively. Patients in three risk stratifications manifested significant differences in DSS (P = 0.010) but not in RFS (P > 0.05). ConclusionDistinct different component patterns existed among mMOGCT patients, and predicting survival outcomes in a universal model was challenging.

Clinical Presentation and Histological Types of Ovarian Tumor in Patients Admitted in Tertiary Care Center

Background: Ovarian cancer is the eighth most frequent cancer among women worldwide, accounting for 4% of all cancers in the female population. When compared to other reproductive system cancers, ovarian cancer has a high death and morbidity rate. Objectives: The aim of the study was to assess the clinical presentation and histological types of ovarian tumor in patients admitted in tertiary care center. Methods: A descriptive cross-sectional study was conducted to determine the clinical presentation and histopathological types of ovarian tumour diagnosed at Medical college for women, Uttara and Nightingale medical college, Ashulia. The study was approved by the Institutional Review Board (IRB) and 600 patients diagnosed with ovarian tumors were consecutively included in the study from July 2009 to August 2016. The cases were diagnosed and subclassified in accordance with the WHO Classification of Female Genital Tumours, Fourth Edition. Statistical Package for Social Sciences (SPSS) application, version 25, was used for data analysis. Results: Out of Total Gynaecological admission of 4800 patients during the study period, 600 patients were admitted with diagnosis of ovarian Tumor, So occurance was 12.5%. the mean age of the patients was 35 ± 2.09. About 8.6% of the patients had less than 20 years old. 56.6% were within the age group of 21-40, 29.8% were within the age group of 41-60 and only 5% had more than 60 years. The mean Menarche in years was 14.6 ± 1.02 and Menopause in years was 48.7 ± 2.46. Regarding clinical presentation 37.40% had abdominal pain, 55.50% had abdominal mass, 3% had abdominal distension,2% had ascites, 0.50% had menstrual irregularities and 2.50% were asymptomatic. Regarding surgical procedure, 35% undergone Total abdominal hysterectomy and bilateral salpingo-oophorectomy, 18.33% Bilateral salpingo-oophorectomy, 15% Right salpingo-oophorectomy and Left salpingo-oophorectomy recommendation, 13.33% Right cystectomy, 3.33% Left cystectomy. Regarding consistency of tumour 57.33% were cystic, 37% were solid, 5.33% were complex and 0.33% were Diffuse pattern (metastatic tumor). Benign tumors were 77%, borderline 16.67% and malignant 6.33% cases. Out of 462 benign tumors, Serous cystadenoma (230/49.78%), Mucinous cystadenoma (60/12.98%), benign Brenner tumor (10/2.16%), Mature cystic teratoma (110/23.80%), stroma ovarii (10/2.16%), Fibroma (10/2.16%), Fibro-thecoma (12/ 2.59%), leiomyoma (20/4.34%). Out of 38 malignant tumour, Serous cystadenocarcinoma (11/28.94%), mucinous cystadenocarcinoma (6/15.78%), clear cell carcinoma (1/2.63%), Malignant Brenner tumor (1/2.63%), endometroid adenocarcinoma (4/10.52%), squamous cell carcinoma arising in mature teratoma (1/2.63%), Dysgerminoma (7/18.4%), Immature teratoma (1/2.63%), malignant mixed germ cell tumor (1/2.63%), Adult granulosa cell tumor (4/10.52%), Krukenburg tumor (1/2.63%). Survival status was satisfactory; 99.67% patients was alive. Conclusion: The study found that ovarian neoplasms had ambiguous signs and symptoms, were mostly seen in reproductive age groups, and were mostly benign. The proportion of malignant ovarian neoplasms was significantly lower than that of benign ovarian neoplasms. Although incidence of malignant tumor is less common but gynocologists should be more careful in diagnosis of malignancy as ovaries are pelvic organs and definite screening methods are not available and malignancy can occur in any age.

Is it a teratoma? is it a nephroblastoma? no, it is a teratoma with nephroblastoma: a rare tumor in pediatric oncology

Mixed extragonadal teratoma with malignant nephroblastoma (TWN) is an exceptionally rare and complex combination of solid tumors which has been referred to as “teratoid Wilms tumor,” “teratoid nephroblastoma,” or “teratoma with nephroblastoma.” Here we report a seven-year-old male who presented with a large retroperitoneal mass outside of the right kidney with lung metastases and diagnosed with a malignant mixed germ cell tumor with mature teratoma and extensive malignant nephroblastoma. Our case report highlights the controversial pathogenesis of this rare tumor and describes the variety of treatment regimens delivered for this type of tumor. In this case report, we described a young child with metastatic TWN who was successfully treated with multimodal approach based on Wilms tumor management including surgery, chemotherapy, and radiation.

Premature ovarian insufficiency caused by the treatment of ovarian malignant mixed germ cell tumor: a case report

Background: Premature ovarian insufficiency (POI) will bring women early and long-term adverse consequences, including estrogen deficiency-related symptoms (hot flashes, sweating, decreased libido, insomnia, etc.) and significantly increases the risk of chronic diseases including Alzheimer's disease, cardiovascular disease and osteoporosis, along with increased risk of early death. More importantly, POI has greater harm to women’s fertility. Mostly the causes of POI are unknown. Most important are iatrogenic factors such as radiotherapy, chemotherapy and surgery, which increase the risk of POI.

A lethal encounter with malignant mixed germ cell tumour in an adolescent girl: A double trouble

A lethal encounter with malignant mixed germ cell tumour in an adolescent girl: A double trouble

Ovarian Malignant Mixed Germ Cell Tumor Composed Mainly of a Polyembryoma Pattern With Vasculogenic Mesenchymal Tumor Components.

Ovarian germ cell tumors composed of numerous well-formed embryonal bodies have been described as exhibiting a "polyembryoma pattern." In addition, some germ cell tumors are occasionally concomitant with neoplastic vascular proliferation. These include angiosarcomas and the recently reported mediastinal vasculogenic mesenchymal tumors. A 9-yr-old Japanese girl underwent surgery for a right ovarian tumor. Histologically, the polyembryoma pattern, nongestational choriocarcinoma, and vasculogenic lesions characterized by a neoplastic repetition of embryonic vasculogenesis have been intermingled. The polyembryoma pattern consisted of numerous complete and incomplete embryonal bodies and glandular structures resembling adult-type and fetal-type intestines. Vasculogenic lesions were composed of variously developed neoplastic vessels within the myxomatous stroma, which extended well beyond one low-power (40×) microscopic field. We concluded that the vasculogenic lesion in our case was the ovarian counterpart of the mediastinal vasculogenic mesenchymal tumor. After the surgery, the patient was administered adjuvant chemotherapy and was alive with no evidence of recurrence or other malignancy at 28 mo postsurgery.

Currarino triad.

Currarino triad is an autosomal dominant hereditary condition, characterized by triad of sacral agenesis abnormalities, anorectal malformation and presacral mass consisting of teratoma, anterior sacral meningocele or both. It is caused by mutations in the MNX1 gene. We present a case of a 2-year-old male child, brought by his mother with complaints of abdominal distension, failure to pass urine/faeces for 6 days. On examination, swelling of size 4x3cm was seen in the sacrococcygeal region. Magnetic resonance imaging (MRI) of abdomen and pelvis showed large cystic multi lobulated mass in sacrococcygeal region with dural communication evident of an anterior sacral meningocele. One month later, biopsy was done, which showed malignant mixed germ cell tumor in presacral area. Child underwent sacral partial laminectomy, laminoplasty and transdural ligation in neck of meningocele.

Gonadal neoplastic related lesions in children with disorders of sexual development: a clinicopathological study of twelve cases

Objective: To investigate the clinicopathological features of gonadal neoplastic related lesions in children with disorders of sexual development (DsD). Methods: The clinical manifestations, chromosomal karyotype, histology and immunophenotype of 12 cases of neoplastic related lesions from Guangzhou Women and Children's Medical Center, Guangzhou were analyzed during Jan 2015 to May 2020. Results: Twelve cases of neoplastic related lesions were screened in 205 cases of DsD, and 6 patients with gonadal germ cell neoplasia aged 3-13 years with an average age of 8.3 years. There were 2 males and 4 females. Clinical features showed malformation of external genitalia in 2 cases, short stature in 2 cases, clitoral enlargement in 1 case, lower abdominal pain and a huge pelvic mass in 1 case. Chromosomal karyotyping of peripheral blood showed 2 cases of 46XY and 4 cases of 45X/46XY. Fourteen gonadal specimens were examined. Microscopically, 1 case showed dysgerminoma in left ovary, and malignant mixed germ cell tumors in right ovary, as well as gonadoblastoma (GB) and undifferentiated gonadal tissue (UGT). The remaining 5 cases were all precursor lesions of germ cell tumor. Six specimens showed GB, 3 of UGT, and 3 specimens showed germ cell neoplasia in situ (GCNIS), one of which was accompanied by intratubular seminoma and 1 was GB with GCNIS. The other 6 patients with DsD were aged from 8 months to 2 years and 5 months, including 5 males and 1 females. Clinical manifestations showed 5 cases of hypospadias and 1 case of bilateral indirect inguinal hernia. Microscopically, 6 cases showed maturation delay of gonocytes in seminiferous tubules. Immunohistochemically, the primordial germ cells/gonocytes expressed OCT3/4, PLAP and c-KIT in the 12 cases. Conclusion: Gonadal neoplasia in children with DsD is mainly precursor lesions of germ cell tumor and improved understanding of these lesions is of great significance.

Malignant Germ cell Tumor of Ovary: An Unusual Combination and An Irony of Fate

Malignant mixed ovarian germ cell tumors are very rare malignant ovarian germ cell tumors, with a very high degree of malignancy. They are aggressive cancers affecting young adolescent girls. The commonest combination reported in literature is dysgerminoma and endodermal sinus tumors. Fertility sparing surgery followed by combination chemotherapy is the treatment of choice. The objectives of this case report are the advanced age of presentation, unusual histopathological combination, and the irony of infertility treatment. We report a rare case of 40-year-old woman with Malignant mixed germ cell tumor comprising of components of endodermal sinus tumor, immature teratoma, dysgerminoma and embryonal carcinoma. Patient was on hormonal therapy for the cause of infertility, presented with complains of lower abdominal pain, constipation and incomplete evacuation of bladder for 2months. Transvaginal ultrasonography and CT scan showed a large multicystic space occupying lesion with predominant solid component in midline abdominopelvic location. Tumor markers i.e., AFP, Prolactin and CA125 were raised. Total abdominal hysterectomy and bilateral salpingoophorectomy, pelvic and retroperitoneal node resection, peritonectomy and omentectomy was performed.

Malignant mixed germ cell tumours- A rare case report with unusual presentation in a 05 years old female child

Mixed germ cell tumours (MGCT) of the ovary are malignant neoplasms of the ovary comprising of two or more types of germ cell components. Most of the malignant MGCT consists of dysgerminoma accompanied by endodermal sinus tumours, immature teratoma or choriocarcinoma. There are only few case reports of MGCTs with different combinations of malignant components. We present a very rare case of malignant MGCT in a 05 years old female child, who presented with difficulty in defecation for 6 months, swelling over sacral region for 2 months, along with bilateral inguinal swellings and difficulty in urination for 1 week. Swelling was firm, non-mobile & non-tender measuring 6.6x5 cm. On cytology it was diagnosed as malignant germ cell tumour, which was confirmed on histology as malignant MGCT (predominantly yolk sac tumour >90% and embryonal carcinoma (<10%)), metastasizing into bilateral inguinal lymph nodes.

Imaging in gynecological disease (22): clinical and ultrasound characteristics of ovarian embryonal carcinomas, non-gestational choriocarcinomas and malignant mixed germ cell tumors.

To describe the clinical and ultrasound characteristics of three types of rare malignant ovarian germ cell tumor: embryonal carcinoma, non-gestational choriocarcinoma and malignant mixed germ cell tumor. This was a retrospective multicenter study. From the International Ovarian Tumor Analysis (IOTA) database, we identified patients with a histological diagnosis of ovarian embryonal carcinoma, non-gestational choriocarcinoma or malignant mixed germ cell tumor, who had undergone preoperative ultrasound examination by an experienced ultrasound examiner between 2000 and 2020. Additional patients with the same histology were identified from the databases of the departments of gynecological oncology in the participating centers. All tumors were described using IOTA terminology. Three examiners reviewed all available ultrasound images and described them using pattern recognition. One patient with embryonal carcinoma, five patients with non-gestational ovarian choriocarcinoma and seven patients with ovarian malignant mixed germ cell tumor (six primary tumors and one recurrence) were identified. Seven patients were included in the IOTA studies and six patients were examined outside of the IOTA studies. The median age at diagnosis was 26 (range, 14-77) years. Beta-human chorionic gonadotropin levels were highest in non-gestational choriocarcinomas and alpha-fetoprotein levels were highest in malignant mixed germ cell tumors. Most tumors were International Federation of Gynecology and Obstetrics (FIGO) Stage I (9/12 (75.0%)). All tumors were unilateral, and the median largest diameter was 129 (range, 38-216) mm. Of the tumors, 11/13 (84.6%) were solid and 2/13 (15.4%) were multilocular-solid; 9/13 (69.2%) manifested abundant vascularization on color Doppler examination. Using pattern recognition, the typical ultrasound appearance was a large solid tumor with inhomogeneous echogenicity of the solid tissue and often dispersed cysts which, in most cases, were small and irregular. Some tumors had smooth contours while others had irregular contours. A unilateral, large solid tumor with inhomogeneous echogenicity of the solid tissue and with dispersed small cystic areas in a young woman should raise the suspicion of a rare malignant germ cell tumor. This suspicion can guide the clinician to test tumor markers specific for malignant germ cell tumors. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

A Case of a Rare Malignant Mixed Ovarian Germ Cell Tumor Masquerading as an Ectopic Pregnancy

Malignant ovarian germ cell tumors (MOGCTs) are rare but disproportionately affect young women and adolescent girls. Although clinical presentation varies, these tumors can present with an adnexal mass and raised serum beta-human chorionic gonadotrophin (beta-hCG), mimicking an ectopic pregnancy. We present the case of a 20-year-old nulliparous woman, who was initially treated both medically and surgically as an ectopic pregnancy, and was eventually diagnosed with a malignant mixed germ cell tumor (MMGCT) following laparoscopy. We highlight the diagnostic challenges of ectopic pregnancies versus MOGCTs, and the importance of adopting a fertility-sparing approach in young nulliparous women. J Clin Gynecol Obstet. 2021;10(2):55-58 doi: https://doi.org/10.14740/jcgo743

Surveillance alone in stage I malignant ovarian germ cell tumors: a MITO (Multicenter Italian Trials in Ovarian cancer) prospective observational study

ObjectiveThe aim of this study was to analyze the oncological outcome of stage I malignant ovarian germ cell tumors patients included in the MITO-9 study to identify those who might...

Histomorphological Spectrum of Gonadal and Extragonadal Germ Cell Tumours at a Tertiary Cancer Centre in Southern Rajasthan, India

Introduction: Germ Cell Tumours (GCT) are heterogenous tumours believed to arise from primordial germ cells. The GCT predominantly affects gonads (testis and ovary) and also involves extragonadal sites, characteristically locations along midline of the body. The GCT of testis, ovary and extragonadal sites show peculiar histomorphological features and types subject to the age and site of patient. Definite histopathological typing of GCT is of vital importance to decide the further treatment. Till now, very few studies have been conducted in India on GCT of gonads and extragonadal sites. Aim: To study the pathologic findings of GCT including macroscopic and microscopic features and to classify the tumours according to latest World Health Organisation (WHO) classification of GCT for designated site of origin. Materials and Methods: Retrospective analysis was conducted including 141 cases of GCT of all sites, diagnosed at a tertiary cancer centre in Udaipur, Rajasthan, India between January 2016 to April 2021. Data were collected regarding demographic, clinical, gross and histopathological details. Results were analysed using Statistical Package of Social Sciences (SPSS) software Version 21.0. method. Results: Germinal cell tumours shows various age ranges for different site of origin. Ovarian GCT age varies from seven years to 65 years. Age group of testicular GCT varies from 1-55 years. Extragonadal GCT (EG GCT) was seen as early as in four-day-old newborn. Out of 141 cases, 103 were ovarian, 21 were testicular and 17 were EG GCT cases. Most common ovarian GCT is Mature Teratoma (MT) (85 cases, 82.53%) and most common malignant ovarian GCT is dysgerminoma (9 cases, 8.74%). Most common testicular GCT type is Malignant Mixed GCT (MM GCT) (9 cases, 42.86%) followed by seminoma (5 cases, 23.81%) and Yolk Sac Tumours (YST) (3 cases, 14.29%). EG GCT involves retroperitoneum (5 cases, 29.41%), anterior mediastinum (4 cases, 23.53%), Sacrococcyx (3 cases, 17.65%) and Central Nervous System (CNS) (2 cases, 11.76%) with most common EG GCT is teratoma (9 cases, 52.94%) Conclusion: Gonadal and extragonadal GCT share many common tumours, albeit, distinctive site-specific histopathological findings also present. These features often complicate the definitive diagnosis of GCT for pathologists, specifically in cases of MM GCT.

Disorders of sex development -A complex puzzle for the doctor and the patient-A rare case report

Disorders of Sex Development (DSD) are referred to a group of disorders in which at least two out of gonadal sex, genetic sex, phenotypic sex and genital tract sex show discordance between them. Among the three main categories of DSD, 46XY DSD is a rarer type which we encountered in our case. A 14 year old female presented with abdominal pain and lump since 10 days. On clinical examination she had external sexual characters of a female. Karyotyping revealed a 46XY type. Intra-operatively, there was a normal uterus with a tumor mass in the location of the right gonad which was removed, along with a biopsy taken from the contralateral gonad, both intra-abdominal in location. Histopathologic examination of the tumor mass revealed a malignant mixed germ cell tumour (GCT) comprising of dysgerminoma and yolk sac tumour and the contralateral gonad was found to be testis, with evidence of intratubular germ cell neoplasm unclassified (IGCNU). Patient underwent 4 cycles of chemotherapy after the histopathologic diagnosis but was later lost to follow-up. The relative ambiguity of these disorders with their propensity to develop into type II GCTs makes these cases unique, perplexing and of utmost importance. Keywords: 46XY DSD, Mixed GCT, IGCNU.

Malignant Mixed Germ Cell Tumors of the Ovary: An Analysis of 100 Cases Emphasizing the Frequency and Interrelationships of Their Tumor Types.

One hundred malignant mixed germ cell tumors of the ovary that occurred in patients 3 to 55 years (mean: 20 y) of age are described. The clinical presentation was usually that of any highly malignant tumor of the ovary (abdominal pain and distension), but rarely (3 cases) endocrine manifestations were present. The tumors were usually unilateral (96%), ranged from 4 to 38 cm (mean: 16 cm), and were uniformly solid or, more often, solid and cystic; occasionally the typical appearance of dysgerminoma could be appreciated. The most common tumor type was yolk sac tumor (91%), followed by dysgerminoma (61%), immature teratoma (58%), embryonal carcinoma (38%), and choriocarcinoma (11%). A variety of admixtures were encountered; dysgerminoma and yolk sac tumor was the most common combination (25% of the tumors) with the 2 components often being sharply demarcated. Immature teratoma and yolk sac tumor was the next most common pairing (20%) followed by yolk sac tumor and embryonal carcinoma, with or without immature teratoma (16%). Tumors with a choriocarcinoma component had the most varied combinations of tumor types. Embryoid bodies were seen in 21% of the tumors, most often as fragmented forms arranged in a nodular manner with yolk sac tumor and/or embryonal carcinoma; uncommonly they occurred singly or in clusters. Numerous confluent well-formed embryoid bodies (polyembryoma) were prominent in 2 tumors. Three tumors had a focal diffuse embryoma pattern. The specific tumor types showed the known diverse spectrum of microscopic appearances, but the frequent haphazard arrangement of 2 or more subtypes often resulted in complex morphology. Overgrowth of another neoplastic component, most often primitive neuroectodermal tumor, occurred in 10% of the tumors further complicating the histologic picture. This is the largest series of ovarian malignant mixed germ cell tumors reported and details their characteristics including associations of their subtypes and the frequent apparent role of embryoid bodies in giving rise to yolk sac tumor and embryonal carcinoma components.

Rare Malignancies of the Female Genital Tract

Aims: To analyze rare female genital tract malignancies.
 Method: This is retrospective descriptive study as a census of all rare female genital tract malignancies in two years from 2017 to 2019 at Paropakar Maternity and Women’s Hospital in Kathmandu. Data were retrieved from medical record and entered into Microsoft Excel and SPSS 16 window for analysis.
 Results: There were 156 cases of female genital tract malignancies including 128 common types and 28 rare types. Majority fell under 41- 50 years (n=44; 28.2%) followed by over 60 (n=41; 26.2%) and 51-60 years (n=34; 21.8%). Among ovarian tumors, the rare varieties were adult granulosa cell tumor (n=4), immature teratoma (n=3) and single case each of yolk sac tumor, dysgerminoma, malignant mixed germ cell tumor, carcinoid tumor, juvenile granulosa cell and sertoli cell tumor. There were one case each of carcinosarcoma, serous carcinoma and endometrial stromal carcinoma; two cases each of leiomyosarcoma and choriocarcinoma while there was a single case of placental site trophoblastic tumor. The rare cervical malignancies were small cell (n=2), and clear cell carcinoma (n=1). There were single cases each of basal cell carcinoma of vulva, verrucus carcinoma, fibromyxoid sarcoma of Bartholin’s gland and malignant melanoma of vagina.
 Conclusion: Rare female genital tract cancers were found mostly from the ovary followed by uterus; 18% of total cancers were rare types.
 Key words: female, genital tract, rare malignancy

Huge ovarian embryonal cell carcinoma in an adolescent girl: A case report

Pure ovarian embryonal carcinoma is a rare type of germ cell tumor, usually presenting in adolescent age group with only 30 odd cases reported in literature. They are mostly reported as one of the component of mixed malignant ovarian germ cell tumor. Tumor markers such as Human Chorionic Gonadotropin (HCG), and alpha-fetoprotein (AFP) and Lactate Dehydrogenase (LDH) also contribute to the diagnosis, prognosis and follow - up of germ cell tumors. Here, we report a rare case of a pure ovarian embryonal cell carcinoma in an adolescent girl with atypically raised LDH levels whereas the other markers such as AFP, HCG, CA-125 were normal.A 13 year old adolescent girl presented with pain abdomen and abdominal mass. Ultrasound and CT scanning showed a huge multi-cystic septate abdomino -pelvic mass involving the right ovary. We performed fertility sparing staging laparotomy with right salpingo-oopherectomy, saving the uterus and the left ovary. Presently, patient has completed 3 cycles of adjuvant chemotherapy (BEP regimen). Pure embryonal carcinoma, being an extremely rare tumor, the treatment outcomes and long-term disease-free survival is unknown, often data is extrapolated from its testicular counterpart, however treatment is standardized with fertility sparing USO and combination chemotherapy as the patients are very young. Recurrences occur mostly in the first 2 years following primary treatment. Also, secondary malignancies due to chemo-toxicity is a concern, as patients are very young, warranting a long and intensive surveillance.

Successful Therapy on Patients with Yolksac and Embrional Carcinoma by Surgery and Chemotherapy

Background: Malignant mixed germ cell tumors account for 13-25% of all non seminoma germ cell tumors, almost all cases were found in males (85%), increased in the third decade, and had an average survival rate of 40-45%. With modern management the average 5-year survival rate can be over 80%.Case Report: We reported a case report in Saiful Anwar Malang Hospital, Indonesia, a young man, 26 years old with an malignant epithelial tumor derived from mediastinal or lung. The CT scan of the chest showed an lobulated solid mass of iso-hipodens on the anterior superior mediastinum, mass encompassing the aortic arch, left pulmonalis artery, subclavian artery. The result from transthoracic FNAB with USG guidance showed an malignant epithelial tumor derived from mediastinal or lung, impression of an adeno squamous carcinoma. The AFP, LDH, and NSE serum level was elevated. Patient underwent a surgical sternotomy and tumor debulking. The biopsy showed an malignant mixed germ cell tumor (yolksac and embrional carcinoma). These were confirming the diagnosis of malignant mixed germ cell mediastinal tumor (yolksac and embrinonal carcinoma). Patient received a combination bleomycin, etoposid, cisplatin 3 series chemoteraphy  and evaluated.Conclusion: Some procedures like biopsy, tumor marker, could differentiate the subtype of mediastinal germ cell tumor. The multimodality treatment by combining surgical therapy (surgical sternotomy and tumor debulking) with chemotherapy could increase the survival rate of patients.

Tumor maligno mixto de células germinales de ovario. Reporte de caso

Los tumores malignos de células germinales del ovario, aunque poco frecuentes, son el tipo más común de neoplasias ováricas malignas en niñas y adolescentes; aproximadamente dos tercios de ellas menores de 20 años. Representan 2% a 5% de todos los tumores ováricos de origen germinal. Los tumores comprenden dos o más tipos de componentes de células germinales, e incluyen al disgerminoma acompañado de tumores del seno endodérmico, carcinoma de células embrionarias, teratoma maduro o inmaduro y/o coriocarcinoma. Existen pocos informes de casos de tumores de células germinales mixtas con diferentes combinaciones de componentes malignos. La alfafetoproteína y la gonadotropina coriónica humana son los marcadores tumorales más característicos. Los hallazgos inmunohistoquímicos son importantes para el diagnóstico. La cirugía más quimioterapia adyuvante es la primera opción para preservar la fertilidad en cualquier niña o adolescente que presente con un tumor pélvico en rápido crecimiento. Se presenta un caso de tumor maligno mixto de células germinales de ovario.