Malignant Ovarian Mixed Germ Cell Tumor with High-risk Pathology in a Young Woman: Review of Literature

Background and Aims: Since malignant germ cell tumors (MGCTs) are more frequent in young women, fertility preservation and survival are two main points of management. Here, we introduce a patient with an aggressive MGCT and discuss the fertility preservation in poor prognoses and aggressive tumors. Case Presentation: A 27-year-old G1L1 woman was admitted with bilateral ovarian mass, acute pain, and increased tumor markers. Laparotomy revealed multiple large masses. Optimal debulking and staging were performed. In the final pathology, a MGCT (immature teratoma G2 60-70% + embryonal carcinoma 30-40%) was reported. The patient returned for chemotherapy after a 35-day gap. Before beginning the chemotherapy, aggressive growth of the tumor and multiple metastases were observed. The patient underwent chemotherapy but the tumor progressed again, and in the MRI performed after chemotherapy, diffuse peritoneal carcinomatosis and tumor growth was observed. Unfortunately, the patient expired. Conclusion: fertility preservation surgery despite optimal debulking is not always associated with a favorable prognosis in high-stage or high-risk patients. In cases of advanced and/or aggressive pathology types (IT, YST, EC), it is logical to consult with the patient and her family to abandon conservative surgery and select more radical surgery.