Sarcomatous Transformations Causing Early Recurrence in Malignant Mixed Germ Cell Tumor: From case to analysis

Aim: Our aim is to analyze the malignant mixed germ cell tumors of the ovary that recur due to sarcomatous transformation in the literature, with a case report. Materials and Methods: An electronic database search was conducted from January 1980 to January 2023 using PubMed/MEDLINE. We evaluated the 10 cases included in these articles together with our own case. Patient age (years), first surgery type, tumor types, adjuvant therapy type, recurrence time, recurrent tumor types, and recurrence site were analyzed. Results: We evaluated 11 cases, including our own. The mean age of the 11 patients was 27.36±16.39 years. Nine patients (81.8%) had rhabdomyosarcoma differentiated areas in primary pathology. Ten patients (90.1%) received adjuvant chemotherapy. The mean recurrence time was 10±8.94 months, ranging from 2 to 24 months. Reported areas of recurrence included retroperitoneal, peritoneal, pelvic, scapula, aortic bifurcation, abdominal cavity, and mediastinal area. Discussion: We compiled ten cases in the literature with rhabdomyosarcoma transformation, including our case. Although the prognosis of GCT depends on the clinical stage and location, the presence of a sarcomatous area in GCT is a factor indicating a more aggressive behavior. Diagnostic imaging, including PET-CT scans, can be used for staging recurrent lesions and demonstrating local lymphatic metastasis or lung metastasis, which may indicate sarcomatous differentiation. Conclusion: In patients with sarcomatous differentiation, the choice of chemotherapy may vary according to this component. It is important to determine the presence of the sarcomatous component in malignant germ cell tumors with detailed pathological examination. Close follow-up with radiological means is crucial to detect early recurrence and distant metastases as a result of sarcomatous transformation, as in our case.