TREATMENT OF PURE DYSGERMINOMAS OF THE OV ARY WITH PRESERVATION OF FERTILITY

Between 1982 and 1990, five patients (age 13 - 22 years) with pure dys germinoma of the ovary were treated at the Department of Obstetrics an d Gynecology, University Hospital of Cologne. At laparotomy two women were proved to have FIGO-stage IA disease, the others had IC, IIC and IIIC disease, each. In three of five patients the tumor markers CEA, A FP, beta-hCG, LDH, and CA 125 were evaluated before primary surgery: n o patient showed an elevation of CEA and AFP levels; increased CA 125 levels were found in all three cases; in two of three patients beta-hC G levels were slightly and LDH levels markedly elevated being more tha n 18 times the upper limit of normal in one case. Serum beta-hCG conce ntrations returned to normal in the immediate postoperative period, LD H and CA 125 levels fell to normal prior or immediately after the firs t course of chemotherapy. Preservation of fertility was carried out at primary surgery in four of five patients except one with known gonada l dysgenesis; postoperative chemotherapy was given to two patients wit h stage IIC and IIIC disease. Complete remission has been achieved in all five patients for a follow-up between 39-120 months. One patient ( stage IA disease) had three consecutive full-term deliveries. Accordin g to these results we recommend preservation of fertility for young pa tients with pure dysgerminoma of the ovary, regardless of the stage of the disease, provided that uterus and contralateral ovary are not inv olved. beta-hCG, CA 125, and LDH appear to be useful tumor markers in the diagnosis and management of pure dysgerminomas.