Malignant germ cell tumors of the ovary - Pregnancy considerations

Objective: To study the pregnancy association and malignant germ cell tumor s of the ovary with regard to its effects on tumor prognosis. Study Design: : Seventy-five patients with malignant germ cell tumors of the ovary treate d at the King Faisal Specialist Hospital-Research Center (KFSH-RC) Riyadh, Kingdom of Saudi Arabia between January 1976 and December 1992, were review ed. Data was retrieved from the medical records and the database of ovarian tumor pathology. Patients with tumor/pregnancy association were identified and correlation with obstetrical outcome and tumor prognosis analyzed. Pat ients who conceived after treatment were identified and their reproductive outcome described. Results: Malignant germ cell turner was associated with pregnancy in a group of ten patients. Possible tumor effects upon pregnancy in this group included operative delivery by caesarean section (n=3), mid- trimester termination (n=2), spontaneous abortion (n=1). Four patients had normal vaginal birth with no apparent tumor effects upon pregnancy. Pregnan cy did not seem to influence the tumor prognosis of pure dysgerminoma (n=6) , however, two patients with non-dysgerminomatous germ cell tumor tone endo dermal sinus tumor and one immature teratoma) died of rapidly progressive d isease during the second trimester. Two patients with advanced (stage IIIC) disease concurrent with pregnancy tone pure dysgerminoma and one mixed ger m cell tumor), had normal fetal outcomes and achieved long-term survival. A mongst the 22 patients who planned to conceive after conservative surgery, with or without post-operative adjuvant chemotherapy, 12 conceived (12/22) and achieved a total of 20 pregnancies. Their outcomes included normal birt hs (n=18) including one set of twins and hydatidiform moles (n=2). Conclusi ons: Our findings suggest that, (1) The association of pure dysgerminoma an d pregnancy did not adversely affect the tumor prognosis or fetal outcome. However, the question remains as to whether pregnancy worsened the prognosi s of non-dysgerminomatous germ cell tumors. (2) Recent platinum-based regim ens of multiagent chemotherapy for germ cell tumors did not seem to affect fertility potential. (C) 2000 Elsevier Science Ireland Ltd. All rights rese rved.