Pure malignant immature teratoma of the ovary: the role of chemotherapy and second-look surgery.

Fifteen patients with pure malignant immature teratoma of the ovary were treated at the Institut Gustave Roussy over a 17-year period. Chemotherapy was delivered as primary postoperative therapy in 11 patients. Four other patients received chemotherapy as part of their salvage treatment for recurrent disease. A second-look laparotomy was performed in eight patients. Histological findings were: no tumor in three patients, mature teratoma in four patients, and immature grade 1 teratoma in one patient. The latter five patients had persistent radiologic abnormalities at the end of chemotherapy. Twelve patients remain free of disease 24-228 months from initiation of chemotherapy. Two children were delivered from the two patients who attempted pregnancy. All three patients who died of progressive disease had a grade 3 immature teratoma. We conclude that the treatment of pure immature teratoma of the ovary should include primary conservative surgery and cisplatin-based chemotherapy. Second-look surgery is mandatory in patients with persistant radiologic abnormalities at the completion of chemotherapy.