The peak incidence of ovarian germ cell tumors is between ages 15 and 19 years, and one third of these tumors are malignant.90 Ovarian germ cell tumors are generally rapid-growing and thus nearly 85% of patients present with abdominal and pelvic pain/pressure and a palpable mass.94,96 Rupture, hemorrhage, and torsion are often seen and can mimic the picture of acute appendicitis. A few patients may present with signs of precocious puberty as a result of the production of hormones such as P-hCG and estrogen.93,94 Given that the peak incidence of ovarian germ cell tumors is in the reproductive years, they are often seen in the setting of pregnancy. In one study including over 9000 adnexal masses found during pregnancy, 44% of the 81
cancers were germ cell tumors; of these, dysgerminoma (41%) was the most common histology.97
Seventy percent of patients present with International Federation of Gynecology and Obstetrics (FIGO) stage I-II disease, with the bulk of the remaining 30% representing stage III tumors.98 Most tumors are unilateral with the notable exception of dysgerminomas, which are reported to be bilateral in 10% to 15% of cases. Nevertheless, one series of 26 cases over 15 years noted a 23% rate of bilateral involvement.98 Despite this, bilaterality does not necessarily equate with malignancy, since benign cystic teratomas of the contralateral ovary are also seen in 5% to 10% of cases.94
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