Malignant ovarian germ cell tumors are a rare, heterogeneous group that account for approximately 1% to 2% of the 21,000 new cases of ovarian cancer each year.90 Germ cell tumors (benign and malignant) account for 20% to 25% of all ovarian neoplasms and 58% of tumors in women under age 20. As the name implies, these tumors arise from the primordial germ cells of the ovary and thus share characteristics with malignant germ cell tumors of the testis. In fact, given that ovarian germ cell tumors occur at about one tenth the rate of testicular tumors, many of the advances in therapy, particularly in chemotherapy regimens, were first studied in male patients, and then extrapolated to women.91 Another characteristic of germ cell tumors is the possibility of primary extragonadal tumors whose location (e.g., retroperitoneal or mediastinal) corresponds to the track taken by germ cells during embryonic development.92
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