Diagnosis and treatment of a mixed ovarian malignant germ cell tumor with glioblastoma transformation.

Objectives: Mixed malignant germ cell tumors of the ovary consist of two or more germ cell components, and are a rare but aggressive gynecologic malignancy which typically affect women in early reproductive years. Very few cases of mixed malignant germ cell tumors with glioblastoma component are reported in the literature, and little is known about the most appropriate chemotherapy regimen and long-term outcomes for these rare tumor presentations. Methods: Presented here is the case of a 44-year-old female patient diagnosed with a stage III mixed malignant germ cell tumor of the ovary consisting of immature teratoma (95%) and yolk sac tumor (5%), with concurrent transformation of mature neural tissue to glioblastoma. The patient underwent primary staging surgery with evidence of gliomatosis peritonei on final pathology. Results: In collaboration with neuro-oncology, the decision was made to not alter adjuvant treatment plan on account of the glioblastoma component of this case, so the patient underwent adjuvant chemotherapy with four cycles of bleomycin, etoposide, and cisplatin (BEP) and has been followed for 2.5 years from completion with no evidence of recurrence. Conclusions: The case presented here discusses the rare presentation of mixed malignant germ cell tumor of the ovary with concurrent glioblastoma transformation and gliomatosis peritonei. While long-term outcomes cannot be concluded based on this case, excellent treatment response has been seen at 2.5 years, suggesting that traditional BEP therapy regiment should be considered for similar cases.