Therapie von Keimstrang-Stroma-Tumoren und Keimzelltumoren des Ovars

Many of the sex cord-stromal tumors (thecoma, fibroma, gynandroblastoma, Leydig cell tumor, etc.) are benign or have a low malignant potential and good prognosis. Other sex cord-stromal tumors (granulosa cell tumors, moderately or poorly differentiated Sertoli-Leydig cell tumors, etc.) can have a malignant potential resulting in a fatal course. Except for pure fibromas, most produce steroids. This may result, depending on the patient’s age, in precocious pseudopuberty, disturbances in fertility and menstruation pattern and postmenopausal bleeding. Often, hyperplasia or even carcinoma of the endometrium are found. The therapy of sex cord-stromal tumors is resection, the extent of which depends on the malignant potential of the tumor. Ovarian germ cell tumors constitute a heterogenous group of tumors that develop from totipotent primordial germ cells. In general, the prognosis can be considered favorable if patients are treated according to current standards. Therapy follows a multimodal approach. Recent advances have aimed at the preservation of fertility. Appropriate intraoperative staging is crucial to adequately treat the cancer without comprising future fertility. The introduction of platinum-based chemotherapy represents a significant breakthrough in adjuvant treatment. Patients with stage I disease, except for dysgerminoma and low grade immature teratoma, as well as advanced-stage disease of all germ cell histologies, require adjuvant treatment with bleomycin, etoposide and cisplatin.