In mature and immature teratoma the treatment is surgical. The risk ofrecurrence can be estimated from the parameters primary site (with thecoccygeal tumors being most at risk), histological grade of immaturity andcompleteness of the primary resection including the adjacent organ of origin(coccyx, ovary, testis etc.). In case of a microscopically complete tumorresection there is no role for adjuvant chemo- or radiotherapy irrespectiveof the histological grade of immaturity.
Malignant germ-cell tumors (GCT) account for 2.9% of all malignanttumors of children younger than 15 years of age. More than half of the tumorsoccur at extragonadal sites such as the ovaries (26%), the coccygealregion (24%), the testes (18%) and the brain (18%)represent then primary sites.
In patients with extensive tumor growth, metastatic disease or secretingintracranial tumors a delayed tumor resection after preoperative chemotherapyis preferable. In these patients malignant non-seminomatous GCT may bediagnosed clinically due to the increased serum or cerebrospinal fluid levelsof the tumor markers AFP and/or β-HCG. Current risk adapted treatmentprotocols containing cisplatinum allow long-term remissions in about80% including patients with bulky or metastatic tumors. In thecisplatinum era the prognostic factors like histology, primary site of thetumor and initial tumor stage have partly lost their former impressivesignificance in infants and children. On the other hand the completeness ofthe primary tumor resection according to oncological standards has beenestablished as the most powerful prognostic parameter superior to tumor markerlevels or primary site of the tumor.