A 24-year-old woman undergoes fertility-sparing unilateral salpingo-oophorectomy for a right ovarian immature teratoma. Final histopathology reports grade 2 immature teratoma with microscopic implants of immature tissue on the ipsilateral fallopian tube serosa (FIGO Stage IC2). Peritoneal washings are negative. What is the most appropriate next step?

• A Close surveillance with tumour markers and imaging alone
• B External beam pelvic radiotherapy
• C Adjuvant bleomycin, etoposide and cisplatin (BEP) chemotherapy ✓
• D Completion hysterectomy with contralateral salpingo-oophorectomy

Explanation

Stage IA grade 1 immature teratomas may be observed after surgery, but grade 2 or 3 tumours, or any stage beyond IA, carry recurrence risk and merit adjuvant platinum-based chemotherapy, conventionally three cycles of BEP, which preserves fertility prospects. Radiotherapy has no role. Completion surgery sacrifices reproductive function without added benefit when staging is otherwise limited. Surveillance alone risks relapse of chemosensitive disease.

Reference: Williams Gynecology, 4th ed.

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Written and medically reviewed by the StethoPrep medical team.