Updates in the Management of Malignant Ovarian Germ Cell Tumors.

Malignant ovarian germ cell tumors are rare malignancies primarily affecting adolescents and young adults. Management must balance curative intent with fertility preservation. This review highlights recent advances in malignant ovarian germ cell tumor management, focusing on risk-stratified approaches, surgical techniques, somatic transformation, and long-term surveillance. The bleomycin/etoposide/cisplatin regimen remains the first-line therapy. Fertility-sparing surgery, including unilateral salpingo-oophorectomy with minimal staging, is recommended for adolescent and young adult patients. Chemotherapy is not recommended for those with surgically resected immature teratomas. In advanced-stage malignant ovarian germ cell tumors, adjuvant chemotherapy may be considered for frail patients with chemosensitive tumors. Given the risk of late complications, long-term surveillance and lifelong care are essential for survivors. Future directions emphasize molecular profiling to guide personalized treatment. Multidisciplinary care, precision surgery, and tailored systemic therapies continue to improve survival while preserving quality of life. Collaborative trials are crucial for standardizing salvage approaches and mitigating long-term toxicities, ensuring optimal outcomes for this young, survivorship-focused population.