BACKGROUND: Immature teratoma is malignant ovarian germ cell tumours (MOGCTs). The case in pregnancy is very rare which less than 1% of all ovarian teratoma cases. The aim is to reach optimal and comprehensive management for immature ovarian teratoma in pregnancy to gain the healthiest maternal and fetal outcomes. CASE PRESENTATION: Thirty-one years old female G2P1A0, 8 weeks 1-day pregnancy, with left ovarian solid tumour 15 x 15 x 15 cm in size. At gestational age (GA) of 19 weeks 5 days, the size of the tumour was increasing rapidly to 30 x 30 x 30 cm. Alfa-fetoprotein raised to 699.9 IU/mL and LDH 579 U/L. The patient had gone primary conservative left oophorectomy, omentectomy, and ascites fluid cytology with histopathological conclusion grade II immature teratoma of left ovary containing the immature neuroepithelial and fat component: magnetic resonance imaging (MRI) at 25 weeks 3 days GA, no spreading. Amniocentesis performed at 27 weeks 2 days GA, the fetus had normal 46 chromosomes and sex XX without major structural abnormality. The patient had BEP chemotherapy start at 27 weeks 2 days GA. Patient in labour at 40 weeks 2 days GA. The female baby had spontaneous delivery with 2700 grams in body weight without congenital abnormality. Complete surgical staging performed at 58th days postpartum and histopathological result there was no malignant cell anymore, but post-chemotherapy ovarian atrophy feature had found on the contralateral ovary. The patient showed psychosocial problem including post-chemotherapy depression and premature ovarian failure (POF). Immunohistochemistry (IHC) ER and PR of teratoma tissue showed immature component had ER (-) and PR (+). Follow up of the baby was in good condition. CONCLUSION: BEP chemotherapy become regimen choice for this case with fetal outcomes was good, but there was a POF sign on the mother. Survival of patient on this case is 62%, free recurrence survival post-BEP 84% and progressivity post complete surgical staging 8% without delay the chemotherapy.

BACKGROUND: Malignant Ovarian Germ Cell Tumors (MOGCT) most commonly occur in young women in the reproductive age group. Timely antenatal diagnosis and treatment of the tumour to enhance maternal and perinatal outcomes are the main challenges confronting the obstetrician and the gyne-oncologist. CASE PRESENTATION: Here we present three cases of pregnancy complicated with MOGCTs. The first case (immature teratoma) was complicated by maternal psychological symptoms consistent with stress and histopathological examination confirmed the diagnosis of premature ovarian failure (POF). The second case (dysgerminoma) preterm labour occurred as an obstetric complication, but the baby was born in good condition without IUGR. The third case (yolk sac tumour) treated with docetaxel (brexel)-carboplatin chemotherapy administration there was no maternal or fetal complication. At the end of the pregnancy and delivery, complete surgical staging and cytoreduction were performed, and no metastases were found. CONCLUSION: Optimal management strategies centre on a multi-disciplinary comprehensive team approach is critical resulting in better outcomes for the mother and the baby by avoiding complications.