Hint: Tumor and reproductive outcomes were meticulously evaluated in 42 patients in the study. All patients received a uniform treatment paradigm: comprehensive tumor cytoreduction with preservation of reproductive function, with or without chemotherapy with BEP regimen (bleomycin, etoposide and cisplatin). The survival prognosis was excellent with good reproductive endocrine outcomes regardless of histological type or FIGO stage. This is a study from Korea that included children younger than 16 years or adolescent girls. A total of 42 patients with malignant germ cell tumors (MOGCT) met the criteria, with a median age of 12 years (range 6-16 years) and 29 with premenarcheal status. The most common histologic type was immature teratoma, and 30 (54.3%) had stage I MOGCT. all patients underwent comprehensive tumor cytoreduction with preservation of reproductive function, i.e., at least one side of the adnexa and uterus. None of them had residual lesions. Intraoperatively, 13 patients had tumor rupture, 2 had positive cytology in the abdominal washout, and 2 had lymph node metastasis. Postoperatively, 31 patients received chemotherapy with bleomycin, etoposide and cisplatin (BEP) regimen for a median number of 4 cycles (range 1-6). After a median follow-up of 93 months (range 22-217), there were 6 recurrences and 1 death. Five-year disease-free survival and overall survival rates were 85% and 97%, respectively. Of the 41 patients who survived, 7 had a pre-menarcheal state, 30 had regular menstruation, and 3 had irregular menstruation. No patient developed premature ovarian failure. No one attempted pregnancy, so the reproductive outcome is unknown. Table 2 in the table below shows the surgery and Table 3 shows the patients with recurrent or persistent lesions. Figure 1 shows PFS and OS.