Histology	Primary Site	Stage	Treatment
Mature teratoma	All sites	Localized	Surgery + Observation
Immature teratoma	All sites	Localized	Surgery + Observation
Malignant germ cell tumors	Testicular	Stage I	Surgery + Observation
		Stages II–IV*	Surgery + PEB
	Ovarian	Stage I	Surgery + Observation
		Stages II–IV	Surgery + PEB
	Extragonadal	Stages I–II	Surgery** + PEB
		Stages III–IV*	Surgery** + PEB

*Patients ≥15 years with stage IV testicular tumors and all patients with stages III and IV extragonadal tumors treated with PEB have suboptimal outcome and should be considered for more intensive therapies.

**The role for surgery at diagnosis for extragonadal tumors is age- and site-dependent and must be individualized. Depending on the clinical setting, the appropriate surgical approach may range from no surgery (e.g., mediastinal primary tumor in a patient with a compromised airway and elevated tumor markers), to biopsy, to primary resection. In some cases, an appropriate strategy is biopsy at diagnosis followed by subsequent surgery in selected patients who have residual masses following chemotherapy.