A mysterious malignant mixed germ cell tumor with successful term pregnancy- an enigma

Ovarian germ cell tumors (GCT) comprise 15-20% of ovarian neoplasms of which 3-5% are malignant. The incidence of ovarian germ cell tumor in pregnancy is low and malignant GCT account for 18-26%. Among the malignant GCTs, Dysgerminoma is the most common tumor followed by Yolk sac tumor. An interesting case of Malignant mixed germ cell tumor in 23-year old pregnant lady who had a full term normal delivery is reported. The patient remained asymptomatic till term pregnancy. Routine ultrasonography misdiagnosed as swelling as a fibroid in early 8 week of gestation, which progressed to a size 13x10cm at 32 week gestation. At 38 weeks, patient underwent LSCS along with resection of the tumor which mimicked as fibroid. On histopathological examination along with Immunohistochemistry, it was reported as malignant mixed GCT with Dysgerminoma (85%) and Yolk sac tumor (15%) components. Misdiagnosis is not uncommon in pregnancy; hence multidisciplinary approach can help in arriving at an earlier and correct diagnosis which further helps in early and appropriate treatment thereby increasing the survival rates. This case is reported for its rare presentation mimicking as a fibroid radiologically and histopathological examination reported as Malignant Mixed GCT and was associated with a successful term viable pregnancy.