A Rare Association in Ovarian Mixed Germ Cell Malignancy: A Case Report

Case Reportcarcinoma, yolk sac tumor and mature teratomatous glandular component is reported. Case SummaryA 19-years unmarried girl turned up in the outpatient division of the department of gynecologic oncology of The Gujarat Cancer and Research Institute, with a chief complaint of abdominal pain for the past one month.There were no other associated symptoms or significant histories.She had regular menstrual cycles.Clinically, her performance status was good with a Karnofsky grade of 90.Her general examination revealed normal secondary sexual characteristics.On per abdominal examination, there was a large mass, cystic to firm in consistency reaching almost to the xiphisternum with restricted mobility.Her magnetic resonance imaging revealed a 14x18x25 cm solid-cystic lesion causing moderate ureteric compression.Her tumor marker analysis showed an elevated -HCG (128186 IU/L), LDH (1465 U/L) and CA-125 (58.5 U/mL).Other parameters were within normal limits.In view of elevated -HCG, a detailed history pertaining to conception to rule out gestational choriocarcinoma was elicited.Followed by this, a provisional diagnosis of mixed germ cell tumor was made.Primary staging laparotomy was performed on the patient.The intraoperative finding revealed a right-sided adnexal mass which was sent for frozen section analysis (Figure 1).The report was suggestive of a mixed germ cell tumor.The staging included peritoneal wash sampling, multiple peritoneal biopsies and a biopsy from the suspicious area over the right fallopian tube, right-sided pelvic lymph node dissection and infracolic omentectomy.The uterus and left ovary were preserved.Her intraoperative and postoperative SummaryThe Ovarian germ cell tumors, mixed variant constitute a rare malignancy with two or more germ cell elements frequently presenting among the adolescents.These tumors exhibit an aggressive growth pattern.However, the prognosis are reported to be outstanding.This article reports a case with rarest blend of four germ cell elements.An unmarried 19-years-old girl presented with chief complaint of pain over the abdomen lasting since a month.Clinical evaluation suggested a 14x18x25 cm ovarian unilateral solid-cystic lesion necessitating surgical intervention with tumor marker analysis showing an elevated -HCG, LDH and CA-125.A fertility-sparing surgical procedure of staging laparotomy was performed.The final histopathology report reported a high-grade stage II mixed germ cell tumor.The tumor components included Choriocarcinoma, Embryonal carcinoma, Yolk sac tumor and mature teratomatous glandular component.Adjuvant chemotherapy was administered for 3 cycles.The patient was found disease-free on post-treatment surveillance for 6 months.An integrated approach including surgery followed by chemotherapy and adequate surveillance provides good results in the management of these malignancies.