A case of missed mixed germ cell tumor of ovary in pregnancy

Abstract

Ovarian germ cell tumor accounts for 18-26% of all ovarian cancers complicating pregnancy. This is a rare case of mixed germ cell tumor of ovary, misdiagnosed antenatally as uterine fibroid. A 34-year-old primigravida at 37 weeks + 5 days POG came in latent labor. Term scan showed fibroid of 11x 9cms in posterior wall in lower uterine segment with central cystic area. She underwent emergency LSCS and delivered a male baby weighing 2.005 kg. On exteriorization of uterus, a 10 x 8 cm necrotic mass was present posterior to uterus in rectovaginal space measuring 10 x 8 cm. It was concluded as FIGO Stage IC1 ovarian carcinoma.Histopathology of the mass showed mixed germ cell tumor: 60% yolk sac tumor and 40% dysgerminoma. MRI done after 2 weeks showed a lesion of 10.4 x 9.5 x 7.3 cm in rectovaginal pouch compressing and displacing the rectum posteriorly and to the left side, also displacing uterus and bladder anteriorly, Left ovary normal, Right ovary not visualized. Hence, she received 4 cycles of chemo comprising cisplatin and etoposide.After chemo, PET scan showed a lesion of 6.7x 6.2 x 4.2 cm in the rectovaginal area just right to the midline with right ovary not being visualized separately. Hence, she underwent laparoscopic right oophorectomy. Histopathology showed extensive regressive changes with occasional scattered atypical cells with no conclusive evidence of residual tumor. Follow up serum LDH and AFP are within normal limits and advised to follow up once in 3 months to look for any recurrences. : Any mass during pregnancy even if found to be benign, should be further evaluated and monitored regularly to reduce the morbidity /mortality to the mother.