Advanced Endodermal Sinus Tumor With Contralateral Dermoid Tumor During Pregnancy: A Case Report and Literature Review

Abstract

An endodermal sinus tumor (EST) of the ovary and a contralateral dermoid cyst occur rarely in pregnancy. Alternative treatment for reducing the long-term sequelae in both the mother and fetus should be considered during pregnancy. At 27 weeks of gestation, a patient was diagnosed with advanced EST, FIGO (International Federation of Gynecology and Obstetrics) stage IIIc, by magnetic resonance imaging and surgery. Following optimal debulking surgery, three cycles of multi-agent chemotherapy, consisting of 25 mg/m2 cisplatin and 100 mg/m2 etoposide on days 1 to 4, were instituted at 21-day intervals. Maternal serum !-fetoprotein and CA125 titers soon returned to normal pregnancy levels. A healthy male infant was delivered at 38 weeks of gestation by cesarean section, after which a second-look laparotomy was performed. The micropathologic findings were negative for malignancy, except that a dermoid tumor of the right ovary was confirmed. Consolidation treatment with two cycles of chemotherapy, consisting of 20 mg/m2 cisplatin and 100 mg/m2 etoposide on days 1 to 5 and a total of 30 mg/day of bleomycin on days 6 and 7, was administered at 28- day intervals. The patient had no evidence of disease for 16 months, and her infant son has shown adequate growth and normal development. For pregnant women with an EST of the ovary, the optimal treatment modalities might be initial optimal debulking surgery followed by alternative chemotherapy, and further standard chemotherapy after delivery.