Huge ovarian embryonal cell carcinoma in an adolescent girl: A case report

Abstract

Pure ovarian embryonal carcinoma is a rare type of germ cell tumor, usually presenting in adolescent age group with only 30 odd cases reported in literature. They are mostly reported as one of the component of mixed malignant ovarian germ cell tumor. Tumor markers such as Human Chorionic Gonadotropin (HCG), and alpha-fetoprotein (AFP) and Lactate Dehydrogenase (LDH) also contribute to the diagnosis, prognosis and follow - up of germ cell tumors. Here, we report a rare case of a pure ovarian embryonal cell carcinoma in an adolescent girl with atypically raised LDH levels whereas the other markers such as AFP, HCG, CA-125 were normal.A 13 year old adolescent girl presented with pain abdomen and abdominal mass. Ultrasound and CT scanning showed a huge multi-cystic septate abdomino -pelvic mass involving the right ovary. We performed fertility sparing staging laparotomy with right salpingo-oopherectomy, saving the uterus and the left ovary. Presently, patient has completed 3 cycles of adjuvant chemotherapy (BEP regimen). Pure embryonal carcinoma, being an extremely rare tumor, the treatment outcomes and long-term disease-free survival is unknown, often data is extrapolated from its testicular counterpart, however treatment is standardized with fertility sparing USO and combination chemotherapy as the patients are very young. Recurrences occur mostly in the first 2 years following primary treatment. Also, secondary malignancies due to chemo-toxicity is a concern, as patients are very young, warranting a long and intensive surveillance.