Missed mixed germ cell tumor of the ovary in pregnancy

A report describes a case of a 34-year-old primigravida at 37 weeks + 5 days POG who came in latent labor. A term scan demonstrated a fibroid of 11x 9 cm in the posterior wall in the lower uterine segment with the central cystic area. 

The patient underwent emergency LSCS and delivered a male baby (wt 2.005 kg). Exteriorization of the uterus revealed a 10 x 8 cm necrotic mass posterior to the uterus in rectovaginal space, which was inferred as FIGO Stage IC1 ovarian carcinoma.

Histopathology of the mass demonstrated mixed germ cell tumor: 60% yolk sac tumor and 40% dysgerminoma.

MRI done after two weeks showed a lesion of 10.4 x 9.5 x 7.3 cm in the rectovaginal pouch, compressing and displacing the rectum posteriorly and to the left side, also displacing the uterus and bladder anteriorly. Her Left ovary was normal, while her Right ovary was not visualized. Therefore, she received four cycles of chemo comprising cisplatin and etoposide.

After chemo, a PET scan revealed a lesion of 6.7x 6.2 x 4.2 cm in the rectovaginal area just right to the midline, with the right ovary not seen distinctly. Hence, she underwent laparoscopic right oophorectomy. Histopathology showed profound regressive changes with few scattered atypical cells with no definitive evidence of residual tumor. Follow-up serum LDH and AFP came within normal limits, and the patient was advised to follow up once in 3 months to look for any recurrences.

Pais J A, Fernandes V R, Rao S V, A case of missed mixed germ cell tumor of ovary in pregnancy. Indian J ObstetGynecol Res. 2023;10(2):214-216