A rare case of mixed germ cell tumor in a teenage girl: a case report
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20172378Keywords:
Embryonal cancer, Mixed germ cell tumor, Non-gestational choriocarcinoma, Yolk sac tumor/endodermal sinus tumorAbstract
Germ cell tumors represent only 20% to 25% of all benign and malignant ovarian neoplasms. Mixed germ cell tumors are a rare variety of non–dysgerminomatous germ cell tumors. They contain two or more elements; the most frequent combination being a dysgerminoma and an EST (Endodermal Sinus Tumor). We present a case of malignant mixed germ cell tumor comprising of yolk sac tumor, embryonal carcinoma and choriocarcinoma. A 13-year-old girl presented with a huge 25 x 18 cm mass in abdomen with raised values of CA-125, hCG, AFP (alpha-feto protein) and LDH (lactate dehydrogenase). She underwent laparotomy followed by unilateral salpingoopherectomy and infracolic omentectomy. Histopathology report revealed malignant mixed germ cell tumor comprising predominantly of EST with elements of embryonal carcinoma and non-gestational choriocarcinoma. Following surgery, she was started on adjuvant chemotherapy (Bleomycin, Etoposide and Cisplatin regimen). Mixed germ cell tumor (YST/EST, non-gestational choriocarcinoma and embryonal carcinoma) is a very rare tumor. Careful initial surgery with adequate staging biopsies followed by combination chemotherapy can greatly improve the prognosis of these patients
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References
Gershenson DM. Update on malignant ovarian germ cell tumors. Cancer. 1993;71(4 Suppl):1581-90.
Scully RE, Young RH, Clement PB. Tumors of the ovary, maldeveloped gonads, fallopian tube, and broad ligament. In: Atlas of tumor pathology. Washington, DC: Armed Forces Institute of Pathology. 1998: Fascicle 23,3rd series.
Berek JS, Friedlander M, Hacker NF. Epithelial ovarian, fallopian tube and peritoneal cancer. In: Berek and Hacker’s gynecologic oncology. 5th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2009:443-508.
Kurman RJ, Scardino PT, Waldmann TA, et al. Malignant germ cell tumors of the ovary and testis: an immunohistologic study of 69 cases. Ann Clin Lab Sci. 1979;9:462-66.
de Jolinière JB, Ben Ali N, Fadhlaoui A, Dubuisson JB, Guillou L, Sutter A et al. Two case reports of a malignant germ cell tumor of ovary and a granulosa cell tumor: interest of tumoral immunochemistry in the identification and management. Front Oncol 2014;4:97.
Trinh DT, Shibata K, Hirosawa T, Umezu T, Mizuno M, Kajiyama H et al. Diagnostic utility of CD117, CD133, SALL4, OCT4, TCL1 and glypican-3 in malignant germ celltumors of the ovary. J Obstet Gynaecol Res. 2012;38(5):841-8.
Kawai M, Kano T, Furuhashi Y, Misawa T, Nakashima N, Hattori S. Prognostic factors in yolk sac tumours of ovary. A clinicopathological analysisof 29 cases. Cancer. 1991;67:184-92.
Kurman RJ, Norris HJ. Embryonal carcinoma of the ovary. A clinicopathological entity distinct from endodermal sinus tumour resembling embryonal carcinoma of the adult testis. Cancer. 1976;38:2420-33.
Low JH, Perrin LC, Crandon AJ, Hacker NF. Conservative surgery to preserve ovarian function in patients with malignant ovarian germ cell tumours. A review of 74 cases. Cancer. 2000;89:391-8.
Nishio S, Ushijima K, Fukui A, Fujiyoshi N, Kawano K, Komai K et al. Fertility-preserving treatment for patients with malignant germ cell tumors of the ovary. J Obstet Gynaecol Res. 2006;32:416.
Tewari K, Cappuccini F, Disaia P, Berman ML, Manetta A, Kohler MF. Malignant germ cell tumors of the ovary. Obstet Gynecol. 2000;95:128.
Zanetta G, Bonazzi C, Cantu M, Bini S, Locatelli A, Bratina G et al. Survival and reproductive function after treatment of malignant germ cell ovarian tumors. J Clin Oncol. 2001;19(4):1015-20.
Gershenson DM. Management of ovarian germ cell tumors. J Clin Oncol. 2007;25:2938.