Abstract
A 32 year-old P4 G4 was referred from a rural hospital for fibroids in pregnancy. The pregnancy test was positive. An ultrasound scan reported a huge left extrauterine mass. The uterus was of normal size. There was no pregnancy demonstrated. A laparotomy was done through a midline incision. There was a huge left ovarian tumour occupying the pelvic/abdominal region right up to the xiphisternum. A left salpingo-oophrectomy was done. The post operative period was uneventful. The histopathological report confirmed the diagnosis of ovarian dysgerminoma FIGO stage 1A. She was referred to oncologists for adjvunt chemotherapy.
Introduction
Ovarian dysgerminomas are malignant germ cell tumours occurring in young women. 1 Germ cell tumours account for about 20% of ovarian tumours, the commonest being dysgerminoma. 2
Case report
A 32-year-old woman, P4 G4, was referred from a rural hospital for fibroids in pregnancy after being followed up to 26 weeks of gestation. She had previously had four normal deliveries. She said the mass grew over a period of 4 years.
She was wasted with a BMI of 20 kg/m2. The fundal height was 33 cm (Figure 1). There were no fetal parts nor heartbeat felt. The pregnancy test was positive. An ultrasound scan reported a huge left extrauterine mass. The uterus was of normal size. There was no pregnancy demonstrated.
Photograph of abdominal swelling, mimicking pregnancy.
Full blood count showed a normocytic normochromic anaemia of 9.2 g/dl, a platelet count of 321 and a leucocyte count of 2.87. The chest radiograph, liver function tests, urea and electrolyte levels were all normal. Two units of blood were transfused, the post-transfusion haemoglobin reaching 11.5 g/dl.
A laparotomy was carried out through a midline incision. There was a huge left ovarian tumour occupying the pelvic/abdominal region right up to the xiphisternum. The mass was smooth in outline and was not attached to any other structures. The uterus and right ovary appeared normal. There were no other significant findings. A left salpingo-oophrectomy was performed (Figure 2). Postoperative recovery was uneventful.
Ovarian mass (5 kg), with well circumscribed smooth surfaces, removed from the patient.
The histopathological report confirmed a diagnosis of ovarian dysgerminoma FIGO Stage 1A. She was referred for adjuvant chemotherapy.
Discussion
Ovarian dysgerminomas can produce markedly elevated serum ß-human chorionic gonadotrophin levels3,4 and hence can give a positive pregnancy test as happened in this case.
The treatment for ovarian dysgerminomas may be radical surgery, conservative surgery and/or chemotherapy. Conservative surgery 5 with adjuvant chemotherapy has made the preservation of fertility possible even with advanced diease. 6 It also prevents iatrogenic premature menopause.
The 5-year survival rate for ovarian dysgerminoma Stage 1 A can attain to 100%. 7 Chemotherapy to treat ovarian dysgerminoma does not influence menses, pregnancy or offspring in those who have received it. 7 The recurrence rate for ovarian dysgerminoma is low. 6
Conclusion
Conservative surgery with adjuvant chemotherapy is appropriate in young women to preserve fertility and allow continued ovarian function so that effects of iatrogenic premature menopause are avoided.
Footnotes
Declaration of conflicting interest
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.