2 Case Presentation
A 23-year-old woman presented with a 6-month history of abdominal distention and a progressive increasing palpable mass in the lower abdominal quadrants. At the time of admission, the size of the mass was equivalent to the swelling in a six-month-pregnant woman. Her personal and familial medical history was unremarkable.
Her physical examination revealed a firm, smooth, and painless palpable mass in the right lower quadrant. Ultrasonography revealed a solid right adnexal mass with a diameter of 20 cm, accompanied by mild hydronephrosis on the right side. The left ovary and uterus appeared normal.
Subsequent computed tomography revealed a pelvic mass with a diameter of 22 cm, characterized by an indistinct border between the uterus and pelvic sidewalls. There was also evidence of right ureteral displacement (Figure 1a and 1b). Laboratory tests measuring alpha-fetoprotein, carcinoembryonic antigen, and cancer antigen 125 (CA125) levels did not reveal any abnormal results.
Following the diagnosis of a right ovarian mass, the patient underwent surgical exploration via laparotomy. Consequently, a 22 cm right ovarian mass with external projections, moderate ascites, and peritoneal implants were observed intraoperatively (Figure 2a and 2b). The remainder of the abdominal cavity appeared normal, and ascitic fluid was sampled for cytological examination. Intraoperative cytological frozen analysis of the tumor revealed malignant cells of the germinal nature. Right salpingo-oophorectomy was performed for mass excision, and a biopsy was taken from the left ovary, which appeared more prominent than average. Excision of all tumoral implants, pelvic and paraaortic lymph node dissection, and omentectomy were also carried out. No intraoperative frozen section examination was performed. The patient received a total of 11 units of transfused erythrocytes, eight intraoperatively and three postoperatively, with no postoperative complications. She was discharged on the fifth day after the surgery.
The final histopathological examination revealed a pure dysgerminoma with multiple lymph node involvement and omental and peritoneal metastases. Accordingly, she was diagnosed with FIGO (International Federation of Obstetrics and Gynecology) 3AMOGCT, indicating that the cancer has spread to the serosa of the uterus and/or the tissue of the fallopian tubes and ovaries but not to other parts of the body. Subsequently, the patient was administered BEP (bleomycin, etoposide, and cisplatin) chemotherapy. She provided a complete clinical and radiological response after four cycles of BEP. She was followed up semi-annually during the first year and then annually for the next five years with no signs of recurrence.
The initial examinations, including hysterosalpingography, which were performed due to the patient’s desire to have children, indicated the normal functioning of the left salpinx. She had regular menstrual cycles occurring every 30 days and lasting 4–5 days. Nevertheless, she underwent in-vitro fertilization since she could not get pregnant. The first attempt yielded only one mature oocyte with no fertilization. The second attempt yielded two oocytes, one successfully frozen at the blastocyst stage. However, before carrying out the transfer procedure, spontaneous pregnancy occurred. The patient experienced an uneventful pregnancy and gave birth to a healthy baby girl, during which ligation of the left uterine artery was performed to manage postpartum uterine atony.