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.