“Too Young and Too High”: An Ovarian Germ-Cell Tumor and High Tumor Markers in an 18-Year-Old Female

Abstract

Background: Ovarian germ-cell neoplasms are derived from primordial germ cells of the ovary. Germ-cell tumors of the ovary are relatively uncommon. Only 2%-3% of germ-cell tumors are malignant. Malignant ovarian germ-cell tumors occur primarily in young women; 50%-75% of these tumors are stage I at diagnosis. Even with advanced-stage disease, the survival rates are 60%-80%. In most patients, fertility-sparing surgery can be performed, and postoperative chemotherapy may be necessary for some patients. The prognosis for malignant ovarian germ-cell tumors has improved vastly over the last 30 years, mainly because of modern combination chemotherapy. Case: An 18-year-old nulliparous female with a pelvic mass had tumor markers with extremely high tumor-marker values. During an exploratory laparotomy, widespread abdominal disease was found. The tumor and diseased areas were excised, and the patient was given chemotherapy after the surgery. The final pathology results revealed a mixed germ-cell tumor with a yolk sac and an embryonal carcinoma. As of this writing, she is continuing her chemotherapy cycles without any problems. Results: After surgery and chemotherapy, the patient's tumor markers returned to within normal limits. There were no significant complications associated with her chemotherapy. Conclusions: A team experienced in gynecologic oncology procedures could achieve optimal cytoreduction in such patients without significant morbidity. Thus, young patients with suspected germ-cell tumors and high tumor-marker levels should be referred to centers that have personnel with expertise on gynecologic oncology surgery procedures. ( J GYNECOL SURG 31:32)