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Case Report
Ovarian dysgerminoma in a 14-year-old presenting with an adnexal mass and elevated beta-human chorionic gonadotropin (beta-hCG)
1 Medical Student, University of Colorado School of Medicine, Aurora, CO, USA
2 Department of Obstetrics and Gynecology, Altru Hospital, Grand Forks, ND, USA
3 Department of Gynecologic Oncology, MultiCare Regional Cancer Center, Puyallup, WA, USA
4 Department of Pathology, University of Colorado School of Medicine, Aurora, CO, USA
5 Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, University of Colorado School of Medicine, Aurora, CO, USA
Address correspondence to:
Jo Ellen Fresia
9044 E 48th Ave, Unit 302, Denver, CO 80238,
USA
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Article ID: 100119Z08JF2022
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Fresia JE, Boe B, Breed C, Post MD, Lefkowits C. Ovarian dysgerminoma in a 14-year-old presenting with an adnexal mass and elevated beta-human chorionic gonadotropin (beta-hCG). J Case Rep Images Obstet Gynecol 2022;8(1):19–23.ABSTRACT
Introduction: Ovarian germ cell tumors most commonly affect young women in the second and third decades of life. Dysgerminomas account for 30–50% of malignant ovarian germ cell tumors and are classically associated with elevated lactate dehydrogenase (LDH). Elevated human chorionic gonadotropin (hCG) in the setting of an adnexal mass in this age group may raise concern for ectopic pregnancy. It is critical to maintain a high index of suspicion for possible germ cell tumor in young women with adnexal masses to avoid unnecessary surgical spillage that might upstage a malignancy. We present a case of a 14-year-old female with adnexal mass and elevated hCG who was ultimately diagnosed with ovarian dysgerminoma.
Case Report: A 14-year-old female presented to the emergency room with vaginal bleeding and altered mental status and was found to have a markedly elevated beta-hCG, normal LDH, and an 8 cm complex adnexal mass. She underwent minimally invasive surgery and was ultimately diagnosed with stage 1A dysgerminoma with abundant synctiotrophoblast giant cells. Patient remained in remission for four years until she began experiencing new irregular periods. This time she was found to have an elevated LDH, normal B-hCG, and a 10 cm pelvic mass. She underwent exploratory laparotomy, removal of pelvic mass, right salpingo-oophorectomy, pelvic lymph node debulking, and adjuvant chemotherapy with bleomycin, etoposide, and cisplatin (BEP).
Conclusion: Dysgerminoma, the most common malignant ovarian germ cell tumor, may present with the uncommon profile of markedly elevated hCG and otherwise normal tumor markers. While ectopic pregnancy must be considered in this scenario, keeping dysgerminoma in the differential diagnosis of a young woman with a solid adnexal mass and elevated hCG may allow for intact removal of the mass, possibly helping to avoid adjuvant chemotherapy.
Keywords: Elevated hCG, Malignant germ cell tumor, Ovarian dysgerminoma
SUPPORTING INFORMATION
Author Contributions
Jo Ellen Fresia - Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Brendan Boe - Substantial contributions to conception and design, Drafting the article, Final approval of the version to be published
Christopher Breed - Substantial contributions to conception and design, Drafting the article, Final approval of the version to be published
Miriam Post - Analysis of data, Revising it critically for important intellectual content, Final approval of the version to be published
Carolyn Lefkowits - Substantial contributions to conception and design, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2022 Jo Ellen Fresia et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
