title: Mixed germ cell malignancy of the ovary concurrent with pregnancy.
abstract: BACKGROUND
  A rare malignant germ cell tumor of the ovary during pregnancy was detected by screening of maternal serum alpha-fetoprotein (MSAFP). Treatment of this uncommon tumor during pregnancy incorporated combination chemotherapy including etoposide.
  
  
  METHODS
  An 18-year-old primiparous woman undergoing antenatal genetic screening was found to have an extremely elevated MSAFP of 477.8 IU/mL, or 12.46 multiples of the median. Oophorectomy and staging laparotomy at 20.5 weeks' gestation resulted in the diagnosis of mixed germ cell tumor of the ovary, with both endodermal sinus tumor and grade 3 immature teratoma. The patient received three courses of cis-platinum, etoposide, and bleomycin. Maternal serum AFP titers had returned to normal pregnancy levels by the start of the second course. A healthy female infant was delivered at 39 weeks' gestation following induction of labor for pregnancy-induced hypertension.
  
  
  CONCLUSIONS
  Elevated MSAFP levels may be a presenting sign of malignant ovarian germ cell neoplasms. This report describes both surgical and chemotherapeutic treatment of a germ cell malignancy during pregnancy, with delivery at term. To date, major fetal toxicity from chemotherapy has not been identified.
authors.affiliation: Department of Obstetrics and Gynecology, Pediatrics, and Family Medicine, University of Kansas School of Medicine-Wichita, USA.
authors.forename: D
authors.initials: D
authors.lastname: Horbelt
authors.forename: J
authors.initials: J
authors.lastname: Delmore
authors.forename: R
authors.initials: R
authors.lastname: Meisel
authors.forename: S
authors.initials: S
authors.lastname: Cho
authors.forename: D
authors.initials: D
authors.lastname: Roberts
authors.forename: D
authors.initials: D
authors.lastname: Logan
mesh_terms: D000293:Adolescent; D005260:Female; D018237:Germinoma / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D010051:Ovarian Neoplasms / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: D000509:alpha-Fetoproteins