Endodermal sinus tumour of the ovary in pregnancy.
We present a case of a 30-year-old pregnant woman in whom an ovarian mass was identified by ultrasonography at 15 weeks' gestation. A markedly elevated maternal serum alphafetoprotein (MSAFP) suggested a diagnosis of endodermal sinus tumour of the ovary. A right salpingo-oophorectomy at 19 weeks' gestation enabled histological confirmation of the diagnosis and suggested a stage 1 tumour. Unfortunately tumour recurrence necessitated further laparotomy and delivery by caesarean section at 32 weeks' gestation. A total abdominal hysterectomy and left salpingo-oophorectomy was undertaken with resection of the splenic flexure and formation of a double-barrelled colostomy after which no gross intraperitoneal tumour remained. Three weeks later a new suprahepatic tumour mass was excised and the colostomy was closed. The patient then received four cycles of combination chemotherapy with cisplatin, etoposide, and bleomycin. Unfortunately she developed a faecal fistula at the site of the colostomy. Germ cell tumours are highly responsive to chemotherapy. Over-zealous surgery particularly involving bowel resection may cause unnecessary morbidity and compromise the outcome.
Rajendran
S
S
The Department of Obstetrics and Gynaecology, Leicester General Hospital NHS Trust, England.
Hollingworth
J
J
Scudamore
I
I
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002585:Cesarean Section; D003125:Colostomy / Q000009:adverse effects; D018240:Endodermal Sinus Tumor / Q000097:blood / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology; D010535:Laparoscopy / Q000009:adverse effects*; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery; D010051:Ovarian Neoplasms / Q000097:blood / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000601:surgery*; D012074:Remission Induction; D000509:alpha-Fetoproteins / Q000378:metabolism
D000509:alpha-Fetoproteins