title: A case of endodermal sinus tumor associated with the first pregnancy and successful management of the second pregnancy: a case report and review of the literature.
abstract: BACKGROUND
  Pregnancy complicated by endodermal sinus tumor (EST) of the ovary has rarely been reported.
  
  
  METHODS
  A huge ovarian EST causing bowel obstruction was found in a 22-year-old patient at 34 weeks of gestation. Abnormally high alpha-fetoprotein (AFP) levels suggested a malignant germ cell tumor of the ovary. The patient was submitted to cesarean section and fertility sparing surgery, and then received four courses of combination chemotherapy. There was no evidence of recurrence 19 months after initial treatment but transvaginal ultrasound (US) evaluation showed an intrauterine pregnancy of six weeks. We delivered a 3,200 g healthy male baby with Apgar scores of 8 and 9 by elective cesarean section at 39 weeks of gestation.
  
  
  CONCLUSIONS
  Successful outcome of a second pregnancy is possible after treatment with fertility sparing surgery and combination chemotherapy for an endodermal sinus tumor associated with a first pregnancy. Moreover checking of weekly AFP levels and performing monthly abdominal US could be effective for surveillance of these pregnancies. However management of EST during pregnancy should be based on consideration of the patient's presenting condition, preferences, and gestational age.
authors.affiliation: Department of Obstetrics and Gynecology, Zeynep Kamil Women's and Children's Hospital, Istanbul, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Ayas
authors.forename: I
authors.initials: I
authors.lastname: Aköz
authors.forename: E
authors.initials: E
authors.lastname: Eskicirak
authors.forename: A
authors.initials: A
authors.lastname: Karateke
authors.forename: O
authors.initials: O
authors.lastname: Bozoklu
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D018240:Endodermal Sinus Tumor / Q000175:diagnosis* / Q000188:drug therapy*; D005260:Female; D006801:Humans; D010051:Ovarian Neoplasms / Q000175:diagnosis* / Q000188:drug therapy*; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000175:diagnosis* / Q000188:drug therapy*; D011256:Pregnancy Outcome; D011263:Pregnancy Trimester, Third; D016896:Treatment Outcome; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: D000509:alpha-Fetoproteins