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Dr. Sanjay Dudhat

Dr. Sanjay Dudhat

Head
Department of Oncosurgery
Nanavati Super Speciality
Hospital, Mumbai




Preserving Hopes of Motherhood

Doctors saved an ovary of an adolescent girl with
Yolk Sac Tumour

Preservation of fertility is an extremely important issue for many women diagnosed with a gynaecologic malignancy. Approximately 21% of gynaecological malignancies occurs in women of reproductive age who wish to start a family. It has been reported that between 3-17% patients with ovarian cancer including Germ Cell Tumours are younger than 40 years of age at the time of diagnosis and 7-8% of all stage I epithelial Ovarian Cancers occur in women more than 35 years.

THE CASE

A 17-year old female with history of heaviness and pain in lower abdomen for the past 3 months visited Nanavati Super Speciality Hospital. Her menstrual cycles were slightly irregular. Sonography of abdomen pelvis showed a large pelvic solid mass arising from left ovary. Tumour markers AFP, Beta HCG, CA-125, LDH were done. AFP, Beta HCG showed higher values indicating Germ Cell Tumour. CT scan of abdomen pelvis showed solid large pelvic abdominal mass lesion (18.9 x 8.4 cm) arising from the left ovary without any evidence of ascitis, lymphadenopathy, omental or peritoneal deposits.

THE PROCEDURE

Laparotomy with excision of left ovarian mass and removal of left fallopian tube and salpinx was done. The ovarian mass was removed intact without spillage in the peritoneal cavity. Frozen section showed Germ Cell Tumour possibly Yolk Sac Tumour. Considering the age of the patient, decision was taken to preserve opposite ovary and uterus. Final histopathology revealed Yolk Sac (Endodermal Sinus) Tumour.

THE RESULT

Post operatively patient was given 4 cycles of Chemotherapy (BEP). For the past 6 years, the patient has been doing well and her menstrual cycles has also become regular after 2 years of chemotherapy.

DISCUSSION

Yolk Sac (Endodermal Sinus) Tumour is a second most common Malignant Germ Cell Tumour of the ovary. As all Germ Cell Tumours are chemo sensitive, we can perform fertility preservation surgery in place of radical / debulking surgery. Even if post-operative chemotherapy is given in such Tumours, patient can also conceive. The prognosis for patients with LowMalignant Potential (LMP) Tumours is generally excellent and patients still have the ability to bear children and can be treated with conservative surgery to preserve fertility. But it is very important to defi ne and differentiate between Low Malignant, Potential or Border Line Tumours and also invasive carcinomas. It is also essential to defi ne stage IA Tumour − which is confi ned to the ovary with no capsular infi ltration, no papillary excrescences on the surface and no ascitis. Close observation is required as recurrence rates are 9%.