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Conquering a Yolk Sac–Type Ovarian Germ Cell Tumour in a 15-Year-Old

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  • Conquering a Yolk Sac–Type Ovarian Germ Cell Tumour in a 15-Year-Old

Setting the stage (why this is significant)

Ovarian germ cell tumours (OGCTs) mostly affect young females (10–30 years). They account for ~20–25% of all ovarian tumours, but only ~5% of malignant ovarian tumours. Typical clues are abdominal pain and a palpable mass—exactly how this story begins.

When she arrived

A 15-year-old girl presented with abdominal pain and progressive distension. Examination: fixed lower-abdominal mass with moderate ascites. Ultrasound: complex right adnexal mass (12 × 9 cm) with gross ascites; left ovary normal. Tumour markers: CA-125 1475, AFP >20,000, β-hCG <2, LDH 635, CEA 3.20. PET-CT (baseline):

  • Solid–cystic pelvic mass (11 × 8 × 12 cm) with low-grade patchy uptake (SUV ~2.7)
  • Gross ascites; hypermetabolic abdominal & pelvic nodes
  • Active omental nodularity/stranding
  • Bilateral pleural effusions with metabolically active pleural thickening/nodularity

Working diagnosis: Malignant OGCT, biopsy favouring yolk sac tumour. Given the extent, the team chose neoadjuvant chemotherapy first.

She received BEP ×4 (Bleomycin, Etoposide, Cisplatin).

Response (good news):

  • PET-CT: moderate reduction in the adnexal mass; complete resolution of all other active lesions.
  • Markers fell sharply: AFP 7.21, LDH 221, β-hCG 0.1.

Plain English: chemo knocked out the spread and tamed the primary, turning a widespread problem into a surgically solvable one.

Second move: precise, fertility-sparing surgery

With disease controlled, the aim was to treat the tumour and protect fertility.

Procedure:

  • Laparoscopic right ovarian cystectomy
  • Left ovarian cyst-wall biopsy with intra-operative frozen section

In theatre: the left ovarian lesion proved to be a follicular cyst; frozen section negative for malignancy—so both ovaries were preserved.

Resection specimen (post-chemo): necrosis with fibrous stroma and dense lympho-histiocytic response; no viable tumour cells.

Plain English: chemo did the heavy lifting; surgery tidied up what remained without sacrificing the ovaries.

Why this worked (story logic)

  1. Right sequence: BEP first to systemically debulk, then operate when the field is quiet.
  2. Data-driven: PET-CT and markers (AFP, LDH) guided each step and confirmed response.
  3. Fertility-focused: Laparoscopy + frozen section allowed organ preservation with oncologic safety.
  4. Pathologic proof: No viable tumour post-chemo confirms biological response.
  5. Recovery edge: Laparoscopy → smaller scars, faster healing, shorter stay, early mobilisation.

How we’d explain it to the family

“We used strong medicines first to shrink and sterilise the disease. Then, through keyhole surgery, we removed the tumour, checked the other ovary during the operation, and kept it safe. Your child’s scans and markers improved dramatically, and the tissue we removed showed no living cancer cells.”

Clinician snapshot (drop-in ready)

  • Patient: Female, 15 yrs
  • Presentation: Abdominal pain & distension; fixed lower-abdominal mass; moderate ascites
  • USG: Complex right adnexal mass 12 × 9 cm, gross ascites; left ovary normal
  • Markers (baseline): CA-125 1475, AFP >20,000, β-hCG <2, LDH 635, CEA 3.20
  • PET-CT (baseline): Pelvic solid–cystic mass (11 × 8 × 12 cm, SUV ~2.7); gross ascites; hypermetabolic abdo/pelvic nodes; active omentum; bilateral pleural effusions with active pleura
  • Biopsy: Malignant neoplasm suggestive of OGCT (favours yolk sac)
  • Neoadjuvant chemo: BEP ×4
  • Response: PET—moderate shrinkage of adnexal mass; complete resolution of other active lesions; AFP 7.21, LDH 221, β-hCG 0.1
  • Surgery: Lap right ovarian cystectomy + left cyst-wall biopsy; frozen section negative (left)
  • Pathology (post-chemo): Necrosis with fibrous stroma; dense lympho-histiocytic infiltrate; no viable tumour
  • Advantages: Fertility-sparing, minimally invasive, faster recovery, better cosmesis

The takeaway

In adolescents with advanced OGCT, a chemo-first strategy can dramatically downstage disease and open the door to minimally invasive, fertility-sparing surgery—with pathology sealing the win.