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.
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.
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.
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.
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%.