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Abstract
Introduction/Background Disgerminomas are a type of germ cell tumor that frequently represents 40% of cases and accounts for 3% of ovarian malignancies. Surgical treatment involves tumor removal and staging. The aim of this presentation is to contribute the multidisciplinary management of a disgerminoma case to the literature.
Methodology A 23-year-old nulliparous woman with no notable medical history presented to our clinic with complaints of abdominal pain, increasing abdominal distension over the past month, and a sensation of difficulty walking due to the swelling. Initial examination revealed a palpable mass adjacent to the uterus, which was initially considered a 15-centimeter myoma based on ultrasound imaging. Further abdominal magnetic resonance imaging identified a lobulated cystic lesion measuring 146x132 millimeters in the anterior fundus of the uterus, interpreted as a cystic degenerated subserosal fibroid. The patient was scheduled for laparotomic myomectomy. Tumor markers were negative, and beta HCG level was 62 at admission. During surgery, a 15-centimeter cyst originating from the right ovary was observed, prompting involvement of gynecologic oncology in the case. The patient underwent right unilateral salpingo-oophorectomy. Frozen pathology indicated disgerminoma, leading to the completion of the operation with pelvic-paraaortic lymph node dissection and omentectomy. Upon final pathology, isolated tumor cells were found in the paraaortic lymph node, and rare malignant tumor cells were observed in the abdominal fluid. Medical oncology was consulted, and the patient was evaluated with positron emission tomography, pelvic magnetic resonance imaging, and oocyte freezing. The follow-up of the patient, who planned to undergo chemotherapy after oocyte freezing, is ongoing.
Results Disgerminomas are the most commonly encountered ovarian malignancy, especially in the reproductive age group, emphasizing the importance of fertility preservation.
Conclusion It is crucial to consider the possibility of encountering other gynecologic emergencies.
Disclosures Staging, surgical, and multidisciplinary approaches should always be optimized for fertility preservation.
