Pelvic pain, free fluid in pelvis, and human chorionic gonadotropin serum elevation: recurrence of malignant ovarian germ-cell tumor or early pregnancy?

• Published in: European journal of gynaecological oncology 2013, Vol.34 (5), p.489-492
• Main Authors: Barczyński, B, Rogala, E, Nowicka, A, Nurzyńska-Flak, J, Kotarski, J
• Format: Article
• Language: English
• Subjects: Adult; Chorionic Gonadotropin - blood; Female; Humans; Infant, Newborn; Neoplasm Recurrence, Local - diagnosis; Neoplasms, Germ Cell and Embryonal - complications; Neoplasms, Germ Cell and Embryonal - diagnosis; Ovarian Neoplasms - complications; Ovarian Neoplasms - diagnosis; Pelvic Pain - etiology; Pregnancy
• ISSN: 0392-2936

Conservative treatment of metastatic germ-cell tumor of the ovary does not exclude the possibility of pregnancy in the future. Serum beta-human chorionic gonadotropin (beta-hCG) serves as pregnancy test, and has also been proven to be a useful marker for ovarian germ-cell tumors. This paper is a case report of a 19-year-old patient who was admitted to a district hospital in emergency due to pelvic pain, amenorrhoea, and free fluid in the pelvis. Laboratory tests demonstrated slight increase in beta-hCG serum concentration and transvaginal ultrasound (TVUS) showed no evidence of gestational sac in the uterus. At the age of 14, the patient was diagnosed with malignant germ-cell tumor of the left ovary in FIGO Stage IV and was treated with four courses of chemotherapy according to TGM-95 protocol with etoposide, ifosfamide, and cisplatin, followed by conservative surgery and adjuvant two courses of cytostatics. The initial diagnosis was recurrence of ovarian malignancy and the patient was referred to an oncology center. Wait-and-see approach and repeated ultrasound examination confirmed a normal intrauterine pregnancy which concluded with the delivery of a healthy newborn through cesarean section.