BENIGN DYSGERMINOMA

UNPLANNED PREGNANCY WITH LEFT OVARIAN
TUMOUR - DYSGERMINOMA.

One of my regular patients called Wendy aged 26 years came to see me one morning in September 1982 requesting a termination of her pregnancy. At this stage she was 8 weeks pregnant. I had delivered her previous two babies who were aged 4 and 2 without any problems. I am not keen on terminations but I agreed to do this as she was finding it difficult to manage two infants without adding another one. Incidentally and luckily, I had a new Ultrasound machine brought to my office for demonstration. I thought it will be good to use this machine on Wendy. She agreed to it. It confirmed an 8 week pregnancy. I tried not to show her the foetus. But what I saw was a bit worrying. She had a 6 centimetre left ovarian tumour, both solid in some areas and cystic (filled with fluid) in others. It was knobby in appearance on the surface.

A Diagnosis of ovarian Dysgerminoma was made. Dysgerminoma is a germ cell tumour (primitive cells in the ovary from which all parts of the body grow) of the ovary. It accounts for 1 % of all ovarian cancer. It is common in children, adolescent and young women. It seldom occurs after 50 years of age. It seldom produces symptoms in early stage, as in our present case. The diagnosis is often made fortuitously on routine pelvic examination or ultrasound done during pregnancy. They produce certain substances in the body which can be useful in the diagnosis. These are called tumour markers. These would not have been useful in this case as she was already pregnant. The next important step is to know the staging of the tumour. A simple way to understand this is, if it is confined to one ovary or both ovaries, or it has spread to the surface of the ovary peritoneum and distant organs. Like this they are divided into four stages. By ultrasound I could make out that Wendy’s tumour was very early. The other ovary and the uterus were normal there was no fluid in the abdominal cavity. With this in mind I explained the situation to Wendy. I proceeded to operate on her. I terminated her pregnancy and proceeded to a laparatomy. The ovarian tumour was soft and solid. Peritoneum was clean and I washed the peritoneum and collected this fluid for pathology to look for any malignant cells, no lymph nodes were felt and the liver felt normal. Dysgerminoma can be malignant, but in early stages a simple removal of the ovary with the fallopian tube gives excellent results. This procedure is called unilateral salpingo-oophorectomy. The patient was discharged on day 5. The pathology reported it to be Dysgerminoma without any features of concern. The oncologist was of the opinion that no further therapy was required. Her pregnancy test became negative after four weeks. I took her under my care for the next 5 years. In the first year I did an ultrasound every 3 months then every 6 months and then every year. I saw her after 20 years; she was divorced from her first husband and had had 2 more children in the new marriage. Wendy was very lucky that her unplanned pregnancy became a life saver for her.

Fortunately I had a trial Ultrasound Machine which made the early diagnosis of her stage one Dysgerminoma Tumour possible. A simple unilateral salpingo-oophorectomy saved her fertility and her life.

In adults 3 percent of these can be malignant but they respond well to chemotherapy and radiotherapy.