Ovarian Dysgerminoma With Tubo-Ovarian Torsion in an 11-Year-Old Child: A Rare Occurrence but a Significant Differential Diagnosis in Acute Abdomen.

Abstract

Background: Ovarian tumors are quite uncommon in the premenarchal age group, with the majority being functional cysts. Malignant tumors are unusual in this age group, making the diagnosis of ovarian malignancy in children quite challenging. Dysgerminoma is the most common malignant ovarian germ cell tumor in females. The clinical symptoms often include abdominal pain, distension, a palpable mass, reduced appetite, nausea, and vomiting.

Case presentation: We discuss the case of an 11-year-old premenarchal girl who was brought to the emergency department with abdominal pain persisting for 3-4 days, which had intensified over the 24 hours before she arrived at the emergency department. The pain was accompanied by vomiting. On examination, her lower abdomen showed tenderness, guarding, and rigidity, and a firm mass approximately 10 x 8 cm in size was palpable in the midline. Ultrasonography of the abdomen and pelvis revealed a large hypoechoic mass lesion, approximately 99 x 56 x 92 mm, in the right adnexa. A magnetic resonance imaging with contrast of the abdomen and pelvis was performed for confirmation, which substantiated the diagnosis of the right ovarian lesion with torsion. Following the patient's exploratory laparotomy, a right salpingo-oophorectomy and left oophoropexy were performed. The histopathological report confirmed the diagnosis of dysgerminoma.

Conclusion: Malignant ovarian tumors are quite rare in the premenarchal age group, and the primary goal should be to offer fertility-preserving surgeries. This allows the individual to retain reproductive functions. However, close monitoring is essential, and if needed, radical surgery should be considered to save the patient's life.