Ovarian Yolk Sac Tumor in a 10-Year-Old Girl Following Metachronous Bilateral Mature Ovarian Teratomas.

Abstract

Background: Ovarian germ cell tumors are the most common ovarian malignancies in children. Because these patients have a notable risk of developing metachronous bilateral tumors or recurrences, maximizing the preservation of ovarian tissue during initial surgery is critical to protecting future fertility and endocrine function.

Objective: A previously healthy 8-year-old girl underwent emergency laparotomy for ovarian torsion, resulting the right oophorectomy, with histopathology confirming a mature teratoma. Sixteen months later, a contralateral ovarian mass was detected and treated with ovarian-sparing excision, also diagnosed as a mature teratoma. At age 10 (10 months after the second excision), she was found to have an 8 cm pelvic tumor and elevated α-fetoprotein. Magnetic resonance imaging (MRI) showed complex solid and cystic components suggestive of a malignant germ cell tumor, with no metastases on computed tomography/MRI. The mass was removed intact at exploratory laparotomy, yielding a diagnosis of Fédération Internationale de Gynécologie et d'Obstétrique (FIGO) Stage 1A ovarian yolk sac tumor. She was discharged after completing combination chemotherapy. Currently, she is 16 years old and being managed with hormone replacement therapy.

Conclusions: The presented case highlights a disadvantage of overzealous oophorectomy. Detorsion of the seemingly necrotic ovary followed by second-look surgery could have preserved some ovarian function.