Mixed Germ Cell Tumor (GCT) of Ovary with Atypical Presentation.

Objective: Ovarian carcinomas are considered one of the deadliest malignancies, accounting for a significant number of cancer-related deaths than any other gynecological malignancy. Advanced stage at diagnosis can be attributed to vague presenting symptoms, rarely bizarre, which usually point towards any disease but ovarian tumour. Here, we discuss a similar case, with presentations that compel us to think in favor of disseminated Koch's, but turns out to be germ cell tumor (GCT) of the ovary; thereby pointing at the wide spectrum of bizarre signs and symptoms which should have ovarian malignancies as a differential during workup.

Case report: A 21-year-old unmarried female came to our gynecology outpatient department with complaints of pain lower abdomen, high-grade fever, shortness of breath, and progressively increasing abdominal distension. After routine hematological and imaging workup, she was diagnosed with an ovarian tumour with ascites and bilateral pleural effusion. Fertility-sparing surgery was done after the patient was hemodynamically stable. The histopathology report was suggestive of mixed GCT. The patient was thereby referred to the department of medical oncology for adjuvant chemotherapy.

Conclusion: Mixed GCTs are among the rare and inordinately malignant tumours of the ovary. Though they have their usual presentations, we ought to be heedful of their atypical presentations as well because these form grounds for early diagnosis and management. In our patients, the unusual feature was the high-grade fever with associated shortness of breath (due to pleural effusion), but the effusion was non-malignant and non-infectious in origin. In the literature, there are not many cases of atypical clinical presentation; hence, this could be an area of further research. Besides, such case reports with bizarre manifestations widen our spectrum of diagnostic probabilities, thereby avoiding any gaps in management. Our workup should be comprehensive enough to diagnose the patient as early as possible because these tumors, though aggressive, have a very good prognosis due to excellent chemosensitivity.