An Incidental Finding of Bilateral Dysgerminoma During Cesarean Section: Dilemmas in Management

Abstract

Dysgerminoma is an uncommon malignant tumour arising from germ cells of ovary. It occurs mostly in the reproductive age group. Its association with pregnancy is rare. Its management remains a challenge especially in an unsuspected case. We present a case of a woman, aged 28-year-old gravida2 para1 who reported to us at 36 weeks' pregnancy with severe preeclampsia and previous caesarean section. On ultrasound she was reported as having subserosal fibroids with single live fetus of 35 weeks and 3 days gestation. She delivered a live baby by caesarean section done for failed induction. Intraoperatively bilateral ovarian masses were found and removed which were later confirmed to be dysgerminoma on histopathological examination. As she was not diagnosed dysgerminoma pre-operatively, complete work up i.e., tumour markers and MRI was not done, leading to dilemmas in management. Though standard protocols for management of dysgerminoma with pregnancy exist, yet management of these incidentally diagnosed dysgerminomas remains a dilemma.

Keywords: Fertility sparing surgery; Germ cells of ovary; Incompletely staged dysgerminomas.

[Table/Fig-1]:

Bilateral ovarian tumours intraoperatively.

[Table/Fig-2]:

Bilateral ovarian tumours after excision.

[Table/Fig-3]:

Histopathology showing sheets of tumour cells, separated by fibrous septa (100x, H&E stain).

[Table/Fig-4]:

Microsection showing tumour cells with vesicular nuclei. Fibrous septa showing lymphocytic infiltrate (400x, H&E stain).