# Acute abdominopelvic pain and distension in a 21-year-old woman revealing a mixed germ cell tumor: A case report

## TL;DR

A 21-year-old woman with a rare mixed ovarian tumor was treated with surgery and chemotherapy while preserving her fertility and cultural values.

## Contribution

This case highlights a rare mixed germ cell tumor and a culturally sensitive, fertility-preserving treatment approach in a young patient.

## Key findings

- Mixed germ cell tumors are rare but treatable with surgery and chemotherapy.
- A transvaginal approach preserved the patient's fertility and cultural beliefs.
- Platinum-based chemotherapy and serum markers are effective in follow-up and treatment.

## Abstract

Primary ovarian germ cell tumors (OGCTs) account for 5 % of malignant pelvic neoplasms, predominantly affecting young females and often presenting as medical emergencies. Among OGCTs, malignant mixed germ cell tumors constitute approximately 8 % of cases and are characterized by their aggressive nature. Early and appropriate management of these rare tumors is crucial for optimizing patient outcomes.

We present the case of a 21-year-old female who was admitted urgently due to a large abdominopelvic mass. Clinical evaluation and supplementary investigations confirmed the diagnosis of a mixed OGCT, featuring the most common combination of yolk sac tumor and dysgerminoma. A transvaginal surgical approach was employed to preserve the patient's hymenal integrity and facilitate oocyte preservation, in accordance with her cultural and personal beliefs. The treatment consisted of unilateral adnexectomy followed by platinum-based chemotherapy.

Mixed OGCTs are rare but highly aggressive tumors that primarily affect young women. Despite their aggressive nature, these tumors often have a favorable prognosis when promptly diagnosed and treated. This case highlights the importance of individualized, fertility-preserving approaches in young patients. The combination of yolk sac tumor and dysgerminoma necessitated a multimodal treatment strategy to achieve optimal outcomes while respecting the patient's reproductive aspirations.

Mixed OGCTs are uncommon neoplasms that require early diagnosis and tailored management. This case is noteworthy due to the rare presentation of a mixed germ cell tumor in a young woman and the multidisciplinary approach undertaken to balance oncological management with fertility preservation, utilizing a transvaginal surgical technique to respect the patient's cultural and personal beliefs.

•The extremely rare occurrence of mixed germinal ovarian tumors•Adnexectomy with adjuvant platinum-based chemotherapy is the gold standard of treatment.•Compliance with patient conventions for fertility preservation•Efficacy of adnexectomy with adjuvant platinum-based chemotherapy•The contribution of serum markers to follow-up

The extremely rare occurrence of mixed germinal ovarian tumors

Adnexectomy with adjuvant platinum-based chemotherapy is the gold standard of treatment.

Compliance with patient conventions for fertility preservation

Efficacy of adnexectomy with adjuvant platinum-based chemotherapy

The contribution of serum markers to follow-up