Ovarian Dysgerminoma in a Young Patient: Balancing Oncologic Safety and Fertility Preservation

Abstract

Malignant ovarian tumors are traditionally classified into epithelial tumors, germ cell tumors, and sex cord-stromal tumors, with germ cell tumors accounting for approximately one -third of ovarian neoplasms (Berek & Hacker, 2015; Prat, 2014; Kurman et al., 2020). Germ cell tumors include dysgerminoma, yolk sac tumor, immature teratoma, and other less common histologic subtypes (Low et al., 2012; Talerman, 2007). Dysgerminomas represent nearly one -third of malignant germ cell tumors and predominantly affect young women under 30 years of age (Zaloudek & Norris, 1979; Mangili et al., 2018; Smith et al., 2020). Although rare — comprising 1–5% of all ovarian cancers —, they account for up to 30–40% of malignant germ cell neoplasms (Gershenson, 2007; Young, 2018). Their occurrence during reproductive years explains the occasional association with pregnancy, with incidence estimates ranging from 2.8 to 11 cases per 100,000 pregnancies (ACOG, 2016; ESUR, 2010). Clinically, dysgerminomas may present with pelvic pain, an abdominal mass, menstrual irregularities, or symptoms related to the compression of adjacent organs, although some patients remain asymptomatic until the tumor reaches a considerable size (Thomassin-Naggara et al., 2013; Ulbright, 2005). No consistent hereditary associations have been identified (McCluggage, 2006; WHO Editorial Board, 2020). Imaging plays a central role in initial evaluation, with transvaginal ultrasonography and Doppler as first-line modalities, typically revealing solid, multilobulated masses with heterogeneous echotexture and low-resistance vascular flow (ESUR, 2010; Thomassin-Naggara et al., 2013; Brown et al., 2014). MRI may further characterize tissue and disease extent, but a definitive diagnosis relies on histopathology, immunohistochemistry, and surgical staging (Ulbright, 2005; McCluggage, 2006; Kurman et al., 2014). Serum tumor markers such as LDH, AFP, and \beta-hCG assist in diagnosis, treatment monitoring, and recurrence detection (Gershenson, 2007; Park et al., 2017; Colombo et al., 2019). LDH elevation is particularly associated with dysgerminomas, while AFP and \beta-hCG elevations suggest mixed germ cell components (Kurman et al., 2014; Mangili et al., 2011). Additional markers such as inhibin and CA 125 may support differential diagnosis (Berek & Hacker, 2021; NCCN, 2023). For patients with high-risk features — bilateral tumors, capsular rupture, peritoneal metastases, or lymph node involvement — more extensive surgery may be required, including hysterectomy and bilateral salpingo-oophorectomy (Brown et al., 2014; Mangili et al., 2011; De la Motte Rouge et al., 2008). Platinum-based chemotherapy remains the cornerstone of adjuvant treatment and is associated with excellent survival outcomes even in advanced disease (Williams et al., 1984; Ray-Coquard et al., 2018; Williams et al., 2017). Dysgerminomas exhibit marked chemosensitivity, contributing to five-year survival rates exceeding 90% in early-stage disease (Chan et al., 2008; Droz et al., 2013; Zalewski et al., 2018). Fertility-sparing surgery has demonstrated oncologic safety, with 10-year survival rates above 90% (Morice et al., 2003; Mangili et al., 2018; Zhang et al., 2022). However, inadequate staging negatively impacts outcomes (De la Motte Rouge et al., 2008; Park et al., 2017; Alwazzan et al., 2018). This case illustrates the diagnostic and therapeutic challenges in managing ovarian dysgerminoma in a young patient, emphasizing early diagnosis, adequate staging, multidisciplinary care, and individualized treatment planning (NCCN, 2024; ESMO–EURACAN, 2019; Gershenson, 2023).