Management Dilemma of an Incidentally Discovered Bilateral Dysgerminoma in a Primigravida During a Caesarean Section: A Case Report

Abstract

Dysgerminoma is a rare malignant ovarian germ cell tumor. It is mostly found among the women of reproductive age but not commonly associated with pregnancy. When it occurs in pregnancy, being a rapidly growing pelvic mass, it can cause fetal malpositioning and presentation, resulting in dysfunctional labour or obstruction. Also, the expected symptoms of dysgerminomas could be unnoticed in pregnancy due to the gravid uterus, only being discovered as an incidental finding causing challenges in its management. It was a case of booked primigravida who had an uneventful antenatal period presented in labour at a gestational age of 39 weeks. The labour was arrested at cervical dilatation of 6 cm with persistent fetal malpositioning. Subsequently, she had a caesarean delivery of a live fetus. Intra-operately, bilateral ovarian dysgerminomas were as found incidentally, however, she desired her future fertility to be preserved. She had unilateral oophorectomy and biopsy taken which was later confirmed to be dysgerminoma on histopathological examination. She was referred to gynaecological oncologist for chemotherapy and follow up. In conclusion, it is possible for dysgerminomas to develop de novo in pregnancy and rapidly grow to form a pelvic mass big enough to cause dysfunctional labour or mechanical obstruction at delivery. Fertility sparing surgery with chemotherapy could be an option in women desirous of future pregnancy if bilateral dysgerminomas are incidentally found at caesarean section.