Luh Lany Christina Prajawati Ni, Nyoman Bayu Mahendra I, Aag Putra Wiradnyana, Ketut Ariawati, Ayu bSri Mahendra Dewi I Gusti
Department of Obstetrics and Gynaecology, Pediatrics, Anatomical Pathology, Medical Science Faculty of Udayana University, Sanglah Hospital, Bali, Indonesia.
Open Access Maced J Med Sci. 2019 Mar 15;7(6):1016-1020. doi: 10.3889/oamjms.2019.129. eCollection 2019 Mar 30.
Immature teratoma is malignant ovarian germ cell tumours (MOGCTs). The case in pregnancy is very rare which less than 1% of all ovarian teratoma cases. The aim is to reach optimal and comprehensive management for immature ovarian teratoma in pregnancy to gain the healthiest maternal and fetal outcomes.
Thirty-one years old female G2P1A0, 8 weeks 1-day pregnancy, with left ovarian solid tumour 15 x 15 x 15 cm in size. At gestational age (GA) of 19 weeks 5 days, the size of the tumour was increasing rapidly to 30 x 30 x 30 cm. Alfa-fetoprotein raised to 699.9 IU/mL and LDH 579 U/L. The patient had gone primary conservative left oophorectomy, omentectomy, and ascites fluid cytology with histopathological conclusion grade II immature teratoma of left ovary containing the immature neuroepithelial and fat component: magnetic resonance imaging (MRI) at 25 weeks 3 days GA, no spreading. Amniocentesis performed at 27 weeks 2 days GA, the fetus had normal 46 chromosomes and sex XX without major structural abnormality. The patient had BEP chemotherapy start at 27 weeks 2 days GA. Patient in labour at 40 weeks 2 days GA. The female baby had spontaneous delivery with 2700 grams in body weight without congenital abnormality. Complete surgical staging performed at 58th days postpartum and histopathological result there was no malignant cell anymore, but post-chemotherapy ovarian atrophy feature had found on the contralateral ovary. The patient showed psychosocial problem including post-chemotherapy depression and premature ovarian failure (POF). Immunohistochemistry (IHC) ER and PR of teratoma tissue showed immature component had ER (-) and PR (+). Follow up of the baby was in good condition.
BEP chemotherapy become regimen choice for this case with fetal outcomes was good, but there was a POF sign on the mother. Survival of patient on this case is 62%, free recurrence survival post-BEP 84% and progressivity post complete surgical staging 8% without delay the chemotherapy.
未成熟畸胎瘤是恶性卵巢生殖细胞肿瘤（MOGCTs）。妊娠期病例非常罕见，占所有卵巢畸胎瘤病例的比例不到1%。目的是实现对妊娠期未成熟卵巢畸胎瘤的最佳综合管理，以获得最健康的母婴结局。
一名31岁女性，孕2产1流0，妊娠8周1天，左侧卵巢有一个大小为15×15×15cm的实性肿瘤。妊娠19周5天时，肿瘤迅速增大至30×30×30cm。甲胎蛋白升至699.9IU/mL，乳酸脱氢酶579U/L。患者接受了左侧卵巢原发保守性切除术、大网膜切除术和腹水细胞学检查，组织病理学结论为左侧卵巢II级未成熟畸胎瘤，含有未成熟神经上皮和脂肪成分：妊娠25周3天时进行磁共振成像（MRI）检查，未见扩散。妊娠27周2天时进行羊水穿刺，胎儿46条染色体正常，性别为XX，无重大结构异常。患者于妊娠27周2天时开始接受BEP化疗。患者于妊娠40周时分娩。女婴顺产，体重2700克，无先天性异常。产后第58天进行了完整的手术分期，组织病理学结果显示不再有恶性细胞，但对侧卵巢发现了化疗后卵巢萎缩特征。患者出现了包括化疗后抑郁和卵巢早衰（POF）在内的心理社会问题。畸胎瘤组织的免疫组织化学（IHC）雌激素受体（ER）和孕激素受体（PR）显示未成熟成分ER（-），PR（+）。婴儿随访情况良好。
BEP化疗成为该病例的治疗方案选择，胎儿结局良好，但母亲出现了卵巢早衰迹象。该病例患者的生存率为62%，BEP化疗后无复发生存率为84%，完整手术分期后进展率为8%，且未延迟化疗。
