Jhirwal Manisha, Trivedi Swati, Shekhar Shashank, Sharma Charu
Associate Professor, Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
Senior Resident, Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
Maedica (Bucur). 2024 Sep;19(3):662-666. doi: 10.26574/maedica.2024.19.3.662.
Ovarian carcinomas are considered one of the deadliest malignancies, accounting for a significant number of cancer-related deaths than any other gynecological malignancy. Advanced stage at diagnosis can be attributed to vague presenting symptoms, rarely bizarre, which usually point towards any disease but ovarian tumour. Here, we discuss a similar case, with presentations that compel us to think in favor of disseminated Koch's, but turns out to be germ cell tumor (GCT) of the ovary; thereby pointing at the wide spectrum of bizarre signs and symptoms which should have ovarian malignancies as a differential during workup.
A 21-year-old unmarried female came to our gynecology outpatient department with complaints of pain lower abdomen, high-grade fever, shortness of breath, and progressively increasing abdominal distension. After routine hematological and imaging workup, she was diagnosed with an ovarian tumour with ascites and bilateral pleural effusion. Fertility-sparing surgery was done after the patient was hemodynamically stable. The histopathology report was suggestive of mixed GCT. The patient was thereby referred to the department of medical oncology for adjuvant chemotherapy.
Mixed GCTs are among the rare and inordinately malignant tumours of the ovary. Though they have their usual presentations, we ought to be heedful of their atypical presentations as well because these form grounds for early diagnosis and management. In our patients, the unusual feature was the high-grade fever with associated shortness of breath (due to pleural effusion), but the effusion was non-malignant and non-infectious in origin. In the literature, there are not many cases of atypical clinical presentation; hence, this could be an area of further research. Besides, such case reports with bizarre manifestations widen our spectrum of diagnostic probabilities, thereby avoiding any gaps in management. Our workup should be comprehensive enough to diagnose the patient as early as possible because these tumors, though aggressive, have a very good prognosis due to excellent chemosensitivity.
卵巢癌被认为是最致命的恶性肿瘤之一，与其他妇科恶性肿瘤相比，其导致的癌症相关死亡人数众多。诊断时处于晚期可归因于症状不明确，这些症状很少怪异，通常提示任何疾病，但不提示卵巢肿瘤。在此，我们讨论一个类似病例，其表现促使我们考虑播散性 Koch 病，但最终结果是卵巢生殖细胞肿瘤（GCT）；从而指出在检查过程中应将卵巢恶性肿瘤作为鉴别诊断的广泛怪异体征和症状。
一名 21 岁未婚女性因下腹部疼痛、高热、呼吸急促和腹部逐渐膨隆前来我院妇科门诊。经过常规血液学和影像学检查，她被诊断为卵巢肿瘤伴腹水和双侧胸腔积液。在患者血流动力学稳定后进行了保留生育功能的手术。组织病理学报告提示为混合性 GCT。因此，该患者被转至医学肿瘤学部门进行辅助化疗。
混合性 GCT 是卵巢罕见且恶性程度极高的肿瘤之一。尽管它们有常见表现，但我们也应留意其非典型表现，因为这些表现是早期诊断和治疗的依据。在我们的患者中，不寻常的特征是高热伴呼吸急促（由于胸腔积液），但积液并非恶性且非感染性来源。在文献中，非典型临床表现的病例不多；因此，这可能是一个进一步研究的领域。此外，此类具有怪异表现的病例报告拓宽了我们的诊断可能性范围，从而避免治疗中的任何漏洞。我们的检查应足够全面，以便尽早诊断患者，因为这些肿瘤虽然侵袭性强，但由于化疗敏感性极佳，预后非常好。
