Rapidly growing ovarian dysgerminoma during pregnancy: a case report and literature review

Introduction and importance: Ovarian dysgerminoma is a rare germ cell tumor comprising 1–2% of ovarian malignancies. It predominantly affects women aged 20–30 years old and has a favorable prognosis with nearly 100% 5-year survival for early-stage disease. However, its nonspecific symptoms often delay diagnosis, accentuating the need for timely identification and intervention to optimize outcomes. Case presentation: A 28-year-old pregnant woman presented with a complaint of a heavy sensation during her third month of pregnancy. An ultrasound scan detected a mass that was suspected to be a uterine fibroid tumor. The mass grew to a size of 20×20 cm, completely covering the fetus and causing significant discomfort. A cesarean section was performed at 37 weeks, delivering a healthy fetus. Intraoperatively, a necrotic dysgerminoma was unexpectedly discovered, leading to treatment with the BEP regimen, resulting in a complete response. The patient is currently under observation with favorable tumor marker levels and no abnormalities on imaging. Clinical discussion: The review of literature on 13 pregnant cases showed dysgerminoma can manifest with abdominal pain or distension, or incidentally. Unilateral tumors occurred more frequently on the right side. Imaging aids diagnosis but definitive classification requires immunohistochemistry. Treatment involves surgery with chemotherapy for advanced disease. Prognosis is favorable with appropriate management. Conclusion: Dysgerminoma during pregnancy poses diagnostic challenges due to nonspecific symptoms and physiological changes. A synergistic approach of imaging, histopathology, surgery, and chemotherapy enables accurate diagnosis and treatment. Further research on surgical strategies and patient-centered care is warranted for continued improvement.