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Complexities in Managing Mixed Germ Cell Tumour during Pregnancy: A Multidisciplinary Approach
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DOI：10.7860/JCDR/2026/82739.22926.png)
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Abstract
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Malignant ovarian tumours during pregnancy are rare, and the proportion is also too small. Mixed Germ Cell Tumours (MGCTs) are rare yet very aggressive ovarian cancers that generally afflict women of young age and consist of at least two different germ cell tumour components. Their presence during pregnancy poses distinct clinical and ethical dilemmas, and intervention must be undertaken early enough to maximise survival of the mother, considering the viability of the foetus. In this case, a 28-year-old primigravida with 16+4 weeks of gestation presented with acute pain in the right lower abdomen. Ultrasound was found to have a viable intrauterine pregnancy and a complex right adnexal mass with haemoperitoneum, which was indicative of a ruptured ovarian cyst. Emergency exploratory laparotomy showed a ruptured right ovarian mass, which was actively bleeding, and right salpingooophorectomy was done. Histopathological analysis revealed a malignant mixed germ cell tumour composed of yolk sac tumour and immature teratoma. Postoperatively, tumour markers were significantly high. The multidisciplinary tumour board discussed the case and advised termination of pregnancy and subsequent systemic chemotherapy due to the aggressive tumour behaviour and an urgent need for treatment. The patient was subjected to Medical Termination of Pregnancy (MTP) after counselling; later, she was treated with Bleomycin, Etoposide, and Cisplatin (BEP) chemotherapy. The patient responded well to treatment, experiencing a drop in tumour markers and showing no signs of residual disease. The case highlights the role of early detection and timely surgical intervention of ovarian malignancy identified in pregnancy. It also highlights the importance of multidisciplinary decision-making and the need to balance maternal prognosis and fetal considerations. Aggressive MGCTs need emergent management, and, in some cases, a pregnancy may have to be terminated to administer immediate chemotherapy.
Keywords:
Bleomycin
Cisplatin
Etoposide
Salpingo-oophorectomy
Yolk sac tumour
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