Case Report
Successful Treatment of Nongestational Choriocarcinoma in a 15-Year-Old Girl: A Case Report

https://doi.org/10.1016/j.jpag.2020.11.004Get rights and content

Abstract

Background

Nongestational choriocarcinoma is a rare ovarian malignancy with a prognosis worse than that of gestational choriocarcinoma. Debulking surgery is the primary treatment for ovarian carcinoma. However, fertility preservation is important in young women.

Case

A 15-year-old girl with no sexual experience was admitted for abnormal uterine bleeding. Ultrasonography showed a solid mass in the right ovary and her serum β-human chorionic gonadotrophin levels were markedly elevated. We performed right oophorectomy, omentectomy, and peritoneal washing cytology. The uterus and left adnexa were preserved. She was diagnosed with nongestational choriocarcinoma, stage IIA. She received adjuvant chemotherapy (etoposide, methotrexate, actinomycin, cyclophosphamide, and oncovin regimen) and has been disease-free for more than 5 years.

Summary and Conclusion

Fertility-sparing surgery combined with chemotherapy is an acceptable treatment option for young patients with locally advanced nongestational choriocarcinoma.

Introduction

Choriocarcinoma is a highly malignant ovarian tumor that is characterized by the presence of trophoblastic malignant cells and markedly elevated levels of human chorionic gonadotrophin (hCG) in the absence of an ongoing pregnancy.1 Choriocarcinomas of the ovary are classified as either gestational or nongestational. Many cases are related to pregnancy, and nongestational choriocarcinoma usually occurs in childhood and adolescence. Nongestational choriocarcinomas can be diagnosed definitively in patients who are sexually immature or have not attained coitarche. Nongestational choriocarcinoma accounts for approximately 0.6% of all ovarian tumors and its prognosis is worse than that of gestational choriocarcinomas.1 It usually arises from germ cells and behaves like germ cell tumors. It is often difficult to make a diagnosis of nongestational choriocarcinomas in childhood and adolescence. In this report, we present a case of nongestational choriocarcinoma in a 15-year-old girl.

Section snippets

Case

A 15-year-old girl visited our tertiary medical center in 2014 with symptoms of abnormal uterine bleeding and a suspected pelvic mass. She denied any sexual experience and had an intact hymen. Ultrasonography showed a solid mass (8.5 × 6.3 cm) in the right ovary with a small amount of fluid in the Pouch of Douglas. The size of the uterus was normal, and the endometrium was 1.1 cm thick. Serum β-hCG level (76,600 mIU/mL) was markedly elevated. Computed tomography revealed a heterogeneous solid

Summary and Conclusion

Nongestational choriocarcinoma is an extremely rare ovarian germ cell tumor. Common symptoms include lower abdominal pain, atypical genital bleeding, amenorrhea, nausea, and vomiting. The serum β-hCG level might be the most sensitive parameter for diagnosing the nongestational choriocarcinoma and monitoring the response to treatment. The initial treatment approach for a suspected case of ovarian germ cell tumor is surgery, which serves as a means of establishing the diagnosis and initiating

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The authors indicate no conflicts of interest.

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