Rare case of malignant yolk sac tumor and contralateral teratoma in pregnancy

A 32year old nulligravida was referred to our outpatient clinic in her 24th week of pregnancy with suspicion of placenta praevia. In our scan we could locate the placenta in the fundal area, but in the right adnexal region we detected a 17 × 9 cm inhomogeneous mass with cystic and non-cystic areas. The tumor presented with increased doppler perfusion but without papillary structures. No ascites was found. The contralateral ovary could be visualised. CA 12 – 5 was 78U/ml, CEA normal, AFP and ß-HCG highly elevated. Adnexectomy of the ríght ovary via a longitudinal laparotomy was performed and the histologic evaluation of the tumor revealed a malignant yolk sac tumor of the ovary. After 4 weeks and in her 28th week of pregnancy we started chemotherapy with bleomycin, etoposide and cisplatin and applicated 3 cycles in total. Regular scans of the fetus were performed, growth, doppler of the umbilical artery and amniotic fluid were normal. With 40 weeks she delivered vaginally a 3000 g male baby. In the follow up scan 6 weeks after delivery we detected a 5 cm inhomogeneous mass together with normal ovarian tissue in the area of the left ovary without ascites, highly suspicious for a teratoma. ß-HCG and AFP were still normal, so we decided to excise only the tumor and preserve the main part of the ovary. Histologic analysis confirmed the diagnosis of a benign teratoma. Malignant tumors of the ovary in pregnancy are rare. Most of the tumors represent germ cell tumors. The treatment of the tumors in pregnancy follows same protocols as in nonpregnant women but long term effects on the fetus are not clear. This is a rare case of a malignant yolk sac tumor and contralateral teratoma.