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Obstetrics and
Gynaecology Cases - Reviews
Vidal et al. Obstet Gynecol Cases Rev 2018, 5:120
Volume 5 | Issue 2
DOI: 10.23937/2377-9004/1410120
ISSN: 2377-9004
Open Access
Citaon: Vidal IS, Soares LS, Gurgel KB, Gonçalves AK, Cobucci RN (2018) Hot Flushes in a 15-Year-Old
Girl Post Treatment of Bilateral Ovarian Dysgerminoma: A Case Report. Obstet Gynecol Cases Rev
5:120. doi.org/10.23937/2377-9004/1410120
Received: February 23, 2018: Accepted: March 27, 2018: Published: March 29, 2018
Copyright: © 2018 Vidal IS, et al. This is an open-access arcle distributed under the terms of the
Creave Commons Aribuon License, which permits unrestricted use, distribuon, and reproducon
in any medium, provided the original author and source are credited.
Vidal et al. Obstet Gynecol Cases Rev 2018, 5:120 • Page 1 of 4 •
Hot Flushes in a 15-Year-Old Girl Post Treatment of Bilateral Ovar-
ian Dysgerminoma: A Case Report
Iaponira da Silva Vidal1, Lilian Santos Soares1, Karen Beatriz Gurgel1, Ana Katherine
Gonçalves2 and Ricardo Ney Cobucci3*
and young adults. Dysgerminoma is usually solid mass
and grows rapidly; it is usually unilateral and tends to
more frequently occur in the right ovary. Only 10-15%
of cases have a bilateral involvement [3].
Advances in treang malignant diseases among ad-
olescents have resulted in markedly improved survival
rates. More than 70% of adolescents diagnosed with
cancer can expect to be long-term survivors. Howev-
er, with these advances, survivors now face the conse-
quences of exposure to intensive mulmodality thera-
pies. Girls who are treated with chemotherapy, surgery,
and/or radiaon can potenally suer the loss of the
reproducve funcon. Premature menopause leads to
the early and oen unexpected loss of reproducve po-
tenal as well as the cessaon of ovarian sex hormone
producon. Thus, adolescents who experience prema-
ture menopause are at increased risk of developing a
variety of adverse health outcomes: Hot ushes, osteo-
porosis, accelerated atheroscleroc cardiovascular dis-
eases and psychosexual dysfuncon [4,5].
Case Report
A 15-year-old girl presented with a history of amenor-
rhea, progressive increase of abdominal volume and pain
in the lower abdomen beginning three months previously.
Menarche occurred at age 12 and since then she has
had regular monthly menses and sexual acvity began
at age 14.
*Corresponding author: Ricardo Ney Cobucci, MD, PhD, Department of Gynecology and Obstetrics, Poguar University,
UnP, Salgado Filho Av., 1610, Natal-RN, 59056-000, Brazil, E-mail: rncobucci@hotmail.com
Abstract
Ovarian tumors in adolescents are a medical challenge due
to their rarity. The aim is to describe a case of adnexal dis-
ease in a girl with hot ushes after treatment. A 15-year-old
girl presented a history of menstrual delay and progressive
increase of abdominal volume. Initially, clinical suspicion
was for pregnancy, but after abdominal magnetic reso-
nance imaging, a solid-cystic abdominopelvic mass was
revealed. She underwent laparotomy and pathologic eval-
uation revealed a bilateral ovarian dysgerminoma. Surgical
menopause appeared one year after surgery and improved
after hormone replacement. Ovarian cancer is rare in ado-
lescence. Diagnosis, treatment and follow-up avoid further
complications.
Keywords
Adnexal diseases, Ovarian neoplasms, Premature ovarian
failure
1Federal University of Rio Grande do Norte (UFRN), Brazil
2Department of Gynecology and Obstetrics, Federal University of Rio Grande do Norte (UFRN), Brazil
3Department of Gynecology and Obstetrics, Poguar University, Brazil
CASE REPORT
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Introducon
Ovarian tumors in the adolescent age group are a
medical challenge due to their rarity and controversial
management. The incidence of ovarian masses is es-
mated at 2.6 cases per 100,000 girls per year, and ma-
lignant ovarian tumors account for 0.9% of all childhood
and adolescent malignancies [1,2].
Dysgerminoma is an ovarian tumor that is composed
of primive undierenated germ cells. It is the most
common malignant tumor occurring in the ovary and
these lesions are found most commonly in adolescents
ISSN: 2377-9004DOI: 10.23937/2377-9004/1410120
Vidal et al. Obstet Gynecol Cases Rev 2018, 5:120 • Page 2 of 4 •
revealed bilateral giant adnexal tumors (Figure 2). She
underwent intraoperave evaluaon with frozen/sec-
on and due to the diagnosis of dysgerminoma with
peritoneal involvement, a total hysterectomy with bi-
lateral oophorectomy, omentectomy, appendectomy,
removal of peritoneal lesions, and para-aorc lymph-
adenectomy was done. She had good clinical evoluon
in the postoperave period and was discharged on the
ninth postoperave day.
The histopathological and immunohistochemical in-
vesgaon of resected masses revealed bilateral dys-
germinoma. The FIGO ovarian cancer staging was 3A.
Six months aer surgery, she underwent adjuvant
chemotherapy with bleomycin, etoposide, and cisplan
(BEP) for a period of three months.
Aer a year of surgical treatment, the girl sought
gynecological care complaining of intense hot ush-
es, arthralgia, myalgia and vergo. The evaluaon by
Bla-Kupperman menopausal index presented a score
of 25. She received a prescripon for hormone replace-
ment therapy (HRT) with transdermal estrogen and af-
ter 2 months of treatment underwent a reassessment
with her score dropping to 11. Currently, she is being
monitored in the climaterium outpaent clinic using
HRT with signicant improvement in her symptoms.
Discussion
Malignant ovarian germ cell tumors (MOGCT) repre-
sent more than 50% of the cases of ovarian cancer in ad-
olescence and more than 80% of the paents are aged
15 or less. Tumor markers are important for evaluang
MOGCT for diagnosis and follow-up. They have been
increasingly used for monitoring the clinical status of
malignant germ cell tumors and among the most used
are: Alpha-fetoprotein (AFP), βHCG, cancer angen-125
(CA-125), lactate dehydrogenase (LDH) and carcinoem-
bryonic angen (CEA) [6]. Dysgerminomas, one of the
types of MOGCT, have most commonly been associated
with elevaons in LDH and high serum hCG levels are
present in 3% of cases. Moreover, elevaons in AFP are
even less common [6]. In our case, there were elevated
levels of AFP, βHCG, LDH and CA-125.
She sought a health facility for a suspected pregnan-
cy and a serum level of human chorionic gonadotropin
(βHCG) test was performed that was posive. Because
the fetal heart sounds were not detected, she was re-
ferred to the emergency room, where during the physi-
cal examinaon a hardened abdominal mass with irreg-
ular contours occupying the whole abdomen was ob-
served and was hospitalized for diagnosc claricaon.
Abdomino-pelvic ultrasound examinaon revealed
a solid abdominal mass, with somewhere cysc com-
ponents, and Doppler revealed vascular masses with
a volume of 3700 cc bilaterally. Abdominal magnec
resonance imaging (MRI) revealed a solid-cysc abdom-
inopelvic mass, with probable origin in the le ovary,
hypervascularity and causing mild bilateral hydrone-
phrosis (Figure 1).
The imaging invesgaons pointed to suspicion of
malignant ovarian tumor. Laboratory invesgaons
were given in Table 1.
Based on the clinical, imaging and elevated tumor
markers ndings, she was diagnosed with ovarian ma-
lignancy. She underwent exploratory laparotomy which
Figure 1: Pre-operative abdominal MRI scan picture, show-
ing huge solid pelvi-abdominal mass.
Table 1: Laboratory tests and tumor markers.
Exam Values
Hematocrit 9.9 g/dl
Hemoglobin 28.4%
hCG 1244.79 (↑)
Glycemia 67 g/dl
AFP 176.61 (↑)
CEA 0.5
CA-125 151.5 (↑)
LDH 6663 (↑)
Abbreviations: hCG: Human chorionic gonadotropin; AFP: Al-
pha-fetoprotein; CEA: Carcinoembryonic antigen; CA-125: Can-
cer antigen-125; LDH: Lactate dehydrogenase; (↑): High value.
Figure 2: Intraoperative picture showing both ovaries in-
volved with a huge solid capsulated mass.
ISSN: 2377-9004DOI: 10.23937/2377-9004/1410120
Vidal et al. Obstet Gynecol Cases Rev 2018, 5:120 • Page 3 of 4 •
survival rate. Finally, adequate follow-up will allow for
the diagnosis of sequelae of the disease or therapy,
avoiding damaging consequences in the future of these
adolescents.
Conicts of Interest
The authors declare no potenal conicts of interest
and no sources of support.
Acknowledgements
All authors equally contributed to the design and im-
plementaon of the research, to the analysis of the case
and to the wring of the manuscript.
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surgical treatment without adjuvant chemotherapy has
recently been proposed for paents with FIGO stage 1
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Evidently, bilateral oophorectomy results in pre-
mature ovarian insuciency (POI) and counseling by
a health professional is mandatory in view of the POI
consequences, which can lead to symptoms that signi-
cantly aect the quality of life of adolescents, as seen
in this case. HRT is indicated for the treatment of vaso-
motor and genitourinary symptoms in women with POI
and to improve psychological, sexual and social eects
of the premature surgical menopause among adoles-
cents. It is also recommended to maintain bone health
and prevent osteoporosis and may have a role in the
primary prevenon of cardiovascular disease [12,13].
Lile data exists regarding the treatment regimens
of adolescents with HRT. Treatment regimen proposed
so far are empiric, and further studies are needed to
establish: Opmal dosing in terms of safety and eca-
cy, long-term eect on bone, brain, and cardiovascu-
lar health, and the long-term risk of developing estro-
gen dependent cancers. Transdermal estrogen patch
seems preferable because it doesn’t have the suppres-
sive eect oral estrogens exhibit on both baseline and
growth-hormone smulated insulin-like growth factor-I
(IGF-I) concentraons. Transdermal HRT was also re-
ported to have a posive eect on serum lipid proles,
inammatory markers, and blood pressure. Oral estro-
gen therapy increases renin substrate and the risk of
hypertension [14]. In our case, clearly aer the onset of
HRT the adolescent had a marked improvement in the
symptoms that made her seek professional help.
Conclusion
In adolescence, MOGCT are rare and can be con-
fused with pregnancy as in this case. Early diagnosis and
treatment based on the best evidence provide a high
ISSN: 2377-9004DOI: 10.23937/2377-9004/1410120
Vidal et al. Obstet Gynecol Cases Rev 2018, 5:120 • Page 4 of 4 •
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