Ovarian dysgerminoma with normal serum tumour markers presenting in a child with precocious puberty

A 7-year-old female child was presented to the emergency room with acute abdominal pain and vaginal bleeding. Her assessment revealed a firm large lower abdominal mass with evidence of precocious puberty with bilaterally symmetrically enlarged breast (Tanner stage B4-P1-A1). Abdominal imaging showed a well-defined soft midline pelvi-abdominal single mass measuring 7.0×12.6×11.7 cms with no ascites. Serum tumour markers including lactate dehydrogenase (LDH), beta-subunit of human chorionic gonadotropin (B-hCG) and luteinizing hormone/follicular stimulating hormone (LH/FSH) were all normal. At operation, there was a huge abdominal tumour weighing 558 grams, localized to the right ovary sparing the left ovary, uterus, lymph nodes and other abdominal organs. Unilateral right salpingo-oophorectomy was performed. Histopathologic examination revealed ovarian dysgerminoma with intact capsule; FIGO Ia. Immunohistochemical stainings were positive for placental alkaline phosphatase (PALP), CD 117(c-kit) and calretinin focally but was negative for cancer antigen-125 (CA-125), B-hCG, S-100, carcinoembryonic antigen (CEA), and leukocyte common antigen (LCA). Being fitting in the low risk classification, the wait and see protocol was selected with strict follow-up with pediatric oncologist and pediatric surgeon. Along the duration of 2 years follow up, there was no more vaginal bleeding with dramatic reduction of the breast size and no recurrence.