Mediastinal dysgerminoma complicating pregnancy.

Area of Science:

• Obstetrics and Gynecology
• Oncology
• Maternal-Fetal Medicine

Background:

• Malignancy in pregnancy presents complex management challenges due to limited evidence and the presence of a fetus.
• Mediastinal germ cell tumors are rare, especially during pregnancy, posing unique therapeutic dilemmas.

Observation:

• A 26-year-old primigravida at 23 weeks gestation presented with a substernal mass diagnosed as mediastinal dysgerminoma.
• Treatment involved bleomycin, cisplatin, and etoposide (BEP) chemotherapy, leading to maternal neutropenia and fetal growth restriction requiring early delivery at 31 weeks.

Findings:

• Chemotherapy resulted in significant clinical and radiological tumor regression.
• Postnatal radiotherapy was administered, but the mediastinal dysgerminoma progressed two weeks after treatment completion.
• Mediastinal dysgerminoma behavior differs from ovarian germ cell tumors, limiting extrapolation of treatment outcomes.

Implications:

• The safety and efficacy of BEP chemotherapy in pregnant patients with mediastinal dysgerminoma require further investigation.
• Current treatment strategies for ovarian germ cell tumors complicating pregnancy may not be directly applicable to mediastinal counterparts.
• This case highlights the need for specialized management protocols for rare cancers during gestation.