Case of Bilateral Malignant Dysgerminoma with Fertility Sparing Surgery and Oocyte Cryopreservation: A Case Report and Review of Recent Management Approaches

Abstract

Background: Bilateral ovarian dysgerminoma complicated by torsion is uncommon in adolescents and creates a difficult balance between oncological treatment and preservation of reproductive potential. Case Presentation: A 16-year-old girl presented with severe lower abdominal pain and vomiting. Imaging demonstrated bilateral solid ovarian masses with features suggestive of right ovarian torsion. At staging laparotomy, the right ovary was twisted four times and contained a 15 × 15 cm solid tumour; the left ovary contained a 6 × 6 cm tumour. Bilateral cystectomy and ovarian reconstruction were performed, preserving the residual macroscopically normal ovarian tissue. Histopathological examination confirmed bilateral dysgerminoma with lymphovascular invasion, extensive tumour involvement at the capsular defects or excision margins, and positive ascitic-fluid cytology. Postoperative imaging showed no suspicious enhancing lesion or distant metastasis. The patient subsequently underwent controlled ovarian stimulation and oocyte cryopreservation before receiving planned adjuvant bleomycin, etoposide, and cisplatin chemotherapy. She remains under tertiary oncological follow-up and is disease-free to date. Conclusion: This case illustrates the complexity of managing bilateral ovarian dysgerminoma with torsion in an adolescent. In carefully selected patients, bilateral cystectomy with preservation of residual ovarian tissue may permit fertility-preserving treatment when combined with appropriate staging, adjuvant chemotherapy, oncofertility intervention, structured long-term surveillance, and careful reproductive follow-up.