A 24-year-old woman is found to have a 12 cm left ovarian mass. Serum AFP is markedly elevated at 890 ng/mL; beta-hCG and LDH are normal. Histology reveals a yolk sac tumour. The most appropriate management is:
- A Bilateral salpingo-oophorectomy + hysterectomy + adjuvant BEP chemotherapy
- B Unilateral salpingo-oophorectomy alone as surgery is curative in stage I
- C Unilateral salpingo-oophorectomy with preservation of the contralateral ovary and uterus, followed by BEP chemotherapy ✓
- D Neoadjuvant BEP chemotherapy followed by interval debulking
Correct answer: C. Unilateral salpingo-oophorectomy with preservation of the contralateral ovary and uterus, followed by BEP chemotherapy
Explanation
Yolk sac tumours (endodermal sinus tumours) are malignant germ cell tumours that produce AFP. In young women, fertility-preserving surgery (unilateral salpingo-oophorectomy + staging) is appropriate because the contralateral ovary and uterus are rarely involved and fertility can be preserved. BEP (bleomycin, etoposide, cisplatin) chemotherapy is indicated even in stage I because of high recurrence risk without adjuvant treatment. Radical surgery is not required.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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Written and medically reviewed by the StethoPrep medical team.