Abstract:

Ovarian nongestational choriocarcinoma (ONGC) is an extremely rare malignant ovarian tumor, characterized by high malignancy and poor prognosis. Early diagnosis and prompt chemotherapy are crucial for improving outcomes; however, due to the lack of specific clinical manifestations and imaging features, preoperative misdiagnosis or missed diagnosis is common, leading to delayed treatment. We report a case of a 14-year-old female patient who presented with progressively worsening lower abdominal pain as the initial symptom, with no history of menarche or sexual activity. Preoperative magnetic resonance imaging revealed a right adnexal mass, and emergency ovarian cystectomy was performed. The postoperative immunohistochemical examination, combined with clinical history, confirmed the final diagnosis of ONGC. The patient received postoperative chemotherapy, but the disease progressed rapidly with multiple metastases to the lungs and gastrointestinal tract developing shortly after surgery, resulting in her death after 38 days of operation. Based on this case, serum β-human chorionic gonadotropin should be routinely tested in pediatric and adolescent patients with ovarian tumors, regardless of menstrual or sexual history. ONGC should be highly suspected when MRI demonstrates unilateral ovarian hypervascular cystic-solid masses with hemorrhage and necrosis. Once highly suspected or confirmed, early surgical resection of all lesions should be performed with fertility preservation if possible, followed by timely standardized postoperative chemotherapy. Residual disease after surgery and delayed treatment are two critical factors for poor prognosis. Given the highly malignant nature and rapid progression of this disease, emphasis should be placed on early diagnosis and treatment.

Key words: Choriocarcinoma, non-gestational, Ovarian neoplasms, Carcinoma, Abdomen, acute, Diagnosis, Therapy