Malignant ovarian germ cell tumour in a young woman — structured oral station (12 minutes)

Opening prompt — "How do you frame this woman's presentation?"

Model response — the diagnosis and the principle: ^[1][2]

• "This is a malignant ovarian germ cell tumour until proven otherwise — most likely a yolk sac (endodermal sinus) tumour, given the markedly elevated alpha-fetoprotein and the solid-cystic mass in a 19-year-old."
• "The pregnancy test is negative, excluding a gestational trophoblastic cause of the raised markers. The principle that governs everything from here is that conservative, fertility-sparing surgery is the standard in all stages of ovarian germ cell tumour, because chemotherapy cures the majority."^[1]

Probe 1 — "Describe the surgical procedure you would perform."

• "Fertility-sparing staging surgery: peritoneal washings, careful inspection and biopsy of suspicious areas, unilateral salpingo-oophorectomy, omentectomy, and appendicectomy if the tumour is mucinous." ^[1]
• "I would preserve the uterus and the contralateral ovary. I would not perform a wedge biopsy of a normal contralateral ovary — it defeats the fertility-sparing intent." ^[1]
• "The aim is to achieve no visible residual disease, which is the dominant prognostic factor." ^[1]

Probe 2 — "Reproduce the BEP chemotherapy regimen with the dose of each component."

• "The BEP regimen per the FIGO 2021 update: etoposide 100 mg/m2 IV per day for 5 days; cisplatin 20 mg/m2 IV per day for 5 days; bleomycin 30 IU IV/IM on days 1, 8 and 15. Every 3 weeks for 3 cycles." ^[1]
• "If bleomycin is omitted, 4 cycles of EP are used. Bleomycin is dosed in International Units." ^[1]

Probe 3 — "If this had been a Stage IA dysgerminoma instead, what would change?"

• "Stage IA dysgerminoma is observed after complete surgical staging — no adjuvant chemotherapy." ^[1]
• "The rationale is that dysgerminoma is exquisitely chemo- and radiosensitive; a small proportion recur but are cured at recurrence. Radiotherapy is effective but avoided because of late effects and the efficacy of chemotherapy." ^[1]

Probe 4 — Contrast: "How does this differ from a borderline tumour, and from a granulosa cell tumour?"

• "A borderline tumour is a proliferating epithelial lesion with no destructive stromal invasion; fertility-sparing unilateral salpingo-oophorectomy is preferred over cystectomy because cystectomy roughly doubles recurrence — about 31 percent versus 13 percent (Taniskidi 2026)." ^[4]
• "A granulosa cell tumour is an indolent sex cord-stromal tumour that recurs late — in 16 to 23 percent of patients, often decades later and peritoneal — so surveillance is lifelong, inhibin B and anti-Mullerian hormone based. This is the contrast: germ cell is cured and short-surveillance; granulosa is indolent and lifelong-surveillance." ^[9]

Probe 5 — Communication: "How do you explain the fertility-sparing plan to this young woman?"

• "I would say: 'You have a type of ovarian cancer that responds extremely well to treatment — over 95 percent of women with early disease are cured. The operation will remove the affected ovary and tube but keep your uterus and your other ovary, so you can still have children in the future. After surgery you will need chemotherapy — three cycles of a combination called BEP — which is tough but short, and it does not stop you having a family afterwards. We will follow you closely with blood tests and scans for several years.' "^[1][2]