Malignant mixed germ cell tumor of ovary presenting as advanced disease in an adolescent girl.

Mixed germ cell tumors are very rare in young females. Patient survival, preservation of ovarian function and fertility are becoming an important issue. A locally advanced (III), bulky malignant mixed germ cell tumour in a 12-year-old girl presented to the Department of Radiotherapy, Regional Institute of Medical Sciences, Imphal, Manipur, in January 2011 with abdominal distension for one month. On physical examination, there was a large lower abdominal mass approximately 16x 14 cm2. Abdominal and pelvic CTs showed a lobulated 19x 15x10 cm soft tissue attenuation mass lesion in the pelvis extending superoanteriorly to supra-umbilical area. Laboratory investigations revealed increased serum LDH (4,245 IU/ L) and serum P-hCG (105.4 mIU/ml). Ultrasonography (USG)-guided fine needle aspiration cytology (FNAC) from left ovarian mass was suggestive of malignant germ cell tumour. In view of bulky and advanced stage, patient was administered four cycles of neoadjuvant chemotherapy (inj. ifosphamide 1,440 mg, inj. etoposide 90 mg, inj. cisplatin 24 mg for D1 -5, four weekly) followed by left salpingo-oophorectomy with wedge biopsy of right ovary and partial omentectomy, and another two cycles of adjuvant chemotherapy with same regimen. Biopsy tissue histopathology report also confirmed mixed germ cell tumour. Patient was kept on regular follow-up and she has been disease-free for the last four years. The present authors' treatment policy in such bulky and advanced tumor in adolescents is effective.

Gastric acid study in patients operated on for perforated duodenal ulcer.

OBJECTIVES: To determine the acid secretory status of patients operated on for perforated duodenal ulcer, with or without prior history suggestive of acid-peptic disease. METHOD: Basal and peak acid output were measured in 48 patients with perforated duodenal ulcer who were treated by simple closure alone, 10 patients with uncomplicated chronic duodenal ulcer and 30 normal controls. Patients operated on for perforated duodenal ulcer were analyzed according to presence (or absence) and duration of prior history of acid-peptic disease. RESULTS: Peak acid output was similar in controls and patients with perforated duodenal ulcer with no prior symptoms. However, patients with prior symptoms had significantly higher peak acid output, similar to those with uncomplicated duodenal ulcer. CONCLUSION: Patients with perforated duodenal ulcer with no antecedent history of acid-peptic disease have normal gastric acid output. These patients may therefore have other etiological factors for their ulcers.