LAUSR

CASE PRESENTATION A 33yearold woman with a diagnosis of highgrade mixed germ cell tumor including immature teratoma and yolk sac tumor presented for a second opinion in the setting of growing abdominal and pelvic masses, despite chemotherapy. She was originally seen 6 months prior by a local gynecologist in the setting of bladder pain. After ultrasound she was found to have a 15cm complex mass arising from the right adnexa. She then underwent a minimally invasive right salpingooophorectomy at an external institution, which was complicated by intraoperative spillage. Final pathology demonstrated a mixed germ cell tumor. Postoperative tumor markers were notable for an elevated AFP (581.2 ng/mL) and CA125 (74.3 U/mL). After oocyte cryopreservation she received four cycles of bleomycin, etoposide, and cisplatin (BEP) and two cycles of etoposide and cisplatin without bleomycin in order to receive one cycle past normalization of her AFP. Her adjuvant chemotherapy course was complicated by the development of pulmonary fibrosis caused by the bleomycin. Before her cancer diagnosis, the patient was healthy with no known medical problems and no prior surgeries. Her family history was only notable for her father’s diagnosis of nonHodgkin’s lymphoma. Upon examination at our institution, she was found to have a right lower quadrant mass palpated at the site of her prior laparoscopic incision, and her abdomen was distended. Her AFP had normalized, but CA125 and CEA were increasing. She underwent a CT