Question

What is the treatment for a 4 x 6 mm dysgerminoma in a 12 year old girl?

• A. Right cystectomy
• B. Right oophorectomy
• C. TAH with BSO
• D. Bilateral oophorectomy

Hint:

Dysgerminoma in a young girl is usually managed with fertility sparing ovarian surgery on the involved side.

Answer 1

The Correct Option is B

Step 1: Identify the tumor type.
Dysgerminoma is the most common malignant germ cell tumor of the ovary. It occurs mostly in children, teenagers, and young women, and it is highly sensitive to chemotherapy and radiotherapy if it does spread, but the first step in management is always surgical.

Step 2: Recall the surgical principle for germ cell tumors in young patients.
Because dysgerminoma affects young girls who have not completed their family, and because it is usually confined to one ovary at diagnosis, the standard fertility sparing operation taught for this tumor is removal of the involved ovary and tube, a unilateral salpingo-oophorectomy, together with surgical staging such as peritoneal washings and inspection of the other ovary, omentum, and nodes. This preserves the uterus and the opposite ovary for future fertility and hormone production.

Step 3: Explain why the more radical options are wrong here.
Total abdominal hysterectomy with bilateral salpingo-oophorectomy, option C, and bilateral oophorectomy, option D, remove far more than needed in a child with disease apparently confined to one small area, and would take away all future fertility and put the girl into surgical menopause. These are reserved for advanced or bilateral disease, not a small unilateral lesion.

Step 4: A note on the size given in this question.
The lesion described here is very small, only a few millimeters, which is why the option listed as correct in the original answer key is right sided cystectomy, meaning the lesion alone is shelled out while the rest of the ovary is conserved. It is worth flagging that in current gynae oncology teaching, once a germ cell malignancy like dysgerminoma is confirmed, a right salpingo-oophorectomy is generally preferred over a simple cystectomy, because enucleation of a known or suspected malignant tumor risks leaving tumor cells behind and does not allow proper assessment of the ovarian capsule for staging. The answer given here is kept as per the original source key, but it should be treated with caution and cross checked against current departmental protocol.

Step 5: Final answer as per the given key.
\[ \boxed{\text{Right cystectomy}} \]

Answer key note: The original 2001 source key marked this as right cystectomy. Corrected here to right oophorectomy (unilateral salpingo-oophorectomy): standard gynecologic oncology management for a confirmed or suspected dysgerminoma, a malignant germ cell tumor, is removal of the entire ovary and tube on the affected side. Cystectomy alone risks incomplete tumor removal, capsule rupture, and inadequate staging, so it is not accepted management even for a small lesion.