Ovarian dysgerminoma case report - Lessons learnt
Elizabeth Bullivant, Obstetrics and Gynaecology Ultrasound, Sheffield Teaching Hospitals NHS Foundation Trust
A 28 year old presented at the Early Pregnancy Assessment Unit (EPAU) believed to be pregnant with suboptimal Beta-Human Chorionic Gonadotropin (bHCG) levels. On ultrasound scan there was no evidence of an intrauterine pregnancy. However a bulky right ovary was reported containing a ‘39mm cystic area with several septa and the appearance of some solid elements with no associated vascularity’. The ultrasound appearances were interpreted by clinicians as suspicious for ectopic pregnancy. The patient’s bHCG levels were then monitored.
Over a period of three months the patient’s bHCG levels fluctuated and a second ultrasound scan was performed by a Specialist Nurse Practitioner where a bulky right ovary was reported, but nil else. The case was then referred to the Trust’s gynaecology diagnostic multidisciplinary team (MDT) meeting where images from both ultrasound scans were reviewed by a Consultant Radiologist and Specialist Sonographer. The outcome from the meeting was that a further ultrasound scan would be performed by the Specialist Sonographer as appearances of the right ovary from both ultrasound scans did not appear normal. At this ultrasound scan appearances of the right ovary were highly suspicious for a lesion. Pathology confirmed ovarian dysgerminoma.
Discussion
Many lessons were learnt from this case and recommendations included standardisation of ultrasound reports on EPAU, interpretation of ultrasound reports and who should review reports, together with the remit of Specialist Nurse Practitioner focused scanning. Positive outcomes from the case highlighted the value of a gynaecology diagnostic MDT meeting and the role of the Specialist Sonographer working closely with a Consultant Radiologist and Gynaecologists