Ovarian Tumor Dilemma

We had two patients with ovarian tumors last month. What was unusual was that both were adolescent girls. One had a solid ovarian tumor. The other had a partly cystic and partly solid tumor. Both presented with pain in abdomen, and on examination were suspected to have torsion of the tumors. Tumor markers like alpha fetoprotein, human chorionic gonadotropin, carcinoembryonic antigen, and CA125 were in the normal range. We performed laparotomy in each case, and found a torsion of the tumor. The tumor was excised. There was no metastatic disease. Histoapathological examination revealed hemorrhagic necrotic mass, with no tissue type identifiable. We were left with a dilemma. We had strong suspicion of a germ cell tumor based on the age and the nature of the tumor in both the cases. But there was no supportive evidence, since the disease was nonmetastatic and the primary tumor was destroyed by necrosis due to torsion. The patients might develop a recurrence of the tumor at a later date, and they will need a close follow up examination to detect and treat the recurrence. It is possible that the disease was benign. Since it is not possible to state so with any degree of accuracy, both of the patients are left with the worry of a possible malignant disease that may haunt them at a later date.