Clinical case 2

Cryopreserved Ovarian Tissue Transplantation in a Woman with Dysgerminoma: Potential and Challenges

Introduction

Transplantation of cryopreserved ovarian tissue is an established method of fertility restoration in selected patient groups. However, its application in women with malignant ovarian tumors, such as dysgerminoma, remains highly controversial because of the potential risk of reintroducing malignant cells. To date, no cases of ovarian tissue transplantation have been reported in women with this diagnosis. We present a case for discussion within ISFP to evaluate potential risks and benefits.

Case Description

A 28-year-old woman was diagnosed with dysgerminoma at the age of 22. No specific etiological factor was identified. She underwent surgery at that time and again at the age of 26, which ultimately resulted in bilateral oophorectomy. She did not receive chemotherapy or radiotherapy after either procedure, although some lymph nodes showed increased activity and an omentectomy was performed. During both surgeries, a significant portion of morphologically normal ovarian cortex was harvested and cryopreserved. Two years after the last surgery, a PET scan demonstrated no abnormalities.

The patient now suffers from premature menopause, presenting with severe vasomotor symptoms, vaginal dryness, loss of libido, and psychological distress related to both her condition and infertility. Hormone replacement therapy has not been recommended due to concerns about a possible increased risk of recurrence. She is currently inquiring about the possibility of ovarian tissue transplantation, both to relieve menopausal symptoms and to potentially restore fertility.

Considerations

Transplantation of ovarian tissue solely for the management of menopausal symptoms cannot be justified. The central question is whether fertility restoration could be considered in such a patient. If the cryopreserved tissue could be verified as free of malignant cells, parallels may be drawn with patients diagnosed with borderline ovarian tumors, in whom ovarian tissue transplantation has been performed, resulting in healthy live births. In such cases, the transplanted tissue was removed after delivery to minimize the risk of recurrence.

Dysgerminomas are highly sensitive to chemotherapy and radiotherapy, and current data do not indicate that pregnancy itself increases the risk of recurrence. A cautious strategy could therefore involve transplantation for a strictly limited period (e.g., up to 18 months). During this window, either oocyte retrieval or spontaneous conception could be attempted, followed by removal of the transplanted tissue to reduce long-term oncological risk.

Nevertheless, such an approach remains experimental and would require intensive monitoring, fully informed patient consent, and careful consideration of ethical and financial implications. Importantly, success cannot be guaranteed, and the oncological risk cannot be completely excluded.

Conclusion

This case highlights an urgent clinical dilemma: how to balance the fertility aspirations of a young woman against the oncological safety concerns associated with her history of dysgerminoma. While ovarian tissue transplantation cannot currently be recommended outside a strictly controlled research context, this case may merit expert discussion to evaluate whether a cautious, time-limited approach could ever be ethically justified in highly selected patients.