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Abstract: Background. : Mixed yolk sac tumors of the ovary are biologically aggressive even in early stage disease. Case. : A 41-year-old woman presented with a large pelvic mass and anterior vaginal wall tumor. At surgery vaginal biopsies were performed followed by an exploratory laparotomy with resection of the mass. Pathology of the ovary revealed a primary yolk sac tumor associated with poorly differentiated endometrioid and undifferentiated carcinoma with vaginal metastasis only. She was initiated on bleomycin, etoposide, and cisplatin, with three additional cycles of etoposide and cisplatin. Initially the patient experienced a complete response, however her disease recurred and she currently is dead of her disease. Conclusion. : To our knowledge this is the first case of a mixed ovarian germ cell tumor with vaginal metastasis. [Copyright &y& Elsevier]

Background: Heterotopic pregnancy is a rare event that usually presents in the first 6-8 weeks of pregnancy., Case: A 35-year-old primigravida was referred to the hospital at 18+ weeks' gestational age for evaluation of chronic abdominal pain. Ultrasound revealed a heterotopic pregnancy. The patient underwent surgery for removal of the ectopic pregnancy., Conclusion: Heterotopic pregnancy can present at any time during pregnancy and should be considered in any pregnant woman with abdominal pain.

Ovarian cancer is deadly if not detected early, but it is only one of many causes of pelvic masses, which are common. The physician's job is to determine if a mass is likely to be malignant and needing surgical evaluation. The best predictors of malignancy are a combination of factors that include the patient's age, family history, menopausal status, symptoms, findings on physical examination and imaging studies, and blood level of the cancer biomarker CA125.