A three-cell type malignant mixed germ cell tumor of the ovary is very rare neoplasm. Presently, there has been no reported incidence of the three-cell type mixed germ cell tumor in the literature. Malignant germ cell tumors comprise less than 5% of all ovarian neoplasms. Mixed germ cell tumors, most of which have only two elements.

This is a case report of a 22-year old, nulligravid, who presented with hypogastric pain and increased abdominal girth. Clitoromegaly was noted at puberty. Patient has normal secondary sexual characteristics and menarche. A large multi-separated cystic abdominopelvic mass was seen on ultrasound. Intraoperatively, the left ovary was transformed into a solid tumor measuring 13.5cm x 7cm x 7cm, dangling separately from the left fallopian tube, such that a left oophorectomy. The uterus was hypoplastic. A thin, white, fibrous tissue inferior to the right fallopian tube was seen, which may represent the right ovary, signifying gonadal dysgenesis. For the purposes of staging, peritoneal fluid cytology, bilateral lymph node dissection infracolic omentectomy, liverand para-aortic lymph node palpation were also performed. Final histopatholic diagnosis was malignant mixed germ cell tumor comprising three element, andodermal sinus tumor (70%), dysgerminoma (25%) and embryonal carcinoma (5%). Patients was diagnosed to have malignant mixed germ cell tumor, left ovary, stage IA; hypoplastic uterus; gonadal dysgenesis, right. Adjuvant chemotherapy was advised due to the aggressive nature of the predominant cell type. Reproductive function is further compromised in the presence of the hypoplastic uterus and gonadal dysgenesis.