Dysgerminoma Masquerading as Gestational Trophoblastic Neoplasia

BACKGROUND: Persistent elevation in beta-human chorionic gonadotropin (β-hCG) following a pregnancy is concerning for gestational trophoblastic neoplasia (GTN). However, the differential diagnosis should remain broad during the evaluation process. CASE: A 34-year-old G3P3 presented with elevated β-hCG four months after cesarean delivery with bilateral tubal ligation. The patient was treated with methotrexate for a presumed new ectopic pregnancy. Due to persistent β-hCG elevation, she received actinomycin-D for GTN treatment. After completing chemotherapy, her β-hCG increased. The patient underwent a laparoscopic hysterectomy with unplanned left oophorectomy due to its nodular appearance at the time of surgery. Pathology confirmed a dysgerminoma of the ovary and benign uterus. CONCLUSION: Although dysgerminomas are uncommon, they should be considered when β-hCG levels remain elevated despite therapies for more common pathologies.