Pure ovarian choriocarcinoma: a difficult diagnosis of an unusual tumor presenting with acute abdomen in a 13-year-old girl

A 13-year-old girl before sexual debut presented with lower abdominal pain and a positive urine pregnancy test. On admission her face was very pale, and a physical examination revealed an acute abdomen with rigidity and tenderness. She was in intermediate shock. Ultrasound examination showed presence of fluid arising from the posterior cul-desac up to the liver, consistent with a possible hemoperitoneum, and identified a 68 78-mm mass in the right adnexa. Laboratory studies revealed the following values: white blood cells 12 109 /L, hemoglobin 5.2 g/L and hematocrit 0.16. Liver function results were within normal limits.