A case of ovarian yolk sac tumor associated with endometrioid adenocarcinoma

Molecular Evidence for Epithelial Origin of Mixed Ovarian Epithelial-Germ Cell Neoplasms: Report of 2 Cases and Review of Literature

Ovarian germ cell tumors (GCT) account for 2% to 3% of malignant ovarian neoplasms in Western countries and typically occur within the first 2 decades. When presenting later in life, GCTs may be associated with epithelial malignancies. In these circumstances, it has been theorized that these tumors may originate from a somatic, rather than germ cell origin, especially in the postmenopausal setting; however, the true derivation is not fully understood. Our database was searched for primary ovarian GCTs associated with a malignant epithelial component in patients above 35 yr of age, from 2006 to 2021. Two cases were identified and in each case, slides were reviewed and targeted next-generation sequencing was utilized to identify and compare gene mutation variants in morphologically distinct components. Patient A is a 58-yr-old, with choriocarcinoma and minor component of mucinous adenocarcinoma, and patient B is a 43-yr-old, with yolk sac tumor and minor component of endometrioid adenocarcinoma. The morphologically distinct areas in each case showed disparate staining patterns; however, next-generation sequencing demonstrated identical mutation variants within both the germ cell and epithelial components. Variants in CDKN2A , PIK3CA , PIK3R1 , and TP53 were present in patient A's tumor, while patient B's tumor showed CTNNB1 , PIK3R1 , and 2 PTEN variants. These mutational patterns are similar to those seen in pure epithelial counterparts, suggesting somatic derivation of the germ cell component. These rare tumors portend a poor prognosis and understanding their origin has clinical and therapeutic implications.

Post-pubertal ovarian yolk sac tumor with unusual follicular growth pattern, simulating struma ovarii

Yolk sac tumors (YST), formerly known as endodermal sinus tumors, are uncommon ovarian neoplasms. They are most common in the second and third decades of life and are rare in women older than 39 years of age. YST exhibit various histologic patterns. Microfollicular pattern resembling thyroid tissue has not been reported. We introduce here a case of yolk sac tumor in a 39 y/o female, presented with pelvic masses and high level of serum Alpha-fetoprotein (Alpha Fetoprotein) (> 1000 IU/ml). The patient underwent left salpingo-oophorectomy. On microscopic study, morphologic findings demonstrated a neoplasm composed of follicular structures with eosinophilic intraluminal content, resembling struma ovarii on low-power field. On Immunohistochemistry study, the tumor cells were positive for Alpha-fetoprotein and Glypican-3. Epithelial Membrane Antigen (EMA), Thyroglobin (TG), Thyroid transcription Factor-1 (TTF1) and sex-cord stromal markers were negative. This case introduces a new histomorphologic pattern of yolk sac tumor in a middle-aged woman. It is important to know that yolk sac tumor can exhibit various histological appearances. Regarding patient’s clinical and laboratory findings, this differential diagnosis should be kept in mind for proper diagnosis of similar cases.

A case of ovarian endometrioid adenocarcinoma with yolk sac differentiation and Lynch syndrome

Ovarian endometrioid adenocarcinoma with yolk sac component has been reported in fewer than twenty cases in the literature. A majority of the diagnoses are described in postmenopausal women without specific reference to germline genetic testing. We describe, to our knowledge, the first case in the English literature of a premenopausal woman that presented with an ovarian endometrioid adenocarcinoma with focal yolk sac component and was subsequently found to have a germline MSH2 mutation confirming a diagnosis of Lynch syndrome. Concurrent diagnosis of ovarian endometrioid adenocarcinoma with yolk sac tumor and Lynch syndrome is an extremely rare finding in a young patient and requires careful follow-up. Genetics evaluation and testing may be reasonable for individuals with this rare or mixed tumor pathology at young age of onset and can have clinical utility in guiding future cancer treatment or surveillance.

Ovarian yolk sac tumor in postmenopausal females: A case series and a literature review

RATIONALE

Ovarian yolk sac tumors (YSTs) are the second most common histologic type of ovarian germ cell tumors. Most patients are adolescent and young women, while cases in postmenopausal women were rarely reported. Due to its rarity, we know little about the treatment and prognosis of postmenopausal patients with ovarian YSTs. We reported 3 cases of mixed ovarian YST in postmenopausal females reviewed the related current English literature.

PATIENT CONCERNS

The ages of the three patients were 61, 58 and 77 respectively. The three patients came to the hospital because of the abdominal discomfort or tenderness, and the third patient also has vaginal bleeding.

DIAGNOSES

Imaging examination revealed pelvic mass with cystic and solid components. The elevated serum AFP level and pathologcial examination confirmed mixed ovarian YST.

INTERVENTIONS

All patients received surgery and chemotherapy. Two patients received PEB (cisplatin, etoposide, and bleomycin) chemotherapy initially and one patient received TC (paclitaxel carboplatin) chemotherapy.

OUTCOMES

One patient relapsed 8 months after diagnosis and underwent re-cytoreductive surgery. The three patients all survived at last follow-up.

LESSONS

The diagnosis of postmenopausal ovarian YST is relatively difficult and it can coexist with other germ cell or epithelial tumors. Postmenopausal ovarian YSTs are aggressive, and may have a worse prognosis compared with those in young patients. More aggressive treatment is needed. When YST mixed with epithelial cancer components, adjuvant chemotherapy regimen should include platinum-based chemotherapy aiming at both epithelial ovarian cancer and germ cell tumors.

Ovarian yolk sac tumor coexisting with epithelial ovarian cancer: An aggressive rare entity

Yolk sac tumor (YST) is the second most common subtype of ovarian germ cell tumors. It usually occurs in the second and third decades of life and is rare in postmenopausal women. In postmenopausal women, YST is commonly an aggressive tumor and can present as a pure germ cell component or as a mixed component with other germ cell or epithelial components. The recognition of this histological subtype is important not only for differential diagnosis but also for determining prognosis and treatment decisions. In this case report, we describe a 61-year-old woman with YST coexisting with epithelial carcinoma focusing on the efficacy of systemic therapies.