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Poudel A, Sedain P, Pokhrel B, Sapkota A, Chamlagain A, Sharma N, Rajbhandary S, Khaniya B, Ojha N. A large yolk sac malignancy in a girl, an uncommon yet challenging ovarian tumor: A case report. Clin Case Rep 2023; 11:e8335. [PMID: 38125622 PMCID: PMC10731108 DOI: 10.1002/ccr3.8335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/01/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023] Open
Abstract
Key Clinical Message Yolk sac tumors are rare and malignant germ cell tumors of the ovary occurring in children and young women. Fertility-sparing surgical intervention with adjuvant chemotherapy has shown to improve prognosis. Abstract We present a case of a 14-year-old girl who presented with the complaints of lower abdominal pain and distention. Her tumor markers were increased, and radiological investigation suggested the diagnosis of malignant left ovarian mass. Histopathology confirmed the diagnosis of Yolk sac tumor. She was subsequently managed with fertility-sparing surgery and adjuvant chemotherapy.
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Affiliation(s)
- Aashish Poudel
- Department of Gynecology and ObstetricsTribhuwan University Teaching Hospital, Institute of MedicineKathmanduNepal
| | - Prajwal Sedain
- Department of Gynecology and ObstetricsTribhuwan University Teaching Hospital, Institute of MedicineKathmanduNepal
| | - Biraj Pokhrel
- Department of Gynecology and ObstetricsTribhuwan University Teaching Hospital, Institute of MedicineKathmanduNepal
| | - Aakash Sapkota
- Department of Gynecology and ObstetricsTribhuwan University Teaching Hospital, Institute of MedicineKathmanduNepal
| | - Anita Chamlagain
- Department of Gynecology and ObstetricsTribhuwan University Teaching Hospital, Institute of MedicineKathmanduNepal
| | - Nisha Sharma
- Department of PathologyTribhuwan University Teaching Hospital, Institute of MedicineKathmanduNepal
| | - Sanyukta Rajbhandary
- Department of Gynecology and ObstetricsTribhuwan University Teaching Hospital, Institute of MedicineKathmanduNepal
| | - Bishal Khaniya
- Department of Gynecology and ObstetricsTribhuwan University Teaching Hospital, Institute of MedicineKathmanduNepal
| | - Neebha Ojha
- Department of Gynecology and ObstetricsTribhuwan University Teaching Hospital, Institute of MedicineKathmanduNepal
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2
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Liu X, Feng S, Zhao L, Luo L. Clinical characteristics and prognostic models of gonadal and extra-gonadal yolk sac tumors: a population-based analysis in children and adolescents. World J Urol 2023; 41:3009-3017. [PMID: 37747514 DOI: 10.1007/s00345-023-04616-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/10/2023] [Indexed: 09/26/2023] Open
Abstract
PURPOSE Yolk sac tumors (YST) are a rare and aggressive germ cell tumor. We aimed to conduct a population-based cohort study and develop a nomogram to predict overall survival (OS) in pediatric patients with YST. METHODS The Surveillance, Epidemiology, and End Results (SEER) database was used to identify all pediatric patients with YST diagnosed between 2000 and 2018. The log-rank test was used to compare survival curves. To examine the impact of each factor on overall survival, a multivariate Cox proportional hazards model was created. Based on the results of the Cox regression model, a nomogram was constructed. RESULTS A total of 520 YST patients were identified. Overall survival rates for all patients were 92.2% at 3-year and 90.3% at 5-year, respectively. The outcome of Cox proportional hazard regression revealed that age, gender, primary sites, and treatment regimens were important independent predictors in this model. Based on the Cox regression model, we created a nomogram for predicting OS in pediatric YST patients. The chance of death increased with age in patients. Furthermore, patients with extra-gonadal YST have a lower survival rate than those with gonadal YST. CONCLUSIONS Our study revealed that age, gender, and primary site were found to be the most important predictors of the overall survival of pediatric YST, providing crucial epidemiological information for clinical management.
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Affiliation(s)
- Xu Liu
- Department of General Surgery, Xuzhou Children's Hospital, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Shaoguang Feng
- Department of Pediatric Surgery, Hangzhou Children's Hospital, Hangzhou, 310015, Zhejiang, China
| | - Lingling Zhao
- Department of Pathology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang, China
| | - Laiyue Luo
- Department of Nephrology, Anji Branch of the First Affiliated Hospital of Zhejiang UniversityAnji County People's Hospital, Huzhou, 313300, Zhejiang, China.
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3
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Lu H, Jia D, Tang Q, Shu S. Primary endodermal sinus tumor originating from the sacral ligament: a case report and review of the literature. BMC Pregnancy Childbirth 2023; 23:528. [PMID: 37474890 PMCID: PMC10357729 DOI: 10.1186/s12884-023-05849-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 07/12/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Endodermal sinus tumor (EST) is a malignant tumor originating from the ovary or testis. In most case, ultrasound examination shows ovarian mass. But there is a special kind of extra-gonadal endodermal sinus tumor, which occur in organs other than gonads with insidious onset. Here we reported a case of endodermal sinus tumor, which originated from the sacral ligament presenting as an acute lower abdominal pain. CASE PRESENTATION A 14-year-old girl was admitted to the hospital because of acute lower abdominal pain. The ultrasound showed a mass with 72 mm × 64 mm × 50 mm in Douglas, and there was no abnormality in bilateral ovaries and fallopian tubes. Laparoscopic exploration showed a large amount of blood clots in the pelvic cavity. After removal of the blood, we found rotten fish-like tissue in the left sacral ligament, rapid pathology suggested endodermal sinus tumor. After the operation, we retrospectively examined the value of alpha-fetoprotein (AFP), which was found to be elevated, and post-operative paraffin pathology confirmed the diagnosis. After four cycles of BEP chemotherapy, exploratory laparotomy was performed to remove the visible lesion, but postoperative pathology showed no abnormality. At the one-year follow-up, the patient remained recurrence-free. CONCLUSION Extra-gonadal germ cell tumors are rarely reported. When young teenagers complain of acute lower abdominal pain with elevated AFP, but there was no lesion in bilateral ovaries and fallopian tubes, we must think about the possibility of endodermal sinus tumors. Accurate diagnosis facilitates complete resection of lesions and improves patient's outcomes.
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Affiliation(s)
- Han Lu
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Jinan University Guangzhou, Guangzhou, 510630, Guangdong, People's Republic of China
| | - Dongsong Jia
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Jinan University Guangzhou, Guangzhou, 510630, Guangdong, People's Republic of China
| | - Qionglan Tang
- Department of Pathology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, People's Republic of China
| | - Shanrong Shu
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Jinan University Guangzhou, Guangzhou, 510630, Guangdong, People's Republic of China.
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4
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Utama MS, Kurniadi A, Prahastiwi AACY, Adibrata AA. Role of Radiotherapy in Recurrent Intra-Abdominal Yolk Sac Tumor. Case Rep Oncol 2021; 14:1010-1018. [PMID: 34326736 PMCID: PMC8299403 DOI: 10.1159/000517022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 05/04/2021] [Indexed: 01/10/2023] Open
Abstract
Yolk sac tumor (YST) is a rare malignant germ cell tumor with no appropriate treatment strategy to date. However, patients are treated on a case-to-case basis as per various case reports that have been published. Here, we present a case of 27-year-old female patient who presented to us with chief complaints of severe abdominal pain associated with leucorrhea. She previously had a similar pain episode, which was then evaluated by a multidisciplinary team. She was diagnosed with YST. After that, she underwent 6 cycles of chemotherapy, but there was no improvement. Then the medical oncologist referred her to performed radiotherapy. Then, the radiation oncologist decided to give her curative radiotherapy of 3D-CRT. After completing her sessions, she felt better and clinically improving. After that, she was discharged and scheduled a follow-up visit for first evaluation. At her follow-up visit, she was feeling well, and we decided to have an abdominal MRI.
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Affiliation(s)
- Marhendra Satria Utama
- Radiation Oncology Sub Division, Department of Radiology, Hasan Sadikin General Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Andi Kurniadi
- Gynecology Oncology Sub Division, Department of Obstetrics and Gynecology, Hasan Sadikin General Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | | | - Antony A Adibrata
- Medical Education Program, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
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5
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Extragonadal Yolk Sac Tumor Limited to the Myometrium: Report of a Case With Potential Fertility Preservation and Molecular Analysis Suggesting Germ Cell Origin. Int J Gynecol Pathol 2021; 39:247-253. [PMID: 31033797 DOI: 10.1097/pgp.0000000000000601] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Extragonadal pelvic yolk sac tumor (YST) in postpubertal female patients is a rare malignant neoplasm with potentially 2 distinct histogenetic pathways, and no clear treatment algorithm, especially in young patients desiring future fertility. Here we report a case of extragonadal YST arising within the myometrium in a 30-yr-old nulligravid woman. The patient presented with heavy and irregular bleeding, and imaging studies showed an 8.2 cm uterine mass, most consistent with a degenerating uterine leiomyoma. The patient underwent abdominal myomectomy, and intraoperative frozen section evaluation revealed a high-grade malignancy. Because of the patient's strong desire for future fertility, a conservative wedge resection of the surrounding myometrium and surgical staging with uterine closure and retention of the ovaries were performed. On permanent sections the tumor showed an admixture of glandular, reticular, solid and papillary architectural patterns, moderate to marked nuclear atypia and clear cytoplasm with focal eosinophilic hyaline globules. Immunohistochemical stains were diffusely positive for SALL4, AFP, glypican3, and focally positive for CK20, and negative for EMA, and CK7, confirming the diagnosis of extragonadal YST. The endometrium displayed normal secretory phase morphology without involvement by YST, and the myometrial resection margins were negative. Short tandem repeat genotyping analysis of the tumor revealed allelic gains at 7 loci (involving chromosomes 2, 3, 4, 5, 8, 13, and 15) and allelic loss at one locus assessed on chromosome 11, while next-generation sequencing results showed no mutations in 155 genes tested, suggesting germ cell origin. The patient underwent 4 cycles of adjuvant chemotherapy with bleomycin, etoposide, and cisplatin, and she had 1 cycle of successful oocyte cryopreservation 6 months after completing chemotherapy. The clinical follow-up at 12 mo shows no evidence of disease.
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6
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ElRifai A, Akel S. Extra-gonadal germ cell tumor. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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7
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Zhang H, Liu F, Wei J, Xue D, Xie Z, Xu C. Mixed Germ Cell Tumor of the Endometrium: A Case Report and Literature Review. Open Med (Wars) 2020; 15:65-70. [PMID: 32064359 PMCID: PMC7005913 DOI: 10.1515/med-2020-0010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 01/03/2020] [Indexed: 11/15/2022] Open
Abstract
Germ cell tumors (GCTs) localized extragonadally are rare, with only 14 reported cases of a yolk sac tumor in the endometrium. Here we report a case of mixed endometrium GCTs in a 65-year-old postmenopausal woman with abnormal vaginal bleeding. An ultrasound examination showed an oval-shaped mass in the patient’s uterine cavity. Biochemical examination revealed elevated serum α-fetoprotein (AFP) at 359 ng/mL, whereas the tumor markers CA-125, CA-199, and CEA were all within normal range. Total hysterectomy and bilateral salpingo-oophorectomy were performed;. a histological examination revealed that the malignant components contained a yolk sac tumor, embryonal carcinoma, and focal immature teratoma. Immunohistochemical staining showed that AFPs were diffusively distributed in both the yolk sac tumor and embryonal carcinoma. The stem cell marker OCT3/4 was positive in the embryonal carcinoma component and that the pan-cytokeratin AE1/AE3 staining was positive in glandular areas. GFAPs (Glial Fibrillary Acidic Proteins) were positive in neuroectodermal tubules; the Ki-67 protein was positive in 90% of the tumor cells, whereas CD117 and placental alkaline phosphatase (PLAP) were negative. The cumulative evidence indicated mixed GCTs of endometrium as the final histopathological diagnosis. The patient received three courses of adjunct chemotherapy that provided good therapeutic efficacy as evidenced by the decreased serum AFP level. Our report on this rare case of mixed GCTs of the endometrium, supported by associated histological patterns and immunophenotypes and successful adjunct chemotherapy after surgery, could provide insight on future treatment of this rare but lethal disease.
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Affiliation(s)
- Heping Zhang
- Department of Pathology, Anhui Province Maternal and Child Health Hospital, Hefei 230001, People's Republic of China
| | - Fangyun Liu
- FenLan Medical Lab, Hangzhou 310052, People's Republic of China
| | - Jianguo Wei
- Department of Pathology, Shaoxing People's Hospital & Shaoxing Hospital of Zhejiang University, Shaoxing, People's Republic of China
| | - Debin Xue
- FenLan Medical Lab, Hangzhou 310052, People's Republic of China
| | - Zhengxin Xie
- FenLan Medical Lab, Hangzhou 310052, People's Republic of China
| | - Chunwei Xu
- Department of Pathology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou 350014, People's Republic of China
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8
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Chen LH, Yip KC, Wu HJ, Yong SB. Yolk Sac Tumor in an Eight-Year-Old Girl: A Case Report and Literature Review. Front Pediatr 2019; 7:169. [PMID: 31114774 PMCID: PMC6503144 DOI: 10.3389/fped.2019.00169] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 04/12/2019] [Indexed: 12/22/2022] Open
Abstract
Yolk sac tumor (YST), which most frequently arises in the gonads as a type of germ cell tumor, is rare in children but is highly malignant. It has been suggested that alpha-fetoprotein (AFP) can be applied as a feasible tumor marker because its level was elevated in >90% of YST. The treatment generally involves debulking surgery of tumors followed by systemic chemotherapy. Metastasis process of YST in children is different from that in adults and thus the treatment option is required. In this study, we described a rare case of YST in terms of the clinical manifestation, imaging, and histopathology findings, diagnosis and treatment in an 8-year-old girl. Furthermore, it is important to investigate more thoroughly a patient with history of intermittent abdominal pain and fever with previously multiple accesses, because these might be the critical signs for YST that should be alarmed for early treatment. Although YST is rare in children, pediatric physicians should be aware of this and prompt treatment should be addressed.
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Affiliation(s)
- Li Hsun Chen
- Asian Institute of Tele-surgery (IRCAD-Taiwan), Chang Bing Show Chwan Memorial Hospital, Lukang, Taiwan
| | - Kui-Chuen Yip
- Division of Family Medicine, Chang Bing Show Chwan Memorial Hospital, Lukang, Taiwan
| | - Hsing-Ju Wu
- Research Assistant Center, Show Chwan Memorial Hospital, Changhua, Taiwan.,Department of Medical Research, Chang Bing Show Chwan Memorial Hospital, Lukang, Taiwan
| | - Su-Boon Yong
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Division of Pediatric Allergy, Immunology and Rheumatology, Department of Pediatrics, Show Chwan Memorial Hospital, Changhua, Taiwan.,Department of Nursing, Meiho University, Pingtung, Taiwan
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9
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Extragonadal Yolk sac Tumor outside of the Midline of the Body: A Case Report of a Child with a Yolk Sac Tumor of the Pontocerebellar Angle. TUMORI JOURNAL 2018; 95:840-2. [DOI: 10.1177/030089160909500634] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Yolk sac tumor is a rare germ cell neoplasm occurring mainly in the gonads. Extragonadal yolk sac tumor is a very rare malignancy; its main distribution is along the midline of the body at three principal sites: mediastinum, central nervous system and retroperitoneum. Most yolk sac tumors are diagnosed between seven months and three years of age. We report a case of primary yolk sac tumor in a 13-month-old child. The tumor was located in the pontocerebellar angle, an atypical location that may not have suggested a yolk sac tumor as first diagnosis. We want to highlight the importance of performing tumor marker measurements during the first year of life, also for tumors located away from the midline.
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10
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Abstract
We present the clinicopathologic features of 15 cases of extragonadal yolk sac tumor (EGYST) detected in female patients and reviewed at our institution from 1988 to 2016. We recorded: patient age, clinical presentation, tumor location, FIGO stage (where applicable), histologic patterns including presence/absence of Schiller-Duval bodies, other germ cell or somatic components, immunoperoxidase results, treatment, and outcome. Patients' ages ranged from 17 to 87 (median, 62) years and presentation included: abnormal uterine bleeding, 12; hematuria, 1; labial mass, 1; abdominal pain, 1. Primary sites were as follows: uterus (11), vagina (1), vulva (1), bladder (1), and peritoneum (1). Seven patients presented at FIGO stage III or IV. The following histologic patterns were observed: microcystic/reticular (7), glandular (8), solid (8), papillary (5), and hepatoid (1). An admixture of histologic patterns was present in 10 cases. Schiller-Duval bodies were seen in only 3 (23%) cases. Eight cases (46%), all uterine primaries, had associated somatic components, and 2 (15%) had a second germ cell component. In 13/14 (93%) cases, the yolk sac tumor component was either missed or misclassified as adenocarcinoma. Immunoperoxidase studies facilitated the diagnosis in all cases as follows: SALL4, 12/12; CDX2, 10/12; α fetoprotein, 7/14; glypican-3, 9/10; cytokeratin 20, 5/9 (rare cells); cytokeratin 7, 3/12 (nondiffuse); PAX8, 2/9 (variable expression). All patients received chemotherapy and all except 1 underwent surgical resection. Follow-up from 5 to 86 months was available for 13 patients: 5 died of disease, 6 are alive with disease, and 2 have no evidence of disease. EGYST arising in the female pelvis of peri/postmenopausal patients may be associated with a somatic component and represent either somatically derived YST or YST differentiation within a somatic carcinoma. EGYST in younger patients is likely a true germ cell neoplasm, and may respond to germ cell appropriate chemotherapy. The benefit of germ cell appropriate chemotherapy in somatically derived EGYST is less clear. Awareness that the presence of glandular or microcystic patterns may lead to under-recognition or misdiagnosis of EGYST in combination with immunomarkers for germ cell and yolk sac differentiation will facilitate the diagnosis.
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11
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Nair VG, Kiran HS, Shanthala PR. Pure Primary Extragonadal Retroperitoneal Yolk Sac Tumour in a Young Child: A Case Report. J Clin Diagn Res 2017; 11:ED09-ED11. [PMID: 28658778 PMCID: PMC5483680 DOI: 10.7860/jcdr/2017/24892.9781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 12/11/2016] [Indexed: 11/24/2022]
Abstract
Germ Cell Tumours (GCTs) in children are uncommon, constituting approximately only 3% of all malignancies in children younger than 15 years of age. Primary extragonadal GCTs constitute only 1-5% of all GCTs and a retroperitoneal site is seen only in 4% of all extragonadal GCTs. Extragonadal GCTs arise from local transformation of primordial germ cells which have been misplaced during the migration of these cells through the midline dorsal mesentery in the fourth-sixth week of embryogenesis. GCTs in children show remarkable variability in age, site, presentation and histology. This is the case of a three-year-old male child who presented with a history of an abdominal swelling which was rapidly progressive in nature. Radiology showed a large retroperitoneal mass and lesions in the liver. Histopathology, immunohistochemistry and serum Alpha-fetoprotein (AFP) values confirmed a diagnosis of pure primary extragonadal yolk sac tumour.
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Affiliation(s)
- Vineeth G Nair
- Junior Resident, Department of Pathology, Yenepoya Medical College, Mangalore, Karnataka, India
| | - HS Kiran
- Assistant Professor, Department of Pathology, Yenepoya Medical College, Mangalore, Mangalore, India
| | - PR Shanthala
- Associate Professor, Department of Pathology, Yenepoya Medical College, Mangalore, Karnataka, India
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12
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Euscher ED. Unusual Presentations of Gynecologic Tumors: Extragonadal Yolk Sac Tumor of the Vulva. Arch Pathol Lab Med 2016; 141:293-297. [PMID: 27959583 DOI: 10.5858/arpa.2016-0151-sa] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Extragonadal germ cell tumors are uncommon, and although they morphologically resemble their gonadal counterparts, unexpected gonadal presentation increases the potential for erroneous diagnoses. Yolk sac tumor is a malignant germ cell tumor characterized by an extraembryonic yolk sac line of differentiation, and relative to other germ cell tumors, is characterized by varied and diverse histologic patterns. When occurring outside of typical age parameters or in extragonadal locations, the histologic variability of yolk sac tumor and its tendency to mimic somatic tumors pose diagnostic challenges. Because extragonadal yolk sac tumor of the vulva is very rare, with only isolated case reports and small series in the literature, it is often not considered in the differential diagnosis. As both prognosis and management of yolk sac tumor differ significantly from those of somatic tumors, accurate diagnosis is essential. This review discusses histologic features of extragonadal yolk sac tumor, addresses somatic tumors arising in the vulva for which yolk sac tumor may be confused, and provides guidance with respect to the use of immunohistochemistry in the diagnosis of yolk sac tumor.
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13
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Rudaitis V, Mickys U, Katinaitė J, Dulko J. Successful treatment of advanced stage yolk sac tumour of extragonadal origin: a case report and review of literature. Acta Med Litu 2016; 23:110-116. [PMID: 28356797 PMCID: PMC5088743 DOI: 10.6001/actamedica.v23i2.3327] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background. Yolk sac tumour diagnosis should be considered for young age patients admitted to the hospital with non-specific complaints of widespread disease. Correct diagnosis and carefully planned treatment is the key to a successful outcome. Methods and materials. We present a rare case of a widespread yolk sack tumour of a uterine broad ligament. Our team directed a special attention towards the patient’s young age, advanced disease, and fertility sparing strategy of treatment. Results and conclusions. Stage IV yolk sac tumours of extragonadal origin are rarely reported in the literature. Hence, diagnosis and treatment often pose a challenge for emergency care unit doctors, gynaecologists, and oncologists. However, it can be a potentially curable disease. Moreover, patients’ fertility can also be preserved. We believe that further analysis of similar cases is necessary to study outcomes and evaluate patients’ responses to a sequence of medical decisions taken for this specific case.
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Affiliation(s)
- Vilius Rudaitis
- Clinic of Obstetrics and Gynaecology, Faculty of Medicine, Vilnius University.,Medical Faculty, Vilnius University, Vilnius, Lithuania
| | - Ugnius Mickys
- National Centre of Pathology, Santariskiu Clinics Affiliate, Vilnius.,Medical Faculty, Vilnius University, Vilnius, Lithuania
| | | | - Justyna Dulko
- Medical Faculty, Vilnius University, Vilnius, Lithuania
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14
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Sukumaran R, Somanathan T, Mathews A, Kattoor J. Primary extragonadal pure yolk sac tumor in a post-menopausal female. South Asian J Cancer 2014; 2:178. [PMID: 24455614 PMCID: PMC3892550 DOI: 10.4103/2278-330x.114151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Renu Sukumaran
- Department of Pathology, Regional Cancer Centre, Trivandrum, Kerala, India
| | - Thara Somanathan
- Department of Pathology, Regional Cancer Centre, Trivandrum, Kerala, India
| | - Anitha Mathews
- Department of Pathology, Regional Cancer Centre, Trivandrum, Kerala, India
| | - Jayasree Kattoor
- Department of Pathology, Regional Cancer Centre, Trivandrum, Kerala, India
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15
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Mui WH, Lee KC, Chiu SC, Pang CY, Chu SK, Man CW, Wong CS, Sze WK, Tung Y. Primary yolk sac tumour of the urinary bladder: A case report and review of the literature. Oncol Lett 2013; 7:199-202. [PMID: 24348848 PMCID: PMC3861607 DOI: 10.3892/ol.2013.1670] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 10/22/2013] [Indexed: 01/02/2023] Open
Abstract
We present a case of rare primary yolk sac tumour of the urinary bladder in adulthood. A 31-year-old female patient presented with a history of chronic ketamine abuse, which has not previously been shown to be associated with malignancy development. The final diagnosis was established only after radical cystectomy. A computed tomography (CT) scan showed paraaortic lymph node metastasis. The patient was treated with systemic chemotherapy. A review of the literature revealed that surgical excision and cisplatin-based chemotherapy remain to be the standard of care for extragonadal yolk sac tumours.
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Affiliation(s)
- Wing Ho Mui
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong SAR, P.R. China
| | - Ka Chai Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong SAR, P.R. China
| | - Sin Chuen Chiu
- Department of Pathology, Tuen Mun Hospital, Tuen Mun, Hong Kong SAR, P.R. China
| | - Chun Yin Pang
- Department of Pathology, Tuen Mun Hospital, Tuen Mun, Hong Kong SAR, P.R. China
| | - Sau Kwan Chu
- Department of Surgery, Division of Urology, Tuen Mun Hospital, Tuen Mun, Hong Kong SAR, P.R. China
| | - Chi Wai Man
- Department of Surgery, Division of Urology, Tuen Mun Hospital, Tuen Mun, Hong Kong SAR, P.R. China
| | - Chi Sing Wong
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong SAR, P.R. China
| | - Wing Kin Sze
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong SAR, P.R. China
| | - Yuk Tung
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong SAR, P.R. China
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16
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Rossi R, Stacchiotti D, Bernardini MG, Calvieri G, Lo Voi R. Primary yolk sac tumor of the endometrium: a case report and review of the literature. Am J Obstet Gynecol 2011; 204:e3-4. [PMID: 21345404 DOI: 10.1016/j.ajog.2010.12.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2010] [Revised: 11/28/2010] [Accepted: 12/07/2010] [Indexed: 11/16/2022]
Abstract
We describe a rare case of a primary yolk sac tumor of the endometrium treated with a simple total hysterectomy without bilateral salpingo-oophorectomy and 3 cycles of the bleomycin, etoposide and cisplatin regimen.
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Affiliation(s)
- Roberto Rossi
- Obstetric and Gynecologic Unit, Mazzoni Hospital, Ascoli Piceno, Italy.
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17
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Sacrococcygeal yolk sac tumor presenting as subcutaneous fluid collection initially treated as abscess. South Med J 2010; 103:1068-70. [PMID: 20818302 DOI: 10.1097/smj.0b013e3181efb572] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Malignant extragonadal germ cell tumors, though more common in infants and children, are rare. They occur in the body's midline and may have internal and external manifestations. We report a case of an 11-month-old female with sacrococcygeal extragonadal yolk sac tumor manifesting as a draining subcutaneous nodule after initial treatment as an abscess. Extragonadal germ cell tumors can present with external manifestations confusingly similar to other more benign soft tissue conditions.
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18
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Zhang B, Gao S, Chen Y, Wu Y. Primary yolk sac tumor arising in the pancreas with hepatic metastasis: a case report. Korean J Radiol 2010; 11:472-5. [PMID: 20592932 PMCID: PMC2893319 DOI: 10.3348/kjr.2010.11.4.472] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Accepted: 12/30/2009] [Indexed: 11/15/2022] Open
Abstract
Extragonadal yolk sac tumor (YST) is a relatively rare entity. We describe here the case of an extragonadal YST that occurred in the pancreas with hepatic metastasis in an adult woman. The contrast enhanced CT images of the abdomen revealed a heterogeneous, solitary mass occupying the pancreatic neck and body with slightly inhomogeneous contrast enhancement. Two low-density lesions in the liver were also displayed on the CT images. The patient underwent surgery and the diagnosis of YST was pathologically verified.
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Affiliation(s)
- Bo Zhang
- Department of Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Province 310009, People's Republic of China
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19
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Kawahara M, Takada A, Tachibana A, Kodama T, Kobayashi H, Takino Y, Sugishita T, Oono Y, Oka T. Germ cell tumor of the colon with an adenocarcinomatous component. Int J Clin Oncol 2009; 14:537-40. [PMID: 19967492 DOI: 10.1007/s10147-009-0880-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2008] [Accepted: 01/23/2009] [Indexed: 12/25/2022]
Abstract
A case of combined germ cell tumor and adenocarcinoma that arose in the colon of a 62-year-old man is described. The clinical and pathological findings are presented. The patient had widespread metastases at diagnosis and poor prognosis after operation (right hemicolectomy) was performed in spite of receiving chemotherapy. Pathologically, the germ cell tumor was composed of a yolk sac tumor and choriocarcinoma. Further, all the metastatic lesions showed a germ cell phenotype. An extragonadal germ cell tumor is extremely rare. To our knowledge, only a few cases have been reported in the English-language literature. Our present report will contribute to the understanding of the characteristics of this rare neoplasm.
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Affiliation(s)
- Masaki Kawahara
- Division of Surgery, Kanto Central Hospital, 6-25-1 Kamiyouga, Setagaya-ku, Tokyo 158-8531, Japan.
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20
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Pasternack T, Shaco-Levy R, Wiznitzer A, Piura B. Extraovarian pelvic yolk sac tumor: case report and review of published work. J Obstet Gynaecol Res 2009; 34:739-44. [PMID: 18840194 DOI: 10.1111/j.1447-0756.2008.00725.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Extraovarian pelvic yolk sac tumors are rare, with only nine cases documented previously in the published work. We report a case of extraovarian pelvic yolk sac tumor occurring synchronously with breast carcinoma. The patient underwent resection of the pelvic tumor and hepatic implant, omentectomy and breast lumpectomy with sentinel axillary lymph node biopsy. The uterus and bilateral adnexa were preserved. Postoperative adjuvant therapy for the yolk sac tumor included three cycles of the bleomycin, etoposide and cisplatin (BEP) regimen. This was followed by adjuvant chemotherapy and radiotherapy for the breast carcinoma. It is concluded that in women with extraovarian pelvic yolk sac tumor who wish to preserve childbearing capacity, fertility-saving surgery followed by fertility-preserving cisplatin-based chemotherapy is adequate and appropriate treatment.
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Affiliation(s)
- Tanya Pasternack
- Unit of Gynecologic Oncology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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21
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Primary yolk sac tumor of the omentum: a case report and review of the literature. Arch Gynecol Obstet 2008; 279:189-92. [DOI: 10.1007/s00404-008-0661-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2008] [Accepted: 04/15/2008] [Indexed: 12/22/2022]
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22
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Filho BCA, McHugh JB, Carrau RL, Kassam AB. Yolk sac tumor in the nasal cavity. Am J Otolaryngol 2008; 29:250-4. [PMID: 18598836 DOI: 10.1016/j.amjoto.2007.09.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2007] [Accepted: 09/03/2007] [Indexed: 11/17/2022]
Abstract
Yolk sac carcinoma (YST) is rare malignant tumor of germ cell origin. It most commonly arises from the gonads but extragonadal sites of origin are reported in 20% of the cases. Head and neck germ cell tumors are uncommon and only a small number are malignant. We present the case of a 48 years old man presenting with a YST of the sinonasal tract and the arterior skull base. The patient underwent an anterior craniofacial resection and postoperative radiotherapy and continues showing no evidence of disease seven years after treatment. We discuss radiological and histological features of this tumor and provide a review of three other cases of YST arising in children.
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23
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Affiliation(s)
- Mao-Jung Tseng
- Department of Obstetrics and Gynaecology, Chang Gung Memorial Hospital, Lin-Kou Medical Centre, Chang Gung University College of Medicine, Tao-Yuan, Taiwan.
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24
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Benzekri A, Vielh P, Sabourin JC. [A mediastinal tumor in a child]. Ann Pathol 2006; 26:223-4. [PMID: 17127857 DOI: 10.1016/s0242-6498(06)70710-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Asmae Benzekri
- Département de Pathologie, Institut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif Cedex, France
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25
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Guzel A, Tatli M, Belen D, Seckin H. Spinal cord compression of primary extragonadal giant yolk sac tumor. Spinal Cord 2006; 45:254-7. [PMID: 16733519 DOI: 10.1038/sj.sc.3101942] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Case report. OBJECTIVE To report an adult male patient with a primary extragonadal giant yolk sac tumor presenting with acute spinal cord compression. SETTING Faculty of Medicine, University of Dicle, Diyarbakir, Turkey. METHOD A 31-year-old man was referred to our department with a diagnosis of Pott's disease, a complaint of back pain and gait difficulty for 2 weeks. Neurological examination showed spastic paraparesis and hypoesthesia below the L2 dermatome level. He also had urinary incontinence. Abdominal computed tomography and lumbar magnetic resonance imaging study revealed a giant cystic mass lesion located in the psoas muscle. Posteriorly, the third lumbar vertebral body was destructed and the tumor was compressing the dural sac. A combined anterior and posterior approach was performed. Pathological diagnosis was a yolk sac tumor. RESULT His neurological status improved during the postoperative course. A chemotherapy protocol was given including bleomycin, etoposide and cisplatin. Five months after the last chemotherapy, he was brought to the emergency unit in sepsis and died despite antibiotherapy. CONCLUSION Yolk sac tumor should be considered in young adult male patients presenting with acute paraparesis even without any signs or medical history of a testis tumor. These tumors may be unresectable; however, decompression of neural structures and stabilization of the spine with instrumentation may cause substantial improvement in neurological deficit and pain relief.
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Affiliation(s)
- A Guzel
- Department of Neurosurgery, University of Dicle, Diyarbakir, Turkey
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Tsai CC, Huang SC, Lin H, Ou YC, Ko SF, Liu YS. Steatotic hepatocellular carcinomatosis mimicking malignant ovarian teratoma. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2006; 27:586-7. [PMID: 16619379 DOI: 10.1002/uog.2767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
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27
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Gopaldas R, Kunasani R, Plymyer MR, Bloch RS. Hepatoid malignancy of unknown origin--a diagnostic conundrum: review of literature and case report of collision with adenocarcinoma. Surg Oncol 2004; 14:11-25. [PMID: 15777886 DOI: 10.1016/j.suronc.2004.09.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
UNLABELLED Hepatoid carcinomas are a group of neoplasms with features resembling hepatocellular carcinomas. Although rare, more cases have been noted to arise from various organs within the last decade. Differentiating these tumors is not only a challenge but also critical, since treatment modalities and operative strategies are dependent upon the exact nature of the hepatoid cancer. Based on a review of literature, we discuss the guidelines for differentiating these tumors and utilize these criteria to differentiate these tumors irrespective of their primary tissue of origin. We also describe an unusual case of hepatoid variant of primary peritoneal yolk sac tumor presenting with extensive carcinomatosis and as a collision with two synchronous primary colonic adenocarcinomas, neither of which has been reported to our knowledge to date, thereby falsely mimicking metastatic dedifferentiated colonic adenocarcinoma. CASE DESCRIPTION A septuagenarian female presented with weight loss, chronic anemia and ascites associated with bloating. Her past history was significant for COPD, hysterectomy and a bilateral oophorectomy 40 years previously. A work up which included computed tomography (CT) and contrast enema revealed significant ascites with multiple peritoneal nodules causing ascending colonic obstruction. Celiotomy revealed the entire peritoneal surface to be studded with nodules, with the largest measuring 6.0 cm. Intraoperative ultrasound, prompted by the frozen section of nodules resembling liver tissue, revealed no intrahepatic nodules. Right colectomy, omentectomy and tumor debulking were performed. The postoperative course was uneventful except for ascitic leak that spontaneously resolved. DISCUSSION The peritoneal nodules consisted of malignant cells arranged in cords that resembled liver tissue. In the absence of a primary identifiable liver disease, this is consistent with either hepatoid variant of primary yolk sac tumor or hepatoid carcinoma arising from the peritoneum. The right colectomy specimen revealed two mucosal ulcers consistent with colonic adenocarcinoma abutting two large tumor nodules on the serosal surface. Although grossly appearing to be contiguous, low power examination showed that the serosal nodule and the mucosal lesion were entirely different, and separated by a definite fibrous band. Immunohistochemical stains and patterns were used to differentiate the type of tumor. This article also discusses the criteria used to differentiate hepatoid yolk sac tumors (hepatoid-YSTs), hepatoid carcinomas and metastatic hepatocellular carcinomas and the phenomenon of opisthoplasia observed in certain malignancies. The difficulties encountered in identifying hepatoid carcinomas and current modalities used to differentiate these tumors are highlighted. The phenomenon of opisthoplasia and the challenges posed by this phenomenon in certain metastatic lesions are reviewed and explanations for the possible origins of hepatoid tumors are considered. CONCLUSION The most likely explanation in our case is that the hepatoid tumor either originated from microscopic remnant ovarian tissue left behind or primarily from the peritoneum. With no evidence of yolk sac component within the colonic tumor or in the draining lymphatics, this essentially excludes the commonly observed metastatic dedifferentiation (opisthoplasia) of adenocarcinoma to primitive forms (also known as combination tumors). Based on analysis of various factors, including tumor behavior and response to chemotherapy, we conclude that our case was a hepatoid variant of yolk sac tumor presenting in an elderly woman with carcinomatosis. This unusual presentation of two entirely different primary malignancies in close proximity is defined as "collision tumor". This is the first reported case of collision tumors involving dual colonic and primary peritoneal hepatoid-YST. Identifying the exact type still remains to be the most challenging aspect in the diagnosis of hepatoid tumors.
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Affiliation(s)
- Raja Gopaldas
- Department of Surgery, Easton Hospital, 250 South 21st Street, Easton, PA 18042, USA
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