Extragonadal Yolk Sac Tumor Limited to the Myometrium: Report of a Case With Potential Fertility Preservation and Molecular Analysis Suggesting Germ Cell Origin

Yolk sac tumor of the uterus in a 2-year-old girl: A case report and literature review

BACKGROUND

Extragonadal yolk sac tumors (YSTs) occurring in the uterus are extremely rare. To report a uterine YST case in a prepubertal girl and review literature on uterine YST to outline clinical management in diagnosis and treatment.

CASE

We present a case of a 2-year-old girl who presented with vaginal bleeding and a pelvic mass. The diagnosis of YST was confirmed via biopsy. After four cycles of neoadjuvant chemotherapy combined with cisplatin, etoposide, and bleomycin (PEB), vaginoscopic examination and laparoscopy revealed a uterine YST without metastasis. The patient was treated with laparoscopic hysterectomy and two cycles of PEB postoperatively. During the 18 months of follow-up, the patient remained disease-free.

SUMMARY AND CONCLUSION

Primary uterine YST is extremely rare and no treatment guidelines have been established to date. Surgery combined with PEB chemotherapy is considered effective for uterine YST.

Preservation of sexual and reproductive function in the treatment of extragonadal yolk sac tumors in the female genital tract

OBJECTIVE

This study aimed to summarize the clinical features, treatment modalities, therapeutic effects, menstruation and fertility outcomes, and prognosis of extragonadal yolk sac tumors (YSTs) of the female genital tract.

METHODS

We reviewed 32 cases of extragonadal YSTs in the genital tract treated between 1983 and 2021. The medical records, including clinical characteristics, histopathology, treatments, chemo-reduced adverse events, and outcomes on long-term follow-up, were collected.

RESULTS

Among the 32 cases, 30 were vaginal YSTs and two were uterine YSTs (endometrial and cervical). Thirty patients (30/32, 93.8%) were <4 years. Abnormal vaginal bleeding (n = 31) and elevated serum alpha-fetoprotein level (n = 32) were the most common presentations. Vaginohysteroscopy and/or pediatric rhinoscopy were used for diagnosis in 17 pediatric patients and evaluation of chemotherapeutic efficacy in 21 pediatric patients. All the patients received combination chemotherapy. Bleomycin/etoposide/cisplatin (BEP) was chosen with prior consideration in 28 cases; 21 patients were treated with BEP alone. Yellow or grayish-yellow tissue with irregular shape was found in 66.7% of the cases during repeat examinations. Five patients underwent surgeries during repeat examinations and follow-ups, and no evidence of malignancy was noted in them. Thirty-one patients achieved complete remission. During a median follow-up of 63 months (2.4-240.3 months), two patients experienced recurrence, three died, and 29 remained disease-free. One patient recovered menstruation and five had undergone menarche.

CONCLUSION

BEP chemotherapy can serve as a preferred treatment modality for vaginal and uterine YSTs. Vaginohysteroscopy and pediatric rhinoscopy can be used for diagnosis and evaluation of chemotherapeutic efficacy in pediatric patients. YSTs possibly appear as yellow or grayish-yellow after chemotherapy.

Use of targeted therapy and immunotherapy for the treatment of yolk sac tumors in extragonadal pelvic sites: two case reports

We present the clinicopathologic features and treatments of two cases of extragonadal yolk sac tumor (EGYST) detected in young females, including one in the myometrium admitted in 2013 and another in the serosal layer of the anterior wall of uterus admitted in 2019. The following details were recorded: patient age, clinical presentation, tumor location, International Federation of Gynecology and Obstetrics (FIGO) stage (where applicable), histologic patterns including Schiller-Duval (SD) bodies, other germ cell or somatic components, immunoperoxidase results, treatment, and outcome. The patients were aged 18 and 32 years old, both displayed the clinical manifestation of pain in the lower abdomen, tumor sizes were 10 and 8 cm, respectively, and alpha-fetoprotein (AFP) was significantly increased (1,210-20,251.0 ng/mL). Both participants underwent surgery and typical SD bodies were observed in postoperative pathology. Immunohistochemistry (IHC) results indicated that they were AFP positive (+) and Sal-like protein 4 (SALL4) (+). Both patients received multi-line chemotherapy after surgery, and participant 2 received targeted therapy and immunotherapy. At 36 months after surgery, one patient died, and the other was still receiving treatment. The benefit of germ cell appropriate chemotherapy in somatically derived EGYST has not been fully elucidated. Our report first showed that it is possible to reduce the recurrence rate and improve the prognosis of patients with EGYST by adding targeted therapy and immunotherapy (bevacizumab + tislelizumab) to traditional chemotherapy regimens.

Yolk sac tumor of the endometrium in a post-menopausal woman: Case report and review of the literature

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Seven of eighteen postmenopausal female endometrial YST cases were pure YST.

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IHC supports somatic tumor cell retro-differentiation yielding extra-gonadal YST.

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Studying genetic alterations in endometrial YST may elucidate its histiogenesis.