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Gevers EF, Meredith S, Shah P, Torpiano J, Peters C, Sebire NJ, Slater O, White A, Dattani MT. Cushing syndrome in a child due to pro-opiomelanocortin (POMC) secretion from a yolk sac tumor. Eur J Endocrinol 2017; 176:K1-K7. [PMID: 27879325 DOI: 10.1530/eje-16-0776] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Revised: 11/14/2016] [Accepted: 11/22/2016] [Indexed: 11/08/2022]
Abstract
CONTEXT Pituitary microadenomas and adrenal tumours are the most common causes for endogenous Cushing syndrome (CS) in children. CASE DESCRIPTION We describe a two-year old girl with Cushing syndrome due to ectopic pro-opiomelanocortin (POMC) production from an abdominal yolk sac tumor. Cortisol concentrations were elevated but adrenocorticotropic hormone (ACTH) concentrations were equivocal. The use of antibodies specifically detecting ACTH precursors revealed that plasma ACTH precursors were elevated. Additionally, an ACTH assay with a low cross-reactivity for precursors showed low concentrations of ACTH. Immunohistochemistry suggested POMC but not ACTH production by the tumour. CONCLUSION We describe a yolk sac tumour as a novel source of ectopic POMC production leading to CS in a young girl.
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Affiliation(s)
- Evelien F Gevers
- Department of EndocrinologyGreat Ormond Street Hospital for Children, London, UK
| | - Suzanne Meredith
- Division of DiabetesEndocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Pratik Shah
- Department of EndocrinologyGreat Ormond Street Hospital for Children, London, UK
- Section of Genetics and Epigenetics in Health and DiseaseGenetics and Genomic Medicine Programme, UCL Institute of Child Health, London, UK
| | - John Torpiano
- Department of PaediatricsPaediatric Endocrine Service, Mater Dei Hospital, Msida, Malta
| | - Catherine Peters
- Department of EndocrinologyGreat Ormond Street Hospital for Children, London, UK
| | - Neil J Sebire
- Department of HistopathologyGreat Ormond Street Hospital and Institute for Child Health (UCL), London, UK
| | - Olga Slater
- Department of OncologyGreat Ormond Street Hospital for Children, London, UK
| | - Anne White
- Division of DiabetesEndocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Mehul T Dattani
- Department of EndocrinologyGreat Ormond Street Hospital for Children, London, UK
- Section of Genetics and Epigenetics in Health and DiseaseGenetics and Genomic Medicine Programme, UCL Institute of Child Health, London, UK
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2
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Qzler A, Dogan S, Mamedbeyli G, Rahatli S, Haberal AN, Dursun P, Ayhan A. Primary yolk sac tumor of endometrium: report of two cases and review of literature. J Exp Ther Oncol 2015; 11:5-9. [PMID: 26259383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Primary YST of the endometrium is very rare, therefore there is no guideline for treatment. We report two cases of endometrial YSTs presenting different symptoms and showing different prognoses and discuss the clinical management of these tumors. The present report shows first time that bone and lung metastasis in primary YSTs of endometrium. As the number of reported cases with endometrial YSTs, more information about the prognosis of the disease may be obtained.
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3
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Yu XJ, Zhang L, Liu ZP, Shi YQ, Liu YX. Ovarian malignant mixed germ cell tumor with clear cell carcinoma in a postmenopausal woman. Int J Clin Exp Pathol 2014; 7:8996-9001. [PMID: 25674278 PMCID: PMC4313977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 11/01/2014] [Indexed: 06/04/2023]
Abstract
Malignant germ cell tumors of the ovary are very rare and account for about 2-5% of all ovarian tumors of germ origin. Most patients are adolescent and young women, approximately two-thirds of them are under 20 years of age, occasionally in postmenopausal women. But clear cell carcinoma usually occurs in older patients (median age: 57-year old), and closely related with endometriosis. Here we report a case of a 55-year old woman with right ovarian mass that discovered by B ultrasonic. Her serum levels of human chorionic gonadotropin (hCG) and α-fetoprotein (AFP) were elevated. Pathological examination revealed the tumor to be a mixed germ cell tumor (yolk sac tumor, embryonal carcinoma and mature teratoma) with clear cell carcinoma in a background of endometriosis. Immunohistochemical staining showed SALL4 and PLAP were positive in germ cell tumor area, hCG, CD30 and OCT4 were positive in epithelial-like cells and giant synctiotrophoblastic cells, AFP, AAT, CD117 and Glyp3 were positive in yolk sac component, EMA and CK7 were positive in clear cell carcinoma, CD10 was positive in endometrial cells of endometriotic area. She was treated with surgery followed by seven courses of chemotherapy. She is well and serum levels of hCG and AFP have been decreased to normal levels.
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MESH Headings
- Biomarkers, Tumor/blood
- Biopsy
- Carcinoma, Embryonal/blood
- Carcinoma, Embryonal/chemistry
- Carcinoma, Embryonal/diagnostic imaging
- Carcinoma, Embryonal/pathology
- Carcinoma, Embryonal/therapy
- Chorionic Gonadotropin/blood
- Endodermal Sinus Tumor/blood
- Endodermal Sinus Tumor/chemistry
- Endodermal Sinus Tumor/diagnostic imaging
- Endodermal Sinus Tumor/pathology
- Endodermal Sinus Tumor/therapy
- Endometriosis/pathology
- Female
- Humans
- Immunohistochemistry
- Middle Aged
- Neoplasms, Complex and Mixed/blood
- Neoplasms, Complex and Mixed/chemistry
- Neoplasms, Complex and Mixed/diagnostic imaging
- Neoplasms, Complex and Mixed/pathology
- Neoplasms, Complex and Mixed/therapy
- Ovarian Neoplasms/blood
- Ovarian Neoplasms/chemistry
- Ovarian Neoplasms/diagnostic imaging
- Ovarian Neoplasms/pathology
- Ovarian Neoplasms/therapy
- Postmenopause
- Teratoma/blood
- Teratoma/chemistry
- Teratoma/diagnostic imaging
- Teratoma/pathology
- Teratoma/therapy
- Treatment Outcome
- Ultrasonography
- alpha-Fetoproteins/metabolism
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Affiliation(s)
- Xiu-Jie Yu
- Department of Pathology, Tianjin Central Hospital of Gynecology and Obstetrics Tianjin, China
| | - Lin Zhang
- Department of Pathology, Tianjin Central Hospital of Gynecology and Obstetrics Tianjin, China
| | - Zai-Ping Liu
- Department of Pathology and Laboratory Medicine, Dalhousie University Halifax, Nova Scoria, Canada
| | - Yi-Quan Shi
- Department of Pathology, Tianjin Central Hospital of Gynecology and Obstetrics Tianjin, China
| | - Yi-Xin Liu
- Department of Pathology, Tianjin Central Hospital of Gynecology and Obstetrics Tianjin, China
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4
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Tao T, Yang J, Cao D, Guo L, Chen J, Lang J, Shen K. Conservative treatment and long-term follow up of endodermal sinus tumor of the vagina. Gynecol Oncol 2012; 125:358-61. [PMID: 22178761 DOI: 10.1016/j.ygyno.2011.12.430] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Revised: 12/03/2011] [Accepted: 12/08/2011] [Indexed: 11/27/2022]
Affiliation(s)
- Tao Tao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy Of Medical Sciences & Peking Union Medical College, People's Republic of China
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5
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Abstract
We present the case of a large yolk sac tumour of the ovary in a 14-year-old girl with high level of serum alpha-feto-protein (AFP). Multidisciplinary care is important to do appropriate surgical treatment with the aim of fertility preservation.
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Affiliation(s)
- M Beurdeley
- Service de Chirurgie Pédiatrique, Hôpital Mère-Enfant, CHU Dupuytren, 87000 Limoges, France
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6
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Abstract
Gastric yolk sac tumors are extremely rare and their prognosis is poor; most patients have widespread metastases at the time of diagnosis. The treatment of gastric yolk sac tumors consists of aggressive chemotherapy combined with radiotherapy and surgery. Here, we first report a case of gastric yolk sac tumor presenting as an early gastric cancer that was cured after a gastrectomy with lymphadenectomy.
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Affiliation(s)
- Yeon Soo Kim
- Department of Internal Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Seok Hyun Kim
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Jae Koo Seong
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Byung Seok Lee
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Hyun Yong Jeong
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Kyu Sang Song
- Department of Pathology, Chungnam National University College of Medicine, Daejeon, Korea
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7
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Ye YL, Qin ZK, Zhou FJ, Han H, Liu ZW, Yu SL, Li YH, Chen ZF. [Clinical analysis of stage I pediatric testicular yolk sac tumors: a report of ten cases]. Ai Zheng 2008; 27:1226-1228. [PMID: 19000459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND & OBJECTIVE At present, pediatric testicular yolk sac tumor is hard to be diagnosed at early stage, and the treatment strategy for this disease after radical inguinal orchiectomy is uncertain. This study was to summarize our experience in diagnosing and treating clinical stage I pediatric testicular yolk sac tumors. METHODS Clinical data of ten patients with clinical stage I pediatric testicular yolk sac tumors treated from July 2001 to June 2007 were analyzed. RESULTS Testicular masses with low or uneven echoes were detected by B ultrasound in 11 testes of ten patients. The serum level of alpha fetoprotein (AFP) was increased in nine patients. Radical inguinal orchiectomy (RIO) was performed for all patients whereas chemotherapy was not administered preoperatively. Pathology examination was used to confirm the diagnosis of yolk sac tumor. One patient with vascular invasion and another one with bilateral testicular yolk sac tumor received cisplatin-based adjuvant chemotherapy. Retroperitoneal lymph node dissection (RPLND) was not performed in these patients. No recurrence was found in nine patients during follow-up with a mean of 3 years. The patient with bilateral testicular tumor had retroperitoneal and lung metastases at 23 months after adjuvant chemotherapy, and achieved complete remission again after salvage chemotherapy. CONCLUSIONS With the combination of B ultrasound and serum AFP level, we can assess and diagnose stage I pediatric testicular yolk sac tumor. RIO could be used to treat it with good outcomes, while RPLND is not necessary. Chemotherapy is recommended to treat patients with high-risk of relapse.
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Affiliation(s)
- Yun-Lin Ye
- State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, China
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8
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9
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Baruah R, Saha M, Barua KC, Tamuly B. Endodermal sinus tumour of stomach--a case report. INDIAN J PATHOL MICR 2007; 50:354-7. [PMID: 17883071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
This is a case report of an endodermal sinus tumour arising in the stomach of a 1 1/2 years male child. The tumour occupied full thickness of fundus and part of the body of the stomach. H&E sections of the tumour tissue showed endodermal sinus tumour with predominantly reticular and endodermal sinus patterns. Elevated level of alpha-fetoprotien was detected in the serum of the patient and within the tumour tissue by immunohistochemical technique.
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10
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Aoki Y, Higashino M, Ishii S, Tanaka K. Yolk sac tumor of the ovary during pregnancy: A case report. Gynecol Oncol 2005; 99:497-9. [PMID: 16051324 DOI: 10.1016/j.ygyno.2005.06.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2005] [Revised: 06/06/2005] [Accepted: 06/07/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND There is a therapeutic dilemma for the pregnant patient with malignancy requiring chemotherapy. CASE We had a case of a 30-year-old pregnant woman with a yolk sac tumor who underwent right salpingo-oophorectomy at 22 weeks gestation. Chemotherapy during pregnancy was postponed because of concern with the risks of the chemotherapy to the fetus. After the operation, L2 fraction of alpha-fetoprotein (AFP) depending on the affinity for Lens culinaris agglutinin (LCA) as an indicator for a maternal source of AFP had been detectable since 30 weeks gestation and elevated rapidly with advancing gestation. Tumor recurrence was confirmed clinically at 34 weeks gestation. She was induced, delivering a healthy baby, and received seven complete chemotherapy courses (cisplatin, etoposide, and peplomycin). Currently, the mother (39 months after last chemotherapy) and child are doing well. CONCLUSION AFP-L2 may be a sensitive indicator for a yolk sac tumor derived AFP, leading to an earlier detection of tumor recurrence during pregnancy.
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Affiliation(s)
- Yoichi Aoki
- Division of Molecular Genetics, Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata 951-8510, Japan.
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11
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Abstract
BACKGROUND Yolk sac tumor is a rare neoplasm characterized by high malignancy given its premature metastasis, that is frequent in adolescence. CASE REPORT A 21-year-old woman came to our observation for an ovarian cyst (13 cm in diameter). Following salpingo-oophorectomy, it was revealed as a yolk sac tumor by histological diagnosis. The patient exhibited a highly elevated level of alpha1-fetoprotein (AFP) (1156 UI/ml). She is now undergoing chemotherapy treatment. CONCLUSION This is an interesting case of yolk sac tumor in a young girl, at an age typical for germ cell tumor. AFP represents a valid marker resulting in a useful diagnostic tool.
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Affiliation(s)
- Sandro Razzi
- Department of Pediatric, Obstetric and Reproductive Medicine, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100 Siena, Italy
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12
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Deshmukh C, Bakshi A, Bhagwat R, Kurkure P. Yolk sac tumor of vagina. Indian J Pediatr 2005; 72:367. [PMID: 15876777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
Yolk sac tumors are common in children. By virtue of being chemosensitive, they are amenable to cure by chemotherapy alone and radical surgery is often not required. Yolk sac tumors occurring in the vagina are rare and thus may not be recognized early or may be inadvertently subjected to radical surgery. The authors report a case that presented to them after radical surgery with elevated Alpha-fetoprotein level is reported. The management of this case and review of the relevant literature are discussed here.
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Affiliation(s)
- C Deshmukh
- Department of Pediatric Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
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13
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Abstract
Endodermal sinus tumour usually arises in a gonad; extragonadal endodermal sinus tumours are rare. We report a 3-year-old boy with an endodermal sinus tumour arising in the greater omentum, which may be the second reported case in the English literature. He presented with a solid mass in the upper abdomen and a markedly raised serum alpha-fetoprotein (AFP) level. Following percutaneous needle biopsy and omentectomy, histological examination revealed classic morphological features of an endodermal sinus tumour. This rare diagnosis is possible from the imaging features in association with a raised serum level of AFP.
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Affiliation(s)
- Yang Xinghui
- Radiology Department, Children's Hospital of Zhejiang University, Hangzhou, Zhejiang Province, China.
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14
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Sorscher S. Elevated parathyroid hormone-related peptide in a patient with an extragonadal germ-cell tumour and hypercalcemia. Can J Surg 2004; 47:144. [PMID: 15132472 PMCID: PMC3211908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Affiliation(s)
- Steven Sorscher
- Department of Hematology and Oncology, Marshfield Clinic, Wausau, Wisc 54401, USA.
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15
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Horiuchi F, Nagai Y, Kawamura A, Nikaido T, Mitsuhashi A, Tanaka N, Suzuka K, Ishikura H. Cytologic features of functioning stromal cells in a yolk sac tumor of the ovary. A case report. Acta Cytol 2004; 48:83-6. [PMID: 14969187 DOI: 10.1159/000326289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Functioning stromal cells are sometimes seen in primary and metastatic ovarian neoplasms. However, the cytologic features of functioning stromal cells have been described only rarely. CASE A 19-year-old woman had an alpha-fetoprotein-producing ovarian yolk sac tumor with functioning stroma. Her preoperative serum testosterone level was elevated. Imprint cytology showed that the functioning stromal cells had centrally located nuclei with low nuclear/cytoplasmic ratios. Occasionally these cells had vacuolated cytoplasm, suggesting the presence of lipids. In sharp contrast, the yolk sac tumor cells had more pleomorphic and hyperchromatic nuclei. We were able to distinguish between neoplastic and functioning stromal cells on the basis of these findings. In addition, immunostaining for inhibin on imprint cytologic slides was of great help in identifying functioning stromal cells. CONCLUSION Because functioning stromal cells may unexpectedly induce hormonal effects in a variety of ovarian tumors, it is important to identify such cells in cytologic specimens.
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16
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Yamamoto R, Ohkouchi T, Wakui Y, Minobe S, Watari H, Shimizu K, Satomura S, Sakuragi N. A study on the microheterogeneity of alpha-fetoproteins produced by yolk sac and germ cell tumors. Acta Obstet Gynecol Scand 2003; 82:876-82. [PMID: 12911452 DOI: 10.1034/j.1600-0412.2003.00170.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND It is generally believed that the lower the grade of differentiation of glycoprotein-producing cells, the more often modification by bisecting N-acetylglucosamine (GlcNAc) or fucose (Fuc) at the sugar chain of the glycoprotein or increase in branching of side chains occurs. We examined the characteristics of the alpha-fetoprotein (AFP) sugar chain stored in amniotic and exocoelomic fluid during 5-9 weeks of gestation and analyzed serum-derived AFP of patients with germ cell tumors. METHODS Total AFP concentrations in embryonic fluid at 5-9 weeks of gestation (n = 11) and serum of patients with germ cell tumors (n = 7) were measured using a radioimmunoassay (RIA) method. The percentages of AFPs reactive with Lens culinaris agglutinin (LCA), concanavalin A (Con A), erythroagglutinating phytohemagglutinin-E4 (E-PHA) and Ricinus communis agglutinin-120 (RCA 120) were obtained by lectin-affinity electrophoresis coupled with antibody-affinity blotting. RESULTS It was revealed that at 5-9 weeks of gestation, AFP variants that had been modified by the Fuc residue, which bound to the GlcNAc residue at the reducing end of the sugar chain, and bisecting GlcNAc residues gradually decreased as pregnancy advanced; however, the presence of N-acetylneuraminic acid (Neu5Ac) at the nonreducing ends changed little. CONCLUSIONS It appears very likely that the changes in the relative amounts of AFP variants in the embryonic fluid during early pregnancy were due to differentiation of the yolk sac. The grade of differentiation of yolk sac tumors was very similar to that of the normal yolk sac at around 6 weeks of gestation.
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Affiliation(s)
- Ritsu Yamamoto
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-Ku, Sapporo, 060-8638, Japan.
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17
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Kanemitsu F, Kageoka T, Kira S. Mitochondrial creatine kinase with atypical pI values detected in serum of a patient with ovarian hepatoid yolk sac tumor. J Chromatogr B Analyt Technol Biomed Life Sci 2003; 783:191-7. [PMID: 12450538 DOI: 10.1016/s1570-0232(02)00640-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Atypical mitochondrial creatine kinase (creatine N-phosphotransferase, CK, EC 2.7.3.2) was detected in the serum of a patient with carcinoma of germ cell origin, probably hepatoid yolk sac tumor. The pI of the oligomeric atypical mitochondrial CK (Mi-CK) was found at the acidic side compared to that of the typical ubiquitous Mi-CK (uMi-CK), while the molecular size of the atypical Mi-CK was similar to that of the typical uMi-CK. The pIs of the oligomeric and the dimeric atypical Mi-CKs became the same as those of the typical uMi-CK upon treatment with 2-mercaptoethanol. Therefore, the atypical Mi-CK was suggested to be an oxidized form of uMi-CK, and the oxidation might have occurred in the mitochondria because the oligomeric atypical Mi-CK had atypical pIs. The physicochemical characteristics of the oxidized uMi-CK were similar to those of the typical uMi-CK.
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Affiliation(s)
- Fusae Kanemitsu
- Clinical Laboratories, Kurashiki Central Hospital, 1-1-1 Miwa, 710-8602, Kurashiki, Japan
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18
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Kamoi S, Ohaki Y, Mori O, Okada S, Seto M, Matsushita N, Kawamura T, Araki T. A case of ovarian endometrioid adenocarcinoma with yolk sac tumor component in a postmenopausal woman. APMIS 2002; 110:508-14. [PMID: 12193212 DOI: 10.1034/j.1600-0463.2002.100609.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The co-existence of an endometrioid adenocarcinoma with an ovarian yolk sac tumor is very rare. Only eight cases have been reported in the English language literature. A 54-year-old postmenopausal woman with a 6-month history of progressive abdominal distension was seen at our hospital. MR imaging revealed a large cyst with a solid intramural node. Serum alpha-fetoprotein and CA125 levels were 13143 ng/ml and 170 U/ml, respectively. At laparotomy, a large tumor approximately 20 cm in diameter was found to occupy the abdominal cavity, adhering to the swollen appendix and part of the omentum. Microscopically, foci of endometrioid adenocarcinoma together with a yolk sac tumor component were observed within a large endometriotic cyst. Since the tumor was clinically staged 1c, the patient was given 500 mg of intraperitoneal carboplatin postoperatively, followed by five courses of combination chemotherapy consisting of cisplatin, etoposide and peplomycin at 4-week intervals. The levels of both serum alpha-fetoprotein and CA 125 decreased gradually to normal ranges and remained normal at the most recent follow-up on 29 December, 2001. In contrast to a very poor prognosis of this tumor in previously reported cases, our patient showed no sign of recurrence during a 21-month follow-up period.
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Affiliation(s)
- Seiryu Kamoi
- Department of Obstetrics and Gynecology, Nippon Medical School Chiba Hokusoh Hospital, Inba, Chiba, Japan.
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Abstract
Over the last 3 decades, the management of pediatric yolk sac tumors of the testis has changed significantly. These changes reflect improvement in the treatment of testicular tumors in adults and children, such as the advent of platinum-based chemotherapy regimens. They also reflect increased understanding of the biology and natural history of prepubertal yolk sac tumors of the testis as a unique disease entity.
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Affiliation(s)
- R W Grady
- Section of Pediatric Urology, Children's Hospital & Regional Medical Center, University of Washington Medical Center, Seattle, USA
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20
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Abstract
Gastric yolk sac tumors (YST) are very rare and are mainly reported in elderly people. We present a case of a 36-year-old man with a poorly differentiated gastric cancer showing a mixture of adenocarcinoma and yolk sac tumor that metastasized to Virchow's node. Both biopsies, Virchow's node and gastric tumor, contained areas of adenocarcinoma and yolk sac tumor that stained strongly positive for alpha fetoprotein (AFP) by the immunohistochemistry method. A high level of serum AFP (38,200 ng/mL) was also noted in this case. The response to chemotherapy in this case of mixed gastric yolk sac tumor and adenocarcinoma was not as favorable as would be expected in a pure primary germ cell tumor.
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Affiliation(s)
- L Wang
- Department of Pathology, University of California at Los Angeles-Harbor Medical Center, Torrance, USA
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21
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Rajendran S, Hollingworth J, Scudamore I. Endodermal sinus tumour of the ovary in pregnancy. EUR J GYNAECOL ONCOL 1999; 20:272-4. [PMID: 10475120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
We present a case of a 30-year-old pregnant woman in whom an ovarian mass was identified by ultrasonography at 15 weeks' gestation. A markedly elevated maternal serum alphafetoprotein (MSAFP) suggested a diagnosis of endodermal sinus tumour of the ovary. A right salpingo-oophorectomy at 19 weeks' gestation enabled histological confirmation of the diagnosis and suggested a stage 1 tumour. Unfortunately tumour recurrence necessitated further laparotomy and delivery by caesarean section at 32 weeks' gestation. A total abdominal hysterectomy and left salpingo-oophorectomy was undertaken with resection of the splenic flexure and formation of a double-barrelled colostomy after which no gross intraperitoneal tumour remained. Three weeks later a new suprahepatic tumour mass was excised and the colostomy was closed. The patient then received four cycles of combination chemotherapy with cisplatin, etoposide, and bleomycin. Unfortunately she developed a faecal fistula at the site of the colostomy. Germ cell tumours are highly responsive to chemotherapy. Over-zealous surgery particularly involving bowel resection may cause unnecessary morbidity and compromise the outcome.
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Affiliation(s)
- S Rajendran
- The Department of Obstetrics and Gynaecology, Leicester General Hospital NHS Trust, England
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Abstract
Patients who receive peripheral blood stem cell transplants are at risk of developing cancer recurrence due to the presence of malignant cells in the transplants. We investigated a sensitive method to detect malignant cells in the peripheral blood and peripheral blood stem cells of patients with testicular cancer using nested, reverse transcription-polymerase chain reaction (RT-PCR) to measure alpha-fetoprotein gene expression. Using this technique, a single cancer cell could be detected in 10(6) peripheral blood mononuclear cells. This is the first report of an attempt to detect circulating malignant cells in the peripheral blood of patients with testicular cancer by nested RT-PCR.
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MESH Headings
- Actins/genetics
- Adult
- Carcinoma, Embryonal/blood
- Carcinoma, Embryonal/genetics
- Carcinoma, Embryonal/pathology
- Carcinoma, Hepatocellular/genetics
- Endodermal Sinus Tumor/blood
- Endodermal Sinus Tumor/genetics
- Endodermal Sinus Tumor/pathology
- Gene Expression
- Germinoma/blood
- Germinoma/genetics
- Germinoma/pathology
- Hematopoietic Stem Cell Transplantation
- Hematopoietic Stem Cells/chemistry
- Hematopoietic Stem Cells/pathology
- Humans
- Male
- Middle Aged
- Monocytes/chemistry
- Neoplasms, Germ Cell and Embryonal/blood
- Neoplasms, Germ Cell and Embryonal/genetics
- Neoplasms, Germ Cell and Embryonal/pathology
- Neoplastic Cells, Circulating/pathology
- RNA, Messenger/metabolism
- RNA, Neoplasm/analysis
- Reverse Transcriptase Polymerase Chain Reaction
- Sensitivity and Specificity
- Teratoma/blood
- Teratoma/genetics
- Teratoma/pathology
- Testicular Neoplasms/blood
- Testicular Neoplasms/genetics
- Testicular Neoplasms/pathology
- Tumor Cells, Cultured
- alpha-Fetoproteins/genetics
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Affiliation(s)
- T Yuasa
- Department of Urology, Shiga University of Medical Science, Otsu, Japan
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23
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Abstract
Primary yolk sac tumour of the liver is exceedingly rare. A 28 year old woman presented with a cystic liver mass and a markedly raised serum alpha-fetoprotein concentration. She underwent a partial hepatectomy for a suspected hepatocellular carcinoma but histological examination of the tumour revealed the classical morphological and immunohistochemical features of a yolk sac tumour. There was no evidence of an extrahepatic primary source. Review of this case, together with the six previously reported adult cases of primary yolk sac tumours of the liver, revealed several features of the tumour that may aid differentiation from hepatocellular carcinoma, with potential therapeutic implications.
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Affiliation(s)
- N A Wong
- Department of Pathology, University of Edinburgh, UK
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24
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Abstract
Endodermal sinus tumor is a malignant germ cell tumor which usually arises in gonads. Extragonadal endodermal sinus tumors in the head and neck are very rare. Here a gingival endodermal sinus tumor is reported. The lesion demonstrated typical microscopic features of the endodermal sinus tumors of gonads. The tumor cells showed alpha-fetoprotein immunoreactivity in immunohistochemical evaluation. The serum alpha-fetoprotein level was high. This is the first gingival case in the related literature.
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Affiliation(s)
- A Kutluhan
- Department of Otolaryngology, School of Medicine, Yüzüncü Yil University, Van, Turkey
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25
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Konno A, Kudo M, Ichihara T, Yamagami M, Horita S, Ohama K, Taketa K, Koizumi S. Yolk sac tumor with a unique uniform hepatoid pattern histology. Acta Paediatr Jpn 1998; 40:466-9. [PMID: 9821708 DOI: 10.1111/j.1442-200x.1998.tb01970.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Yolk sac tumors (YST) exhibit several different histological subtypes and the mechanisms of cellular differentiation and prognosis of each subtype remain unknown. RESULTS We report two infants with sacrococcygeal YST; one represented a typical histological subtype and the other showed a hepatoid subtype with uniform histology. The isoform of alpha-fetoprotein (AFP) in the patient with the hepatoid pattern was examined by lectin-affinity immunoelectrophoresis and represented as a YST, but not hepatocellular, subtype. The patient with typical YST responded well to VAB-6 combination chemotherapy. However, this regimen was only partially effective to the patient with the pure hepatoid histological subtype, and an etoposide with ifosfamide and cisplatin (VIP) regimen as a salvage chemotherapy combined with complete tumor resection was useful to achieve complete remission (CR). Both of the patients have been in CR for more than four years.
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Affiliation(s)
- A Konno
- Department of Pediatrics, Kanazawa University School of Medicine, Ishikawa, Japan.
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26
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Affiliation(s)
- S Sekiya
- Department of Obstetrics and Gynecology, Chiba University School of Medicine, Japan
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27
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28
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Wada H, Kubo M, Wada T, Ueno Y, Horita S, Ohki T, Munemoto S, Kuroda E, Taguchi H, Muramatsu N. [A case report of a 6-year-old boy with intracranial yolk sac tumor treated by VAB-6 regimen]. No Shinkei Geka 1995; 23:65-8. [PMID: 7531296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Several clinical trials have demonstrated that cisplatin-based chemotherapy for primary intracranial germ-cell tumors is effective as a neoadjuvant chemotherapy. In this report, we describe a 6-year-old boy, Down syndrome and Hirschsprung's disease with intracranial pure yolk sac tumor treated by combined chemotherapy with cisplatin, vinblastine, bleomycin and cyclophosphamide (modified VAB-6 regimen). He had been admitted to our hospital because of intractable vomiting, and left facial nerve palsy since 1 month before. An MRI revealed an enlarged mass, 4cm in diameter, in the left cerebello-pontine angle with uniformal enhancement by Gd-DTPA, and bilateral ventricular dilatation. He was found to have increased serum alpha-fetoprotein level (AFP 11, 786ng/ml), but not human chorionic gonadotropin beta-subunit. After a partial resection of the tumor, diagnosed as pure yolk sac tumor, and ventriculo-peritoneal shunt, three courses of combined chemotherapy with cisplatin, bleomycin, vinblastine and cyclophosphamide (modified VAB-6 therapy) were carried out. The serum AFP level returned to normal, and the tumor mass entirely disappeared (a complete response) on MRI after the second course of chemotherapy. However, cisplatin-induced vomiting and mild neutropenia and renal tubular injury developed after the third course of chemotherapy. Irrespective of administration of recombinant human G-CSF and broad spectrum antibiotics, he suffered from pneumonia and died of septic shock and multiple organ failure. Autopsy showed microscopic residual tumors. The combination chemotherapy with cisplatin, bleomycin, vinblastine and cyclophosphamide is effective for initial treatment of childhood intracranial yolk sac tumor. It is necessary, however, to reevaluate the cisplatin dosage and treatment schedule in order to reduce such side effects as bone marrow suppression and renal damage.
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Affiliation(s)
- H Wada
- Department of Pediatrics, Ishikawa Prefectural Central Hospital
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29
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Chen RJ, Chen CK, Chang DY, Chow SN, Huang SC, Hsieh CY, Lin MC, Hsu HC. Immunoelectrophoretic differentiation of alpha-fetoprotein in disorders with elevated serum alpha-fetoprotein levels or during pregnancy. Acta Oncol 1995; 34:931-5. [PMID: 7492383 DOI: 10.3109/02841869509127207] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Our study aims to make differential diagnosis by immunoelectrophoresis for some common conditions with elevated levels of serum alpha-fetoprotein (AFP). One hundred and nine cases with elevated AFP levels were included in this study: yolk sac tumor (n = 8), hepatocellular carcinoma (n = 26), gastric cancer (n = 12), chronic hepatitis (n = 27) and normal pregnancy (n = 36). Lectin agarose gel electrophoresis, antibody-affinity blotting, and immunoreaction were used to identify the specific patterns of AFP in the respective conditions. The results showed that there were three possible bands: L1, L2 and L3. Yolk sac tumor produced a prominent L2 band and a light L3 band. Hepatocellular carcinoma produced a prominent L1 band and a light L3 band. Gastric cancer produced only an L1 band. Chronic hepatitis had a light L1 band and a pronounced L3 band. In pregnancy, the AFP pattern is similar to that of hepatocellular carcinoma. Immunoelectrophoresis is a useful method facilitating the differentiation of AFP origins.
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Affiliation(s)
- R J Chen
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei
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30
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Nam JH, Chung DG, Kim YM, Kim YT, Mok JE. Endodermal sinus tumor arising from a dysgenetic gonad in a 46,XX female combined with müllerian agenesis. Gynecol Oncol 1994; 55:465-8. [PMID: 7530678 DOI: 10.1006/gyno.1994.1324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The occurrence of neoplastic transformation in a dysgenetic gonad of a female with 46,XX karyotype is very rare. Moreover, to our knowledge, a case of endodermal sinus tumor arising from that setting combined with Müllerian agenesis has not been reported. This case suggests the possibility of development of cancer in a dysgenetic ovary of a female even with 46,XX or Müllerian agenesis.
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Affiliation(s)
- J H Nam
- Department of Obstetrics and Gynecology, Asan Medical Center, College of Medicine, University of Ulsan, Poongnap-dong, Songpa-gu, Seoul, Korea
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31
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Abstract
A rare case of cerebellar yolk sac tumor is described. A 4-year-old boy was admitted for the treatment of a cerebellar tumor and, following total removal of the tumor, he was treated with combination chemotherapy consisting of cisplatin, vinblastine, and bleomycin. He died 18 months after the primary diagnosis due to tumor recurrence. Serum alpha-fetoprotein level was well correlated with the clinical course and the amount of the tumor mass in neuroimaging.
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Affiliation(s)
- T Fujiwara
- Department of Neurological Surgery, Kagawa Medical School, Mitoyo General Hospital, Okayama University Medical School, Japan
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32
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Abstract
Serum alpha-fetoprotein (AFP) subfraction profile is a predictive indicator for the discrimination of hepatic malignancies, benign liver diseases and yolk sac tumor in adults. In the present study, AFP subfractions were examined in AFP-positive sera from 59 patients of less than 15 years of age. Fractionation of AFP was carried out by lectin affinity crossed-line immunoelectrophoresis. Concanavalin A, Lens culinaris hemagglutinin and phytohemagglutinin E were used as lectins. Fifty-four of 59 (91.5%) AFP subfraction profiles in patients with pediatric diseases were classified into three common types: (1) benign liver disorder, (2) hepatic malignancy and (3) yolk sac tumor. An atypical AFP subfraction profile resembling hepatic malignancy type was found in 5 of 59 (8.5%) infants. It was concluded that estimation of serum AFP subfraction profiles facilitates differential diagnosis of various AFP-positive pediatric diseases, such as hepatoblastoma, hepatoma, hepatic cirrhosis, hepatitis or germ cell tumors.
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Affiliation(s)
- T Ishiguro
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Ohtsu, Japan
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33
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Abstract
Between 1971 and 1993, 12 children with testicular germ cell tumors were treated at the Department of Urology, Faculty of Medicine, Kyoto University. Seven patients had yolk sac tumors and 5 had mature teratoma. Of the 7 patients with yolk sac tumors 6 had stage I and 1 had stage III tumors. Initial management of the stage I tumors consisted of high orchiectomy in 5 patients and high orchiectomy plus retroperitoneal lymph node dissection in 1 patient. Of these 6 patients, 4 were cured by surgery alone but lung metastases developed in the other 2 patients. One of them was salvaged with thoracotomy and chemotherapy but the other died of tumor. The patient with stage III tumor had bulky tumor spread to lung and retroperitoneum, but seems to have been cured by chemotherapy followed by resection of the residual mass although follow-up is still inadequate (14 months). Six of the 7 patients (85.7%) are alive 13 months to 21 years after diagnosis. Five patients with mature teratoma were treated by high orchiectomy or, more recently, enucleation and all are alive 4 months to 22 years after surgery.
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Affiliation(s)
- A Terai
- Department of Urology, Faculty of Medicine, Kyoto University, Japan
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34
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Taketa K, Endo Y, Sekiya C, Tanikawa K, Koji T, Taga H, Satomura S, Matsuura S, Kawai T, Hirai H. A collaborative study for the evaluation of lectin-reactive alpha-fetoproteins in early detection of hepatocellular carcinoma. Cancer Res 1993; 53:5419-23. [PMID: 7693340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Lectin-affinity electrophoretic separation of serum alpha-fetoprotein (AFP) was carried out using AFP Differentiation Kits, which used Lens culinaris agglutinin-A (Kit L) and erythroagglutinating phytohemagglutinin (Kit P). Separated AFP bands were detected with a sensitive antibody-affinity blotting technique and determined quantitatively by densitometry, and the results were expressed as percentages of the intensity of total AFP bands. Sera from 424 patients with acute hepatitis, chronic hepatitis, liver cirrhosis, hepatocellular carcinoma, and extrahepatic tumors were assayed for proportion of AFP present as Lens culinaris agglutinin-A-reactive AFP (AFP-L3) and erythroagglutinating phytohemagglutinin-reactive AFPs (AFP-P4+P5). From the maximum Youden indices determined, cutoff levels were set at 15% for both AFP-L3 and AFP-P4+P5 to discriminate between patients with chronic hepatitis and liver cirrhosis and patients with hepatocellular carcinoma. AFP-L3 and AFP-P4+P5 showed sensitivities of 55.3 and 61.0% at specificities of 93.9% and 82.3%, respectively. Thirty-eight % of tumors that measured less than 20 mm in diameter were positive for AFP-L3 and AFP-P4+P5. AFP-L3 exceeded the cutoff level of 15% 4.0 +/- 4.9 months before detection of hepatocellular carcinomas by imaging techniques with a sensitivity of 48% and a specificity of 81%. Thus, these tests are useful for the early detection of hepatocellular carcinomas in patients with hepatitis or liver cirrhosis.
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Affiliation(s)
- K Taketa
- Department of Public Health, Okayama University Medical School, Japan
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35
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Abstract
BACKGROUND Determination of serum concentration human chorionic gonadotropin (HCG) and alpha-fetoprotein (AFP) is crucial in diagnosis, prognosis, treatment, and follow-up of patients with germ cell tumors. Elevation of these markers almost indicates progression or recurrence of the germ cell tumor. However, an increase in these tumor markers can be produced by several benign causes. METHODS The authors report nine cases of gonadal germ cell tumors that had increased serum levels of AFP without tumoral progression, recurrence, or residual tumor. RESULTS The AFP elevations were attributed to liver damage secondary to drugs (chemotherapy, anesthetics, or antiepileptics), virus, or alcoholism. No clinical evidence (or in some cases surgical evidence) of malignant tumor activity was found in any of the patients. CONCLUSIONS The elevation of serum levels of AFP in patients with germ cell tumors can be produced by liver dysfunction. These elevations must be interpreted with caution to avoid unnecessary treatments.
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Affiliation(s)
- J R Germà
- Unidad de Oncologia Médica, Hospital de La Santa Creu i Sant Pau, Universidad Autonoma de Barcelona, Spain
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36
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Abstract
A patient with adenocarcinoma of the rectum containing germ cell elements in the form of endodermal sinus tumor and choriocarcinoma is described, believed to be the first such tumor reported in the literature. The serum levels of alpha-fetoprotein and human chorionic gonadotropin were markedly elevated. The source of the markers was localized to the neoplastic tissue by the immunoperoxidase technique. The patient developed extensive hepatic metastases thought to be due to choriocarcinoma for which she received chemotherapy. One wk after commencing treatment a massive fatal hepatic hemorrhage occurred.
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Affiliation(s)
- A G Ostör
- Department of Pathology, Royal Women's Hospital, Melbourne, Victoria
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37
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Fujii Y, Taketa K, Aoi T, Taga H, Hirai H. Increased serum levels of monosialo-alpha-fetoprotein in hepatocellular carcinoma and other malignancies. Tumour Biol 1993; 14:319-24. [PMID: 7694351 DOI: 10.1159/000217845] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Serum alpha-fetoprotein (AFP) from cord blood and from patients with hepatitis, cirrhosis, hepatocellular carcinoma, gastrointestinal tumors and yolk sac tumor was analyzed by extended agarose gel electrophoresis coupled with our sensitive detection method of antibody-affinity blotting. AFP was separated into AFP-A, AFP-B and AFP-C from the anode to the cathode, corresponding to disialo-, monosialo- and asialo-AFP, respectively, as revealed by the results of neuraminidase digestion of serum AFP. AFP-Af, which migrated ahead of AFP-A as band or leading smear and varied widely in intensity, was eliminated in calculating the proportions of other band intensities. Disialo-AFP was the major component and monosialo-AFP the minor one in benign conditions, the latter being 4.2 +/- 6.0% in chronic hepatitis and 9.0 +/- 8.9% in cirrhosis. Monosialo-AFP in hepatocellular carcinoma was increased significantly, the proportion being 29.9 +/- 11.2%. AFP in other malignancies was further characterized by the appearance of asialo-AFP.
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Affiliation(s)
- Y Fujii
- Department of Public Health, Okayama University Medical School, Japan
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