Pure yolk sac tumor of ovary in an adult: a rare occurrence

Background: Malignant ovarian germ cell tumors are relatively rare, making up less than 2-3 % of all ovarian malignancies. However, although they represent only a small fraction, they frequently affect young women of reproductive age. Malignant germ cell tumors are subdivided into dysgerminoma and non-dygerminomatous tumors. The most common types of non-dysgerminomatous tumors are yolk sac tumors (YSTs). Case Report: The authors present a case report of a 32-year-old woman with a history of gradual abdominal distention and an increased serum level of alpha-fetoprotein (AFP). She was diagnosed with a pure YST after removing her left ovary. Then, she was subsequently treated with adjuvant chemotherapy by four cycles of bleomycin, etoposide, and cisplatin after fertility-sparing surgery. Conclusion: This case report shows that older patients could have this tumor with no associated tumor.

Yolk sac tumor; Endodermal sinus tumor; Ovarian cancer.

[1] Smith H.O., Berwick M., Verschraegen C.F., Wiggins C., Lansing L., Muller C.Y., et al.: “Incidence and survival rates for female malignant germ cell tumors”. Obstet. Gynecol., 2006, 107, 1075.

[2] Dallenbach P., Bonnefoi H., Pelte M.F., Vlastos G.: “Yolk sac tumours of the ovary: an update”. Eur. J. Surg. Oncol., 2006, 32, 1063.

[3] Shah J.P., Kumar S., Bryant C.S., Ali-Fehmi R., Malone J.M. Jr., Deppe G., et al.: “A population-based analysis of 788 cases of yolk sac tumors: A comparison of males and females”. Int. J. Cancer, 2008, 123, 2671.

[4] Kojimahara T., Nakahar K., Takano T., Yaegashi N., Nishiyama H., Fujimori K., et al.: “Yolk sac tumor of the Ovary: A retrospective multicenter study of 33 Japanese women by Tohoku Gynaecologic Cancer Unit (TGCU)”. Tohoku J. Exp. Med., 2013, 210, 211.

[5] Guida M., Pignata S., Palumbo A.R., Miele G., Marra M.L., Visconti F., et al.: “Laparoscopic treatment of a yolk sac tumour: case report and literature review”. Translational Med., 2013, 7, 1.

[6] Fujita M., Inoue M., Tanizawa O., Minagawa J., Yamada T., Tani T.: “Retrospective review of 41 patients with endodermal sinus tumour of the ovary”. Int. J. Gynaecol. Cancer, 1993, 3, 329.

[7] Brown J., Friedlander M., Backes F.J., Harter P., O'Connor D.M., de la Motte Rouge T., et al.: “Gynecologic Cancer Intergroup (GCIG) consensus review for ovarian germ cell tumors”. Int. J. Gynecol. Cancer, 2014, 24, S48.

[8] Kang H., Kim T.J., Kim W.Y., Choi C.H., Lee J.W., Kim B.G., Bae D.S.: “Outcome and reproductive function after cumulative highdose combination chemotherapy with bleomycin, etoposide and cisplatin (BEP) for patients with ovarian endodermal sinus tumor”. Gynecol. Oncol., 2008, 111, 106.

[9] Talerman A., Haije W.G., Baggerman L.: “Serum alphafetoprotein (AFP) in diagnosis and management of endodermal sinus (yolk sac) tumor and mixed germ cell tumor of the ovary”. Cancer, 1978, 41, 272.

[10] Talerman A., Haije W.G., Baggerman L.: “Serum alphafetoprotein (AFP) in patients with germ cell tumors of the gonads and extragonadal sites: correlation between endodermal sinus (yolk sac) tumor and raised serum AFP”. Cancer, 1980, 46, 380.

[11] Li Y.K., Zheng Y., Lin J.B., Xu G.X., Cai A.Q., Zhou X.G., et al.: “CT imaging of ovarian yolk sac tumor with emphasis on differential diagnosis”. Sci. Rep., 2015, 5, 11000.

[12] Moniaga N.C., Randall L.M.: “Malignant mixed ovarian germ cell tumour with embryonal component”. J. Pediatr. Adolesc. Gynecol., 2011, 24, e1.

[13] de La Motte Rouge T., Pautier P., Duvillard P., Rey A., Morice P., Haie-Meder C., et al.: “Survival and reproductive function of 52 women treated with surgery and bleomycin, etoposide, cisplatin (BEP) chemotherapy for ovarian yolk sac tumor”. Ann. Oncol., 2008, 19, 1435.

[14] Nasioudis D., Chapman-Davis E., Frey M.K., Caputo T.A., Holcomb K.: “Management and prognosis of ovarian yolk sac tumors; an analysis of the National Cancer Data Base”. Gynecol. Oncol., 2017, 10. 31251.

[15] Tong X., You Q., Li L., Cai L., Wang C., Zheng J.: “Prognostic factors of patients with ovarian yolk sac tumors: a study in Chinese patients”. Onkologie, 2008, 31, 679.