Indian Journal of Radiology and Imaging Indian Journal of Radiology and Imaging

GYNAECOLOGY AND OBSTETRICS
Year
: 2005  |  Volume : 15  |  Issue : 4  |  Page : 525--527

Ovarian yolk sac tumor


AN Dave, FA Shah, RP Sagar, HB Raval, CB Patel, GR Agrawal 
 Department Of Radiology And Imaging, K.M. School of Post Graduate and Research institute. Smt. N.H.L. Mumicipal Medical College, L.G. General Hospital, Ahmedabad, India

Correspondence Address:
A N Dave
Department Of Radiology And Imaging, K.M. School of Post Graduate and Research institute. Smt. N.H.L. Mumicipal Medical College, L.G. General Hospital, Ahmedabad
India




How to cite this article:
Dave A N, Shah F A, Sagar R P, Raval H B, Patel C B, Agrawal G R. Ovarian yolk sac tumor.Indian J Radiol Imaging 2005;15:525-527


How to cite this URL:
Dave A N, Shah F A, Sagar R P, Raval H B, Patel C B, Agrawal G R. Ovarian yolk sac tumor. Indian J Radiol Imaging [serial online] 2005 [cited 2020 May 28 ];15:525-527
Available from: http://www.ijri.org/text.asp?2005/15/4/525/28788


Full Text

 Introduction



Ovarian yolk sac tumor is a subtype of germ cell tumor, characterized histologically by papillary projections which resembles the yolk sac of the rodent placenta. This is a rare tumor; but it accounts for about 10% of malignant germ cell tumours. The tumour usually presents as a rapidly growing mass in young women.

 Case report



A 11 year old girl presented with complaints of lower abdominal pain and swelling with dribbling of urine since last 6 months.

On examination lower abdominal palpable lump noted. Routine hematological investigations were normal. Patient was undergone x ray KUB, IVU, ultrasonography and MRI.

IVU was done which shows bilateral moderate hydronephrosis and hydroureter, with laterally displaced ureters. [Figure 1]

USG was performed with 3.5 MHz curvilinear probe shows bilateral hydronephrosis and hydroureter with large mix echogenic mass arising from pelvis displacing baldder and uterus anteriorly. Left ovary apperars normal. Right ovary not seen separately from the mass. On colour doppler examination there is increased vascularity noted at the periphery of mass. No evidence of clacification noted in mass lesion. From these findings mass arising from right ovary was considered.[Figure 2]

MRI was performed which shows on T2W image hetrogenous intense large lobulated soft tissue mass lesion (8 x 8 cm in axial, 14 x 8 cm in coronal and 12 x 9 cm in saggital plane) arising from pelvis and extending upto L5 vertebral level. Intratumoral small hyperintense areas noted suggestive of cystic or necrotic component. On T1W image mass was isointense. Urinary baldder compressed on osterior aspect and pushed anteriorly. Uterus is also compressed and pushed anteriorly and rectum is pushed posteriorly.[Figure 3],[Figure 4]

During operation a large right ovarian mass was noted. Removal of mass with adjacent attached omentum was performed. Specimen was sent for histopathological examination.[Figure 5]

HISTOPATHOLOGY report shows typical ovarian yolk sac tumor.[Figure 6]

 Discussion



Yolk sac tumor, so called endodermal sinus tumor, is a rare and highly malignant germ cell tumor. [1]

This is a rare tumor, but it accounts for about 10% of malignant germ cell tumors. The tumor usually presents as a rapidly growing mass in young women. [2]

Clinically the tumor presents as a testicular, ovarian, pelvic, retroperitoneal or a sacrococcygeal mass. Current evidence has proved Teilum's postulate that yolk sac tumor is a unilaterally developed teratoma mimicking embryonal yolk sac tissue [3].

Germ cell tumor constitute approximately 20% of all ovarian neoplasms. Most of them are seen in children and young adults. Approximately 95% of these tumors are benign cystic teratomas; the young patient the more likely the germ cell tumor will be maliganant. [4]

Almost always a unilateral solid or solid and cystic tumor,displays a wide range of histologic patterns (microcystic, endodermal sinus, solid, alveolar-glandular, papillary, myxomatous, macrocystic, hepatoid, primitive endodermal, polyvesicular vitelline).Classic pattern shows perivascular formations (Schiller-Duval bodies) and eosinophilic globules that contain AFP [5]

Ovarian Heploid-yolk sac tumor and hepatocellular carcinoma share a similar immunoprofile. Ovarian Heploid-yolk sac tumor is a highly aggressive tumour, most patients exhibit recurrence or die of disease within 2 years of diagnosis.[6]

Differential diagnosis of yolk sac tomor includes embryonal carcinoma and other germ cell tumors such as seminoma and dysgerminoma.[3]

Maliganant endodermal cells within yolk sac tumor express alpha fetoprotein, which can be detected in tumor tissue or serum.[5]

References

1Turkish journal of cancer, summary, yolk sac tumor, a clinical and therapeutical analysis of 9 cases. 1991, volume 21, number 2, page(s) 76-82.
2The Encyclopaedia of medical imaging volume IV 2
3Afroz N, Khan N, Chana RS. Cytodiagnosis of yolk sac tumor. Indian J Pediatr 2004;71:939-942 [Gonzalez-Crussi F. The human yolk sac and yolk sac (endodermal sinus) tumors, A review. Perspect Ped. Path. 1979; 5: 179].
4Rosai and Ackerman's surgical pathology, vol 2, chapter 19: 1681
5American journal of pathology, 1999; 155:1823-1829
6Devouassoux-Shisheboran, Schammel & Tavassoli, (1999) Ovarian hepatoid yolk sac tumours: morphological, immunohistochemical and ultrastructural features , histopathology 34(5), 462-469. doi:10.1046/j.1365-2559.1999.00650.x