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
Click here for correspondence address and email
Keywords: Tumor, Ovarian, USG
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;15:525-7
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 2014 Mar 13];15:525-7. Available
from: http://www.ijri.org/text.asp?2005/15/4/525/28788
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 More Details) 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
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Turkish journal of cancer, summary, yolk sac tumor, a clinical and therapeutical analysis of
9 cases. 1991, volume 21, number 2, page(s) 76-82.
The Encyclopaedia of medical imaging volume IV 2
Afroz 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].
Rosai and Ackerman's surgical pathology, vol 2, chapter 19: 1681
American journal of pathology, 1999; 155:1823-1829
Devouassoux-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
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