Lactate dehydrogenase isoenzyme-1 in the mediastinal yolk sac tumor

LDH isozymes in both the serum and tumor tissues of 4 patients with mediastinal yolk sac tumors, and in the cystic content of tumors transplanted into nude mice was examined. Our findings suggested that LDH-1, along with AFP, is an important marker of this tumor, and that LDH isozyme study is necessary for its diagnosis.     

A mediastinal germ cell tumor of yolk sac type--case report

OBJECTIVE: We report an extremely rare case of germ-cell tumor localized at the level of the anterior mediastinum. Clinical presentation: A 36-year-old man who presented with left subclavial vein thrombosis was admitted to our hospital for specific cure. Computed tomographic scan of the chest showed a large anterior mediastinal mass. Surgical intervention revealed an infiltrative mediastinal tumor involving the left subclavial vein, which was biopsied for morphological examination. Histologically, the tumoral mass proved to be a carcinoma, with papillary and tubular growth patterns. Immunohistochemical stains for alpha-fetoprotein were positive in the tumor cells while stains for carcinoembryonic antigen and placental like alkaline phosphatase were negative. The serum level of alpha-fetoprotein of this patient was elevated, as well. This supported the diagnosis of Yolk sac tumor, a rare primary tumor within the mediastinum. Postsurgery, the patient received a combination chemotherapy consisting of cisplatin, vepesid and bleomycin every 3 weeks for a total of 4 cycles. During the treatment, the alpha-fetoprotein level, was decreasing. Conclusion: Primary mediastinal Yolk sac neoplasm is a rare tumor. The diagnosis should be made not only by morphological studies but also the patient's age and the elevation of serum alpha-fetoprotein. In spite of modern chemotherapy, the prognosis of mediastinal yolk sac tumor remains poor. The single most important prognostic indicator is whether the tumor mass can be completely excised before or after chemotherapy.     

A case of mediastinal yolk sac tumor successfully treated with chemotherapy and surgery

A 28-year-old man was admitted due to increasing respiratory symptoms. X-ray examination of the chest showed a tumor mass in the anterior mediastinum with possible invasion into the chest wall and upper lobe of right lung. No tumor was found in the testis. Serum alpha-fetoprotein (AFP) concentration was 6400 ng/ml. Serum levels of CEA and HCG were within normal limits. Percutaneous biopsy of the tumor strongly suggested yolk sac tumor with an evidence of AFP by an immunoenzyme labelling technique. The serum AFP rapidly decreased after two courses of combination chemotherapy. En bloc resection of the tumor was successfully performed and third chemotherapy was added. Mediastinal yolk sac tumors should be treated with combination chemotherapy and surgical resection.     

Gonadal and extragonadal yolk sac tumor

Yolk-sac tumours are germ-cell tumours with gonadal and extragonadal location. Histologically they consist of primitive cellular forms configurated as a loose network. These tumours are of extreme malignancy and should be treated as radical as possible. Surgery should be combined with anticancer chemotherapy. However, with adequate treatment only children suffering from testicular tumours and not older than 2 years of life have a fair chance to survive. 3 cases are dealt with in detail.     

Clinical stage I pure yolk sac tumor of the testis in adults has different clinical behavior than juvenile yolk sac tumor

PURPOSE: We evaluated the clinical behavior of clinical stage I pure yolk sac tumor of the testis in adults to determine whether the behavior of this entity is different than that of clinical stage 1 nonseminoma. MATERIALS AND METHODS: We searched the testis cancer database at our institution for adults with clinical stage I pure yolk sac tumor of the testis who underwent retroperitoneal lymph node dissection. We identified 12 such patients and reviewed the database and hospital charts to determine clinical behavior. RESULTS: Disease was pathological stage I in 8 of the 12 patients (66%), including 1 with recurrence after retroperitoneal lymph node dissection. Disease was pathological stage II in 14 patients (33%), including 1 who remains disease-free after electing adjuvant bleomycin, etoposide and cisplatin. Of the 3 patients who elected observation after retroperitoneal lymph node dissection only 1 has had recurrence, while 2 (66%) were cured by retroperitoneal lymph node dissection only. CONCLUSIONS: Contrary to juvenile yolk sac tumor, which has a strong tendency toward hematogenous metastasis, the behavior of clinical stage I adult pure yolk sac tumor is similar to that of all other stage I nonseminomas in adulthood.     

Adult testicular pure yolk sac tumor.

Here we describe the clinical, ultrasonographic and histological features of a rare pure adult yolk sac tumor detected in the right testis of a 44-year-old male. Due to the rarity of this neoplasm (less than 10 cases have been reported), there is no unanimous consensus for therapy following inguinal orchiectomy. We believe that nerve-sparing retroperitoneal lymph node dissection could be potentially curative and useful for future interpretations of this tumor's potential evolution.     

Primary yolk sac tumor of the common bile duct

Yolk sac tumor (YST) is a germ cell neoplasm usually arising from the gonads. Extragonadal YST has been reported in the mediastinum, retroperitoneum, liver, and pelvis. Primary YST of the common bile duct (CBD) has not been previously reported. We describe an 11-month-old girl with a YST arising from the CBD who presented with obstructive jaundice. Imaging studies revealed an intraluminal CBD mass with intrahepatic biliary dilatation and extraluminal infiltration of the head of the pancreas. A complete resection was carried out, and postoperative chemotherapy with cisplatin, etoposide and bleomycin was administered.     

Postchemotherapy retroperitoneal residual mass in infantile yolk sac tumor

BACKGROUND: Persistent postchemotherapy retroperitoneal residual mass with normalization of alpha-fetoprotein (AFP) in infantile yolk sac tumor is rare. METHODS/RESULTS: A 38-month-old boy with recurrent yolk sac tumor was treated with cisplatin-based combination chemotherapy. After chemotherapy, the retroperitoneal lymph node metastasis, 7 x 6 cm in size, decreased to 2 x 2 cm. Serum AFP levels returned to normal. The retroperitoneal residual mass was resected and histologically showed complete necrosis without viable cancer cells. CONCLUSION: The patient has remained free of disease for 36 months after operation.     

Extragonadal yolk sac tumor in a superior scrotal mass.

We report a case of an extragonadal yolk sac tumor in a superior scrotal mass. Testicular ultrasonography was normal preoperatively and after chemotherapy. Serum alpha-fetoprotein was initially increased to 344.55 ng./ml. (normal 0 to 15) but it returned to normal after surgery and chemotherapy.     

儿童与成人单纯性睾丸卵黄囊瘤临床特点对比分析

目的:通过对比儿童与成人单纯睾丸卵黄囊瘤的特点,提高睾丸卵黄囊瘤的诊疗水平。方法:选取2008年5月至2018年7月病理确诊的单纯性睾丸卵黄囊瘤75例患者为研究对象,其中64例患者年龄18岁设为儿童组,11例患者年龄≥18岁设为成人组。回顾性分析所有患者的临床资料,比较两组患者临床表现、实验室检查、病理学表现、临床分期、治疗方案及预后。结果:儿童组年龄6个月至5岁[(1.38±0.89)岁],肿瘤大小0.9～6.0(2.48±1.12) cm;成人组年龄25～49岁,中位年龄34(29,46)岁,肿瘤大小3.5～6.3(5.16±1.32) cm;两组最常见的就诊原因为患侧睾丸无痛性肿大,4例(6.3%)儿童,5例(45.5%)成人以睾丸疼痛就诊。儿童与成人组肿瘤直径及首诊表现差异有统计学意义(P0.05)。所有患者均行根治性高位精索离断式睾丸切除术,儿童组24例行化疗,1例行腹膜后淋巴结清扫术(RPLND);成人组5例行化疗,3例行RPLND。所有患者术前甲胎蛋白(AFP)均不同程度升高。病理结果示肿瘤细胞小,核仁明显,胞质多空泡,形态不规则,细胞排列疏松,细胞内外可见透明小体。10例患者失访,余65例随访10～78(52.00±23.78)个月;儿童组2例单纯转移,3例单纯复发,3例复发伴转移,5例死亡;成人组5例单纯转移,1例单纯复发,1例复发伴转移,4例死亡。结论:成人与儿童睾丸卵黄囊瘤在临床表现、生物学行为、治疗、预后等方面有很大区别。儿童睾丸卵黄囊瘤患者多为临床I期,首选根治性睾丸切除术,预后良好;成人患者恶性程度较高,易复发和转移,预后较差,应联合根治性睾丸切除术、RPLND及化疗等治疗方式。     

Intraabdominal testis with yolk sac tumor in a 2-year-old child

A case of a large yolk sac tumor in an undescended testicle in a 2-year-old child is presented. No such similar finding has been reported in a young child. Despite the large size of the primary tumor, the high level of serum alpha-fetoprotein and the relatively late clinical presentation, this was a stage I lesion, and the child responded to surgical resection of the tumor and chemotherapy.     

颅内及椎管内卵黄囊瘤1例

正卵黄囊瘤是一种少见的起源于生殖细胞的生殖细胞瘤,常见于儿童及青少年,多发于卵巢、睾丸及骶尾部,主要沿身体中线分布,发生于其他部位少见,颅内及椎管内者极为罕见。我们收治1例颅内及椎管内髓外卵黄囊瘤患者,报道如下。患者女性,28岁。因"腰腿痛1月余,加重1周"于2016年11月28日收入我院。患者既往体健,曾于1个月前因腰痛伴右下肢疼痛,来我院就诊,初步检查后考虑"肌筋膜炎",给予对症治疗,效果较差,伴随双下肢进行性肌     

An unusual successfully treated case of pulmonary yolk sac tumor

Extragonadal germ cell tumors are relatively rare, particularly malignant yolk sac tumors arising in the lung parenchyma. We report a case of a huge malignant yolk sac tumor in the right middle lobe. The patient was successfully treated with neoadjuvant chemotherapy followed by complete resection of the tumor.     

Spinal cord compression of primary extragonadal giant yolk sac tumor

STUDY DESIGN: Case report. OBJECTIVE: To report an adult male patient with a primary extragonadal giant yolk sac tumor presenting with acute spinal cord compression. SETTING: Faculty of Medicine, University of Dicle, Diyarbakir, Turkey. METHOD: A 31-year-old man was referred to our department with a diagnosis of Pott's disease, a complaint of back pain and gait difficulty for 2 weeks. Neurological examination showed spastic paraparesis and hypoesthesia below the L2 dermatome level. He also had urinary incontinence. Abdominal computed tomography and lumbar magnetic resonance imaging study revealed a giant cystic mass lesion located in the psoas muscle. Posteriorly, the third lumbar vertebral body was destructed and the tumor was compressing the dural sac. A combined anterior and posterior approach was performed. Pathological diagnosis was a yolk sac tumor. RESULT: His neurological status improved during the postoperative course. A chemotherapy protocol was given including bleomycin, etoposide and cisplatin. Five months after the last chemotherapy, he was brought to the emergency unit in sepsis and died despite antibiotherapy. CONCLUSION: Yolk sac tumor should be considered in young adult male patients presenting with acute paraparesis even without any signs or medical history of a testis tumor. These tumors may be unresectable; however, decompression of neural structures and stabilization of the spine with instrumentation may cause substantial improvement in neurological deficit and pain relief.     

Biphagic pulmonary blastoma with a lesion of yolk sac tumor

Biphagic pulmonary blastoma (BPB) is one of the rare pulmonary malignant neoplasms. Here, we describe a case of BPB with a histological feature of yolk sac tumor, accompanied with an elevated serum α-fetoprotein level (531.1 ng/ml). The tumor was detected in the right upper lobe as a 10-cm mass. The patient underwent right upper lobectomy and mediastinal lymph node dissection. Histological examination revealed that the tumor was composed of immature mesenchymal and epithelial elements, and it was accompanied by foci of yolk sac tumor-like features that showed positive staining for α-fetoprotein antibody. Adjuvant chemotherapy consisted of cisplatin and etoposide. After surgery, the serum level of α-fetoprotein decreased below normal. Local recurrence was disclosed 27 months after surgery, and radiation therapy was performed. The patient is currently alive 70 months after surgery.     

Primary yolk sac tumor of the cerebellar vermis: case report.

A rare case of yolk sac tumor in the cerebellar vermis is reported. A 2-year-old boy developed headaches, vomiting, and an unsteady gait. Later a tumor was demonstrated in the medial part of the cerebellum by gadolinium-enhanced magnetic resonance imaging (MRI). The tumor was totally removed, and the surgery was followed by chemotherapy. Soon after surgery the elevated alphafetoprotein (AFP) levels in the serum and cerebrospinal fluid were observed to decrease to normal levels. Three months later enhanced MRI showed a lesion in the vermis without any elevation of AFP, and the lesion turned out to be a granuloma. Six months after the second surgery a tumor recurred that could not be totally removed. Cranial radiotherapy was given together with chemotherapy, which resulted in a decrease of AFP to the normal range. The patient is doing well without any elevation in AFP at 1 year 6 months after onset. Related problems in the diagnosis and treatment of yolk sac tumors are discussed.     

Clinical dilemma in management of yolk sac tumor of childhood testis.

An "expectant" approach to management of yolk sac type testis tumors in two boys led to therapeutic failure. The rationale for such "nontherapy" in light of current knowledge is discussed. The need for more sophisticated tumor staging as well as improved chemotherapeutic approaches in treatment planning is suggested.