Nuclear deoxyribonucleic acid content (ploidy) of endodermal sinus (yolk sac) tumor

Paraffin sections from 30 endodermal sinus (yolk sac) tumors were Feulgen-stained, and nuclear DNA content (ploidy) was assessed through DNA cytophotometry using the microTICAS image analysis system. The series consisted of 20 ovarian, 8 testicular, 1 sacrococcygeal, and 1 mediastinal tumors. Of the 30 endodermal sinus (yolk sac) tumors 29 were shown to be aneuploid, whereas the remaining tumor which exhibited the recently described primitive intestinal or enteric pattern was diploid and may thus be considered a neoplasm showing a somewhat higher degree of differentiation as compared to tumors showing the other histologic patterns of endodermal sinus (yolk sac) tumors.     

Gonadal endodermal sinus (yolk sac) tumor with pure intestinal differentiation: a new histologic type

We studied 3 cases of a variant of endodermal sinus tumor (EST) or yolk sac tumor (YST). Two tumors originated in the ovary and one in the testis. The patients had very high levels of serum alpha-fetoprotein (AFP). All three tumors had a characteristic histologic appearance and were composed of acinar structures lined by columnar epithelium with large, immature nuclei. Immunohistochemistry and electron microscopy, including freeze-fracture studies, confirmed that this unusual tumor is one with exclusive intestinal differentiation. We feel that this unique tumor is a pure EST (YST) with exclusive intestinal differentiation.     

Immunohistochemical demonstration of a hitherto undescribed localization of hemoglobin A and F in endodermal cells of normal human yolk sac and endodermal sinus tumor

In this study of 4 human yolk sacs, the presence of hemoglobin A and F (HbA and HbF) is demonstrated for the first time in epithelial cells (type 1) and erythroid-like cells (type 2) in the endodermal layer by immunoperoxidase technique. Our findings strongly support the hypothesis previously proposed that the red blood cells formed in the yolk sac are of endodermal origin. Tumor with yolk sac differentiation (8 endodermal sinus tumors and 1 embryonal carcinoma with vitelline areas) similarly showed HbA and HbF localisation in endodermal cells. None of 59 germ cell tumors of other types contained these hemoglobins in the neoplastic cells.     

Alpha1-antitrypsin and alpha-fetoprotein. Protein markers in endodermal sinus (yolk sac) tumors.

A combined immunocytochemical and quantitative serum and tissue study was performed on a group of endodermal sinus (yolk sac) tumors, localizing and measuring both alpha1-antitrypsin (AAT) and alpha-fetoprotein (AFP) in tumor tissue and patient sera. Utilizing indirect immunofluorescent and triple-sandwich immunoperoxidase methods, both proteins were demonstrated within intra- and extracellular periodic acid-Schiff-positive hyaline globules characteristic of the tumor, as well as within the cytoplasm of tumor epithelial cells lining endodermal sinuses, where AAT deposition predominated. Tumor tissue extracts confirmed the presence of significant quantities of both proteins, and pretreatment serum elevations of both showed a parallel decline during therapy. In this study, AAT is characterized as a tumor protein marker for the first time, and a parallelism between AAT and AFP is demonstrated in both serum and tumor tissue. These findings represent additional supportive evidence for the yolk sac origin of endodermal sinus tumors in man.     

The histogenetic-embryologic basis for reappearance of alpha-fetoprotein in endodermal sinus tumors (yolk sac tumors) and teratomas.

The mechanism of neosynthesis of the human tumor-associated fetal antigen alpha-fetoprotein (AFP) in a variable percentage of patients with testicular, ovarian and extragonadal germ cell tumors has generally been considered unknown or beyond any simple explanation. Of decisive importance is the cellular basis for AFP production 1. in ontogenesis and 2. in malignancy as dependent on an exact tumor histogenesis. Based on (1) the histogenetic-embryologic classification of germ cell tumors and the concept of yolk sac tumor (or endodermal sinus tumor), (2) the available clinical and experimental observations, and (3) the immunofluorescent localization of AFP in the endodermal sinus tumor of the human testis, it is concluded that AFP synthesis in these neoplasms is explained by the fact that they contain yolk sac endoderm, which produce AFP analogous with the physiological AFP synthesis by the fetal yolk sac in early embryogenesis.     

Serum alpha-foetoprotein as a marker for endodermal sinus tumour (yolk sac tumour) or a vitelline component of "teratocarcinoma".

The correlation between serum alpha-foetoprotein (AFP) and the clinical pathological finding of 24 germ cell tumours arising from the testes (14 cases), the ovaries (3 cases), the mediastinum (3 cases), the retroperitoneal region (2 cases), and the sacrococcygeal region (2 cases) are presented. Irrespective of marked differences in age and sex of the patients, primary site of the tumours and clinical outcome, the 24 cases constituted a homogeneous group in fundamental histological patterns and in AFP synthesis. In all cases of endodermal sinus tumour or teratocarcinomas with a distinct vitelline component an increased serum AFP concentrations was found in the pre-operative serum samples. AFP was also demonstrated in the tumour tissue by quantitative determination of AFP in tumour homogenate (5 cases) and, by immunofluorescence technique, positive staining of the cells lining the endodermal sinuses and of the hyaline globules was found (3 cases). In 12 germ cell tumours without vitelline components in the tumour tissue sections, a normal AFP concentration below 20 mug/1 was found in preoperative serum samples.     

Clear cell carcinoma of the ovary simulating a yolk sac tumor

Clear cell carcinoma (CCC) of the ovary is uncommon. In young patients, this tumor may simulate a yolk sac tumor. In this case, the morphologic distinction between these tumors is often difficult but the immunohistochemical staining for CA125 and alpha foeto protein (AFP) and the response to chemotherapy are particularly helpful to resolve this problem of differential diagnosis. We report a case of a 17 year old patient who was operated for a tumor of the right ovary. The diagnosis of a yolk sac tumor was first suggested. However, because of the non response to chemotherapy, a second laparotomy was performed; the definitive pathologic examination concluded to the diagnosis of a CCC of the ovary. The young age and the immunohistochemical staining for AFP are unusual and misleading features for a CCC. Our objective about this particular case is to discuss the anatomoclinical aspects of the CCC of the ovary and to prove the role of immunohistochemistry in the differential diagnosis.     

Embryonal cell carcinoma (endodermal sinus type) of the ovary

This report describes two patients with the pure endodermal sinus type of embryonal carcinoma. The first patient had embryonal cell carcinoma in one ovary and a benign cystic teratoma in the opposite ovary. The second patient had embryonal cell carcinoma confined to one ovary.Embryonal cell carcinoma is a rare and highly malignant ovarian tumor. Only 29 cases of the pure endodermal sinus type of embryonal cell carcinoma have been reported. It commonly occurs during childhood, adolescence, or early adulthood. The prognosis is poor, as shown by the first case.     

The human yolk sac and yolk sac carcinoma: An ultrastructural study

The ultrastructure of the yolk sac of a 39 day old human embryo was studied. The subcellular organization was suggestive of a highly specialized absorptive function proceeding in an exocelomic-vitelline direction. These findings, compatible with intense metabolic activity, are at variance with the concept of rapid involution of the yolk sac following completion of its hemopoietic and angiogenetic functions. The speculation is advanced that a potential avenue exists in the yolk sac whereby maternally derived products encounter fetal endoderm. Ultrastructural features in the normal yolk sac were compared to those existing in a tumor showing the “endodermal sinus” pattern, and reviewed in the light of the pertinent literature. These findings support the concept that attributes and endomesoblastic derivation to such neoplasms.     

The problems of yolk sac tumor morphogenesis in a light of the tumor stem cell theory

The analysis of possible morphogenesis of the different structures in human yolk sac tumor has been considered. The author has supposed that features of blood vessel microarchitecture formation and perpetual differentiation of tumor cells or theirs functional modification play a crucial role in the morphogenesis of YST. The immunohistochemical investigation of some stem cells markers has showed the necessity of accounting of their distribution pattern in various cellular structures for the differential diagnosis of morphogenetical steps of YST. The growth of tumor cells differentiation rate correlates with increasing of stem cells markers expression as well c-kit > OCT4 > CD30 > PLAP.     

Assay and characterization of IgG binding to endodermal cells of the fetal rabbit yolk sac membrane

The transfer of passive immunity in the rabbit is mediated by the fetal yolk sac membrane (YSM) and is initiated by the specific binding of IgG to receptors on the microvillar surface of the endoderm from the YSM. This report describes the preparation of suspensions of endodermal absorptive cells of the YSM and their use in equilibrium binding experiments to characterize the nature of the binding reaction. Equilibrium binding is achieved in 4 h at 4 degrees C. The system is more rapid than, affords greater reproducibility of binding data than, and utilizes only about 1/10 the amount of YSM and ligand as the YSM disc assay system (Tsay and Schlamowitz, 1975) used previously. A Scatchard plot of the binding data over a wide range of IgG concentration was non-linear implying the presence of at least 2 binding elements. Apparent binding constant values for the stronger and weaker binding components in this population differed by about 50-fold. For the weaker binding system, binding decreased when temperature was increased indicating that the reaction was not entropy-driven (i.e., dominated by hydrophobic 'forces') and that ionic interactions might be a major factor. At low ionic strengths the measurement of specific binding was complicated by the effects of secondary ionic interactions. At physiological ionic strength the binding of IgG was species-specific.     

FNAC diagnosis of yolk sac tumor: a case report

Yolk sac tumor is the second most common germ cell tumor of the ovary. A nine year old female child presenting with a lower abdominal mass diagnosed as a yolk sac tumor on fine needle aspiration cytology (FNAC) is described. Ultrasonographically (USG) guided FNAC of the lesion revealed tight clusters and papillary fronds of cells associated with homogeneous acellular eosinophilic bodies. A preoperative diagnosis of this tumor is helpful in planning further diagnostic and therapeutic steps.     

Sinonasal yolk sac (Endodermal sinus) tumor in an adult female – A case report and review of the literature

Yolk sac tumor (YST), also known as endodermal sinus tumor, is a highly malignant germ cell tumor that is extremely rare in the sinonasal region, especially in adults. To the best of our knowledge, only five such cases have been reported till date (four men, one woman). We present a case of sinonasal YST admixed with transitional cell carcinoma in a 58‐year‐old female. Magnetic resonance imaging revealed a mass in the right ethmoid fissure infiltrating into the posterior and anterior ethmoid sinuses and nasopharynx. Positron emission tomography examination showed a maximum standardized uptake value of 6.8. Histological examination of the biopsy specimen revealed two distinct features, YST and transitional cell carcinoma, with evidence of mutual transition that indicated the composite nature of the tumor. Immunohistochemical analysis revealed positive immunoreactivity for Sal‐like protein 4, α‐fetoprotein and glypican3, and negative immunoreactivity for placental alkaline phosphatase, CD30 and CD117 in the YST component. P40 and P63 were detected only in transitional cell carcinoma component. The tumor was subsequently excised and four cycles of adjuvant chemotherapy at intervals of 3 weeks were administered. At 8 months after surgery, there was no evidence of tumor recurrence or metastasis. We have also presented a literature review on YST in sinusoids.