Elsevier

Gynecologic Oncology

Volume 70, Issue 2, August 1998, Pages 295-299
Gynecologic Oncology

Case Report
Ovarian Yolk Sac Tumor with Endometrioid Carcinoma Arising from Endometriosis in a Postmenopausal Woman, with Special Reference to Expression of α-Fetoprotein, Sex Steroid Receptors, and p53

https://doi.org/10.1006/gyno.1998.5048Get rights and content

Abstract

A case of a yolk sac tumor (YST) with an ovarian endometrioid adenocarcinoma arising from endometriosis in a postmenopausal woman is described. Clinically, the case showed an aggressive course and did not respond to chemotherapy; the patient died of her disease 6 months after the operation. Histologically, the tumor consisted predominantly of an endometrioid adenocarcinoma, but it also showed microscopic features characteristic of YST. The tumor also contained benign endometriotic lesions with direct transition to the endometrioid adenocarcinoma. Immunohistochemical study revealed that not only the YST, but also the endometrioid adenocarcinoma was partly positive for α-fetoprotein. There was an inverse relationship between the endometriosis and the endometrioid adenocarcinoma in terms of the expression of sex steroid receptors and p53: adenocarcinoma cells were positive for p53 but negative for sex steroid receptors, whereas endometriotic epithelial cells were positive for sex steroid receptors but negative for p53.

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    Primary debulking surgery may not have been performed if pre-operative histology had revealed yolk sac characteristics. To our knowledge, there are 20 published reports of ovarian endodermal yolk sac tumours in post-menopausal patients ranging between 53 and 86 years at presentation (Table 1) (Kammerer-Doak et al., 1996; Rutgers et al., 1987; Nogales et al., 1996; Horiuchi et al., 1998; Mazur et al., 1988; Arai et al., 1999; Brown and Green, 1976; Kinoshita, 1990; Ferracini et al., 1979; Lopez et al., 2003; Oh et al., 2001; Pliskow, 1993; Lange et al., 2012; Filiz et al., 2003; Roma and Przybycin, 2014; Meguro and Yasuda, 2013). Most (Oh et al., 2001) cases involved mixed yolk sac tumours with embryonal, endometrioid carcinoma, cystadenoma/cystadenofibroma or cystadenocarcinoma subtypes, the oldest case being 82 years of age (Kammerer-Doak et al., 1996; Rutgers et al., 1987; Nogales et al., 1996; Horiuchi et al., 1998; Mazur et al., 1988; Arai et al., 1999; Lopez et al., 2003; Roma and Przybycin, 2014; Meguro and Yasuda, 2013).

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    To the best of our knowledge, 35 cases with APOT in postmenopausal women have been documented so far in the English literature. Of them, preoperative serum AFP elevation was proven in 20 cases as well as immunohistochemical expression for AFP [3-20]. The clinical features and histologic findings of these cases are summarized in Table 2.

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    YSTs represent about 7.3% of malignant germ cell tumors.4 YSTs coexisting with a variety of histologic patterns has been described but those with an epithelial malignant component are extremely rare.5 We describe a rare case of ovarian endometrioid adenocarcinoma with a YST component occurring in a postmenopausal woman.

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Kurman, R, J

1

To whom correspondence and reprint requests should be addressed. Fax: +81-263-34-0944.

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