A case of primary intracardiac yolk sac tumour with extracardiac extension

Abstract

Primary cardiac tumour is a rare entity as secondaries in the heart are more common. A 2-year-old child was having repeated respiratory tract infection with poor oral intake and poor activity for 3 months. His symptoms progressed from New York Heart Association (NYHA) Class II to IV. On evaluation he had an intracardiac mass with extracardiac extension. Emergency tumour excision under deep hypothermic circulatory arrest was performed with provisional diagnosis of sarcoma. But Serum markers, histopathological examination and immunohistochemistry confirmed diagnosis of yolk sac tumour. Postoperative recovery was uneventful and the child was receiving adjuvant chemotherapy. Extensive literature review revealed only four cases of primary intracardiac yolk sac tumour published till date. Our case report is unique, in that intracardiac tumour had extracardiac extension by infiltration through right atrial wall. Previous four reports mention purely intracardiac mass.

Figure 1:

Preoperative chest roentgenogram showing cardiomegaly and massive pericardial effusion.

Figure 2:

Preoperative 2DECHO showing right atrial mass.

Figure 3:

CT Thorax showing intracardiac right atrial mass with extracardiac extension.

Figure 4:

Intraoperative image of extracardiac mass.

Figure 5:

Intraoperative image of intracardiac right atrial mass.

Figure 6:

Right atrium after resection of intracardiac mass.

Figure 7:

Histology H&E 400× showing Schiller Duval bodies.

Figure 8:

IHC for Alpha Feto Protein 400×.