Yolk sac primary tumor of mediastino: a rare case in a young adult

Abstract

Germ cell tumors are rare neoplasms that mostly occur in the gonads, although they can also affect other body sites, especially the anterior mediastinum (50 to 70% of all extragonadal germ cell tumors). We report a case of a primary mediastinal yolk sac tumor, a rare and aggressive germ cell tumors subtype. This was a 38-year-old man who was admitted to Hospital do Servidor Público Estadual "Francisco Morato de Oliveira", complaining about dyspnea and dry cough for 1 year. The computed tomography scan of his chest revealed a large mass in the anterior mediastinum with heterogeneous enhancement to the contrast associated with pleural effusion. There were also high serum levels of alpha-fetoprotein. After neoadjuvant chemotherapy, the patient underwent surgical resection of the mass, followed by pathological examination, which confirmed a primary mediastinal yolk sac tumor, a nonseminomatous subtype of germ cell tumors. Primary mediastinal yolk sac tumors have poor prognosis, despite advances in therapy with surgical resection and cisplatin-based chemotherapy. This poor prognosis is due to the degree of invasion and unresectability in most patients by the time of the diagnosis.

Figure 1. Profile of the thorax radiography showing homogenous densification located in anterior mediastium suggesting round contouring large mass

Figure 2. Thorax tomography scan with contrast media, axial slice, showing voluminous expansive formation in anterior mediastinum without clear cleavage plan with supra-aortic branches and superior cava vein, and erasure of extrapleural fat (arrow), which suggested invasion

Figure 3. Thorax tomography with contrast media showing the contact of mediastium mass with aorta a pulmonary trunk (arrow). A stroke to left is seen and also compressive atelectasis of pulmonary parenchyma adjacent to injury

Figure 4. Histopathology of yolk sac tumor (hematoxylin and eosin staining, 20x). Schiller-Duval body (arrow)