Hepatoid Variant of Yolk Sac Tumor of Both Ovaries with Widespread Intraabdominal and Lung Metastasis: A Case Report

Abstract

Hepatoid variant of yolk sac tumor of ovary is an unusual tumor with an aggressive behavior. It is usually observed in young females, presents with abdominal complaints and is associated with raised α-fetoprotein (AFP) levels. It should be differentiated from other hepatoid tumors involving the ovary. A complete patient evaluation with gross, microscopy, and immunohistochemistry can identify the site of origin to administer appropriate treatment. The current study reported the case of a 30-year-old married parous female presenting with abdominal distention and pain of two months duration. She had regular menstrual cycles. Based on lab investigations her serum AFP level was markedly raised to 34,244 ng/mL (normal range: 0-9 ng/mL). Computerized tomography (CT) scan showed large lobulated heterogeneous mass in both ovaries and omental, gall bladder, and lung metastasis. A CT guided biopsy of the ovarian mass was done. On histopathology, a differential diagnosis of hepatoid variant of yolk sac tumor, hepatoid carcinoma of ovary and hepatoid tumor arising from gall bladder metastasizing to the ovary were observed. Patient underwent surgery. Per operatively gross ascites with bilateral ovarian mass, extensive omental, pelvic, and gall bladder deposits were observed. Bilateral salpingo-oophorectomy with omental deposit biopsy was conducted. Histopathology along with immunohistochemistry confirmed a diagnosis of hepatoid variant of yolk sac tumor in both ovaries with widespread intra-abdominal metastasis.

Keywords: Female; Fndodermal Sinus Tumour; Neoplasm; Ovary.

Figure 1

Gross picture of one of the ovaries showing solid and cystic areas

Figure 2

Histological section showing tumor arranged in discrete masses and broad bands of large eosinophilic polygonal cells separated by fibrous stroma (H&E; 200X)

Figure 3

Histological section showing tumor with intraand extra-cellular hyaline globules and scattered syncytiotrophoblastic (H&E; 200X)

Figure 4

Histological section showing tumor with glandular elements (H&E; 200X)

Figure 5

Immunohistochemistry showing intraand extracellular hyaline globules positive for AFP (a), diffuse positivity for Hep Par1 (b), focal positivity for pancytokeratin (c), and focal faint positivity for CK7 (d) (200X)