Ovarian yolk sac tumor with epithelial tumor component in a postmenopausal woman - case report and literature review

Abstract

Ovarian yolk sac tumors are common germ cell tumors usually arising in young women. Yolk sac tumors in elderly women are infrequently encountered and most of them are combined with other epithelial tumor components including endometrioid carcinoma or serous carcinoma. Here, we report an extremely rare case of a yolk sac tumor with mucinous tumor and large cell neuroendocrine carcinoma components in a postmenopausal woman, which is the third yolk sac tumor case with a neuroendocrine tumor element in an elderly woman. An 82-year-old female visited our hospital due to abdominal distention. Abdominal computed tomography (CT) demonstrated a solid and cystic mass, measuring about 9.0 cm in the largest diameter. A total hysterectomy with bilateral salpingo-oophorectomy and excisional biopsy of the peritoneal metastatic lesions was performed. Histologic evaluation revealed a malignant ovarian tumor composed of a variety of tumor components, including a yolk sac tumor, a mucinous tumor with multifocal mucinous carcinomatous areas, and a large-cell neuroendocrine carcinoma. After surgery, the patient refused further treatment and the disease recurred in the pelvic peritoneum and a left supraclavicular lymph node nine months later.

Keywords: Composite tumor; adult; ovarian yolk sac tumor.

Figure 1

Microscopic features of the ovarian tumor. (A) The ovary showed a solid and cystic mass with multifocal hemorrhage. (B-D) The YST component exhibited a variety of histologic features, including solid sheet-like (B), papillary (C), and glandular patterns (D). (E) There were markedly pleomorphic cells in some areas. (F) The mucinous tumor component showed a cystic appearance. (G) Stromal invasion was noted in the mucinous tumor, suggesting mucinous carcinoma. (H) A large-cell neuroendocrine carcinoma component was also found in focal areas. (I and J) There were transitional regions between the mucinous tumor and the neuroendocrine tumor components (I) and between the mucinous tumor and the YST components (J).

Figure 2

Immunohistochemical staining for glypican-3 (A) and SALL4 (B) were positive mainly in YST areas and immunohistochemical staining for CK7 (C) and Pax8 (D) was positive mainly in the somatic epithelial tumor areas. Chromogranin A (E) and synaptophysin (F) showed immunoreactivity in the large-cell neuroendocrine carcinoma areas.