Long-term outcome of the vaginoscopic approach for infantile vaginal yolk sac tumors: A case report

Abstract

Introduction: Infantile vaginal yolk sac tumor (YST) is a rare and aggressive form of pediatric cancer that often presents with bloody discharge. Despite advances in chemotherapy, managing post-chemotherapy AFP level rebounds remains a challenge. This case report describes a 7-month-old girl with vaginal YST whose AFP levels rose following 3 cycles of PEB chemotherapy.

Case presentation: Despite aggressive PEB chemotherapy, the patient's AFP levels increased, indicating ongoing disease activity. MRI scans failed to reveal any visible lesions, suggesting a potential oversight in disease assessment. However, a vaginoscopy uncovered a 1.5-cm residual lesion in the vaginal area, highlighting the importance of this procedure in identifying occult disease. The lesion was successfully resected, and histopathological examination confirmed clear margins. Postoperatively, there was a marked decrease in serum AFP levels, and no tumor recurrence was observed over a 60-month follow-up period. The patient's ovarian function and uterine development were preserved.

Clinical discussion: This case underscores the value of a multimodal approach in managing vaginal YSTs, particularly when standard imaging fails to detect residual disease. The vaginoscopic approach not only identified a residual lesion missed by MRI but also allowed for minimally invasive treatment, reducing the need for additional chemotherapy and its associated side effects.

Conclusion: The vaginoscopic approach provides a significant alternative for treating vaginal YSTs, especially in cases where AFP levels rise post-chemotherapy. This method emphasizes fertility preservation and minimizes the impact on reproductive health, offering a promising direction for future treatment strategies in pediatric oncology.

Keywords: Case report; Fertility preservation; Infantile vaginal yolk sac tumor; Vaginoscopic approach.

Fig. 1

Sagittal MRI of the pelvis before and after chemotherapy. A) Before chemotherapy, a round and well-defined vaginal mass (arrow) was observed. B) After 3 cycles of chemotherapy, no significant vaginal tumor was detected. C) Follow-up MRI at 60 months revealed no evidence of a mass in the anterior vagina.

Fig. 2

Vaginoscopy before and after chemotherapy. A & B) Vaginal mass before chemotherapy: a red and white botryoid mass (arrow) was visible on in the anterior of the vagina. C) A white and atrophic mass residue (arrow) was observed after chemotherapy. D) Vaginoscopic view after removal of the mass by vaginoscopic operation, showing a normal cervix (arrow). (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

Fig. 3

Histological and immunohistochemical examination before and after chemotherapy. Eosinophilic Periodic acid-Schiff stained section of yolk sac tumors showed a reticular pattern with occasional Schiller-Duval bodies (arrow) before (A, ×100). The tumor cells were diffusely positive for Glypican-3 (B, ×100) and Ki-67 (C, ×100) but not after chemotherapy (B, ×100). With H&E staining, Schiller-Duval bodies were not observed after chemotherapy (D, ×100).