27. A Case of Vaginal Yolk Sac Tumor in an 8 Year Old Girl with Didelphys Uterus

Abstract

<h3>Background</h3> Vaginal yolk sac tumors are quite rare in children. They usually occur in young girls under the age of 3 and present with vaginal bleeding. We present a case where an initial exam under anesthesia revealed no evidence of a vaginal malignancy. However, due to ongoing symptoms, a re-evaluation revealed vaginal yolk sac tumor which had been concealed by a congenital anomaly. <h3>Case</h3> An 8 year old girl presented with a 3 month history of pre-pubertal vaginal bleeding. A workup revealed pre-pubertal hormonal levels, no evidence of vaginal infections or foreign objects and no concerns for sexual abuse. Imaging revealed a didelphys uterus with 2 cervixes and a 9mm collection of heterogeneous material which appeared to be within an obstructed left hemi-vagina. On vaginoscopy there was no visible blood, no distension of the left hemi-vagina that could be visualized, and no evidence of malignancy. Due to ongoing symptoms, exam under anesthesia was repeated in one year. On this exam a bulge was noted in the vagina. The vaginal septum was perforated and significant vaginal tumor was discovered within the left hemi-vagina. This was biopsied and found to be an extra-gonadal yolk sac tumor. She was subsequently referred to oncology and diagnosed with Stage III extra-gonadal yolk sac tumor with negative AFP. She received 4 cycles of cisplatin, bleomycin and etoposide (PEB). She underwent interval debulking of vaginal tumor, which was halted due to excessive bleeding from the tumor. She underwent 2 additional cycles of PEB followed by excision of the vaginal septum. At that time there was no further visible tumor and no tumor was identified on histologic evaluation of the septum. <h3>Comments</h3> This case illustrates difficulty diagnosing a vaginal tumor due to a congenital anomaly. It is critical to continue to follow patients with pre-pubertal bleeding if there is no etiology discovered initially. Though malignancy is a rare cause of pre-pubertal vaginal bleeding, it is important to reconsider this in cases which include congenital anomalies that may delay the diagnosis.