A CASE REPORT OF A PRIMARY YOLK SAC TUMOR OF THE ANTERIOR MEDIASTINUM

Abstract

SESSION TITLE: Disorders of the Mediastinum SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/09/2018 01:15 pm - 02:15 pm INTRODUCTION: Primary Yolk Sac Tumor (YST) of the anterior mediastinum in adult is extremely rare and usually has a poor prognosis. Yolk sac tumor is a subtype of Germ Cell Tumor that is commonly seen in young adult that when found outside the gonads are called extragonadal germ cell tumors (EGGCTs). CASE PRESENTATION: A 27-year-old male non hypertensive and non-diabetic was admitted due to difficulty of breathing associated with chest pain for 2 months. Intermittent fever was also noted. After performing Chest CT scan with contrast and laboratory studies, the results indicated an anterior mediastinal mass. Biopsy and immunohisto-chemical staining revealed a primary yolk sac tumor. Debulking of the mass was done and the procedure was tolerated. Chemotherapy with Cisplatin and Etoposide was given. During the course of this process, there were lesser shortness of breath and no complaints of chest pain. DISCUSSION: Yolk sac tumours appear in both men and women and are usually associated with the testes and ovaries. When the testes and ovaries are not the primary site, the tumours are called extragonadal yolk sac tumours and these are usually located in the mediastinum. In an international study by Bokemeyer et al. with 381 mediastinal GCTs, the most common symptoms on presentation were dyspnea (25%), chest pain (23%), cough (17%), fever (13%), night sweat, or weight loss (11%). Night sweat, fatigue, hemoptysis, and symptoms of superior vena cava compression were seen in <10% of patients with mediastinal GCT. Histologically, extragonadal GCTs and mediastinal GCTs have many similarities. Microcystic/reticular pattern is the most common histological presentation. Schiller-Duval bodies are pathognomonic and are helpful for identification. The treatment regimens of extragonadal and gonadal YSTs are similar since they share histological patterns. Extragonadal nonseminomatous germ cell tumors have considerably poorer prognosis. Chemotherapeutic schemes based on cisplatin have shown significant results with up to 50% of patients achieving long-term survival. CONCLUSIONS: This is the first report of a Primary Yolk Sac Tumor of the anterior mediastinum in Philippine Heart Center. Overall, there are few reports on Primary YST of the anterior mediastinum. Up to date, resection with chemotherapy is the treatment of choice. Reference #1: Woodward PJ, Mostofi FK, Talerman A. Germ cell tumors. In: Eble JN, Sauter G, Epstein JI, Sesterhenn IA, editors. WHO classification of tumors. Pathology & Genetics. Tumors of the Urinary system and Male Genital Organs. Lyon: IARC Press; 2004. p. 237-40. Reference #2: Kuzur ME, Cobleigh MA, Greco FA, Einhorn LH, Oldham RK. Endodermal sinus tumour of the mediastinum. Cancer 1982;50:766-74. Reference #3: A. Papaioannou, K. Porpodis, D. Spyratos, and K. Zarogoulidis, “Yolk sac tumour in the anterior mediastinum,” Pneumon, vol. 26, no. 4, pp. 361–365, 2013. DISCLOSURES: No relevant relationships by CRISTIA MAYSOL MORALES, source=Web Response