Endodermal sinus tumor of the vagina. Report of a case with 7-year survival and literature review of so-called "mesonephromas".

Abstract

The case of an 11-month-old female infant with an endodermal sinus tumor of the vagina is reported. Five months after hysterectomy and vaginectomy, a left obturator nodal metastasis was noted, and subsequently treated by bilateral pelvic node dissection, radiotherapy, and multiple courses of actinomycin D. She is alive and without evidence of disease 7 years following initial treatment. The world literature of “mesonephromas” of the vagina has been reviewed, and it is apparent that such cases can be divided into two groups which are distinct both pathologically and clinically. Clear cell carcinomas (currently thought to be of müllerian derivation) occur primarily in adolescents and mature women, are generally found in the anterior or lateral vaginal wall, and are associated with a relatively satisfactory prognosis (8 of 17 patients alive and tumor-free from 1 to 5 years after primary treatment). Endodermal sinus tumors (such as the present case) are predominantly tumors of infants, are usually found in the posterior vaginal wall or the fornices, and carry a dismal prognosis (only two other 2-year survivors, in addition to the present case, among 13 reported cases). It is suggested that the term “mesonephroma” be replaced by a more precise pathologic diagnosis, and that therapy for vaginal endodermal sinus tumors in infancy continue to be vigorous and aggressive.