SESSION TITLE: Lung Cancer Case Report Posters 2SESSION TYPE: Case Report PostersPRESENTED ON: 10/17/2022 12:15 pm - 01:15 pmINTRODUCTION: The most common germ cell tumor in adults is a non-seminomatous pure yolk sac tumor. We present one such case of metastatic yolk sac tumor complicated by central airway obstruction (CAO) and hemoptysis.CASE PRESENTATION: A 26-year-old male presented with shortness of breath and hemoptysis occurring for one month. CT chest was notable for 3.9 x 4.1 x 3.5cm right hilar mass, hilar lymphadenopathy, and a soft tissue filling defect in the right mainstem bronchus. Patient's vitals were stable and was monitored in the ICU given his impending central airway obstruction with ongoing hemoptysis.Patient underwent rigid bronchoscopy demonstrating an endobronchial mass obstructing the right mainstem bronchus. Mechanical debulking with electrocautery snare was performed. Cryoprobe was used to allow for recanalization of the right main stem. Pathology revealed non-seminomatous yolk sac tumor with no mixed features. AFP was 14788. LDH and Beta-HCG were normal. Scrotal US showed ill- defined mixed hypoechoic and isoechoic focus in the left testis all confirming the diagnosis of metastatic yolk sac tumor.He completed 2 cycles of chemotherapy with bleomycin, etoposide, and cisplatin. He subsequently missed his scheduled appointment with urology for orchiectomy and was lost to follow-up with oncology despite multiple scheduling attempts.After 6 months, the patient returned for evaluation due to worsening dyspnea and hemoptysis. He required right bronchial artery embolization (BAE) and rigid bronchoscope guided tumor debulking which allowed for complete cessation of bleeding. He has restarted chemotherapy and continues his outpatient follow-up. The patient continues to do well without any more hemoptysis or dyspnea.DISCUSSION: Pure (non-mixed) yolk sac tumors account for only 0.6% of germ cell tumors in adult male testicular cancers. With stage IIIC disease our patient's 5-year survival rate is 48%. Most commonly presenting as a mass at primary tumor site, our patients presenting shortness of breath and hemoptysis portended a poorer prognosis due to metastatic spread. Initial treatment is chemotherapy and orchiectomy. Aggressive management with BAE for hemoptysis will improve short term mortality. In addition, mechanical debridement of endobronchial lesions improves patient quality of life and should be repeated as necessary to help maintain patient functionality. Our case displays a multi-modality approach to managing complicated yolk sac tumor. Utilizing interventional radiology (IR), interventional pulmonology (IP), and oncology will allow for the best prognosis for our patient with complicated metastatic yolk sac tumor.CONCLUSIONS: Germ cell tumors have a good prognosis. However, they can metastasize and cause fatal central airway obstruction along with hemoptysis. This requires a multimodality approach to treatment utilizing IR, IP and oncology simultaneously.Reference #1: Anil Hari, Gary Grossfeld, Hedvig Hricak,Chapter 29 - Tumors of the Scrotum, Editor(s): David G. Bragg, Philip Rubin, Hedvig Hricak, Oncologic Imaging, Elsevier, 2002, Pages 603-628Reference #2: Smith ZL, Werntz RP, Eggener SE. Testicular Cancer: Epidemiology, Diagnosis, and Management. Med Clin North Am. 2018 Mar;102(2):251-264. doi: 10.1016/j.mcna.2017.10.003. Epub 2017 Dec 21. PMID: 29406056.Reference #3: Mehta AS, Ahmed O, Jilani D, et al. Bronchial artery embolization for malignant hemoptysis: a single institutional experience. J Thorac Dis. 2015;7(8):1406-1413. doi:10.3978/j.issn.2072-1439.2015.07.39DISCLOSURES: No relevant relationships by Jalal DamaniNo relevant relationships by Sarah Sharkey SESSION TITLE: Lung Cancer Case Report Posters 2 SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: The most common germ cell tumor in adults is a non-seminomatous pure yolk sac tumor. We present one such case of metastatic yolk sac tumor complicated by central airway obstruction (CAO) and hemoptysis. CASE PRESENTATION: A 26-year-old male presented with shortness of breath and hemoptysis occurring for one month. CT chest was notable for 3.9 x 4.1 x 3.5cm right hilar mass, hilar lymphadenopathy, and a soft tissue filling defect in the right mainstem bronchus. Patient's vitals were stable and was monitored in the ICU given his impending central airway obstruction with ongoing hemoptysis. Patient underwent rigid bronchoscopy demonstrating an endobronchial mass obstructing the right mainstem bronchus. Mechanical debulking with electrocautery snare was performed. Cryoprobe was used to allow for recanalization of the right main stem. Pathology revealed non-seminomatous yolk sac tumor with no mixed features. AFP was 14788. LDH and Beta-HCG were normal. Scrotal US showed ill- defined mixed hypoechoic and isoechoic focus in the left testis all confirming the diagnosis of metastatic yolk sac tumor. He completed 2 cycles of chemotherapy with bleomycin, etoposide, and cisplatin. He subsequently missed his scheduled appointment with urology for orchiectomy and was lost to follow-up with oncology despite multiple scheduling attempts. After 6 months, the patient returned for evaluation due to worsening dyspnea and hemoptysis. He required right bronchial artery embolization (BAE) and rigid bronchoscope guided tumor debulking which allowed for complete cessation of bleeding. He has restarted chemotherapy and continues his outpatient follow-up. The patient continues to do well without any more hemoptysis or dyspnea. DISCUSSION: Pure (non-mixed) yolk sac tumors account for only 0.6% of germ cell tumors in adult male testicular cancers. With stage IIIC disease our patient's 5-year survival rate is 48%. Most commonly presenting as a mass at primary tumor site, our patients presenting shortness of breath and hemoptysis portended a poorer prognosis due to metastatic spread. Initial treatment is chemotherapy and orchiectomy. Aggressive management with BAE for hemoptysis will improve short term mortality. In addition, mechanical debridement of endobronchial lesions improves patient quality of life and should be repeated as necessary to help maintain patient functionality. Our case displays a multi-modality approach to managing complicated yolk sac tumor. Utilizing interventional radiology (IR), interventional pulmonology (IP), and oncology will allow for the best prognosis for our patient with complicated metastatic yolk sac tumor. CONCLUSIONS: Germ cell tumors have a good prognosis. However, they can metastasize and cause fatal central airway obstruction along with hemoptysis. This requires a multimodality approach to treatment utilizing IR, IP and oncology simultaneously. Reference #1: Anil Hari, Gary Grossfeld, Hedvig Hricak,Chapter 29 - Tumors of the Scrotum, Editor(s): David G. Bragg, Philip Rubin, Hedvig Hricak, Oncologic Imaging, Elsevier, 2002, Pages 603-628 Reference #2: Smith ZL, Werntz RP, Eggener SE. Testicular Cancer: Epidemiology, Diagnosis, and Management. Med Clin North Am. 2018 Mar;102(2):251-264. doi: 10.1016/j.mcna.2017.10.003. Epub 2017 Dec 21. PMID: 29406056. Reference #3: Mehta AS, Ahmed O, Jilani D, et al. Bronchial artery embolization for malignant hemoptysis: a single institutional experience. J Thorac Dis. 2015;7(8):1406-1413. doi:10.3978/j.issn.2072-1439.2015.07.39 DISCLOSURES: No relevant relationships by Jalal Damani No relevant relationships by Sarah Sharkey