We describe a rare case of a primary yolk sac tumor of the endometrium treated with a simple total hysterectomy without bilateral salpingo-oophorectomy and 3 cycles of the bleomycin, etoposide and cisplatin regimen.
In September 2004, a 30-year-old woman was admitted with abnormal vaginal bleeding that had been ongoing for 2 months. A transvaginal ultrasound showed that the uterine cavity was completely occupied by an oval-shaped tumor, which was hyperechoic, 55 × 37 mm in size, highly vascularized, and showed aspects of neoangiogenesis. Resistive index (RI) was 0.20. Smear cytology was performed and showed that the tumor was a cervical adenocarcinoma. Hysteroscopy showed polypoid formations in the cervical canal and uterine cavity. A biopsy revealed that the tumor was of germ cell origin. Abdominal and pelvic computerized scanning showed a uterine mass mimicking a myoma. No enlarged lymph nodes were present. Alpha-fetoprotein (AFP) levels were 1.762 ng/mL (reference value: 0-20 ng/mL). A test for the beta-subunit of human chorionic gonadotropin (B-hcG) was negative and Ca-125 was borderline (36 U/mL). After consulting the limited existing literature, the case was discussed with the pathologist and oncologist. The patient was informed of the recommended treatment, and she gave her consent. A simple total hysterectomy was performed. Bilateral adnexa were preserved. Pelvic paraaortic lymph nodes were not dissected. The removed uterus measured 11 × 5.5 × 5.6 cm and weighed 170 g. Sectioning of the uterus revealed a tumor with rounded margins. The tumor was yellowish-white with a central hemorrhagic area, extended from the region around the isthmus to the uterine body. The tumor was infiltrating the entire wall of the myometrium and had infiltrated the cervical stroma, reaching 1.5 mm from the outer surface. The tumor had the typical microscopic features of an endodermal sinus tumor in that it had reticular and solid growth patterns, and 47 Schiller-Duval bodies were present. The neoplastic cells and hyaline globules stained positively for AFP. The morphologic and immunohistochemical pattern was consistent with a primary yolk sac tumor (YST) of the endometrium ( Figure ).
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