A case of endodermal sinus tumor associated with the first pregnancy and successful management of the second pregnancy: a case report and review of the literature

Background: Pregnancy complicated by endodermal sinus tumor (EST) of the ovary has rarely been reported.

Case: A huge ovarian EST causing bowel obstruction was found in a 22-year-old patient at 34 weeks of gestation. Abnormally high alpha-fetoprotein (AFP) levels suggested a malignant germ cell tumor of the ovary. The patient was submitted to cesarean section and fertility sparing surgery, and then received four courses of combination chemotherapy. There was no evidence of recurrence 19 months after initial treatment but transvaginal ultrasound (US) evaluation showed an intrauterine pregnancy of six weeks. We delivered a 3,200 g healthy male baby with Apgar scores of 8 and 9 by elective cesarean section at 39 weeks of gestation.

Conclusions: Successful outcome of a second pregnancy is possible after treatment with fertility sparing surgery and combination chemotherapy for an endodermal sinus tumor associated with a first pregnancy. Moreover checking of weekly AFP levels and performing monthly abdominal US could be effective for surveillance of these pregnancies. However management of EST during pregnancy should be based on consideration of the patient's presenting condition, preferences, and gestational age.

Pregnancy; Endodemal sinus tumor

[1] Kumar V., Fausto N., Abbas A.: "Pathologic Basis of Disease". 7th edition. St. Louis, W.B. Saunders/Elsevier, 2005.

[2] Fujita M.. Inoue M., Tanizawa O., Minagawa J., Yamada T., Tam T.: "Retrospective review of 41 patients with endodermal sinus tumor of the ovary". Int. J. Gynecol. Cancer, 1993, 3, 329.

[3] Huntington R.W., Bullock W.K.: "Yol sac tumors of the ovary". Cancer, 1970, 25, 1368.

[4] Novak E.R., Lambrou C.D., Woodruff J.D.: "Ovarian tumors m pregnancy: an Ovarian Tumour Registry review". Obstet Gynecol., 1975, 46, 401.

[5] Kurman R.J., Norris H.J.: "Endoderrnal sinus tumor of the ovary: A clinical and pathologic analysis of 71 cases". Cancer, 1976, 38. 2404.

[6] Azoury R.S., Nasr M.F., Muawnad R.F.: "The endoderrnal smus tumour: special fetures". Int. J. Gynecol. Obstet., 1979, 17, 164.

[7] Weed J.C., Roh R.A., Mendenhall H.W.: "Recurrent enoderrnal inus tumour during pregnancy". Obstet. Gynecol., 1997, 54, 653.

[8] Petrucha R.A.. Rufollo E., Messina A.M.. Bouis P.J., Praphat H "Endodermal sinus tumour: report of a case associated with pregnancy". Obstet. Gynecol.. 1980, 55 (3S), 90S.

[9] Schwartz R.P., Chatwani A.J., Strimel W., Putong P.B.: "Endodermal sinus tumour in pregnancy: report of a case and review of the literature". Gynecol. Oneal., 1983, 15, 434.

[10] Ito K., Yeshirna K., Suzuki H., Noda K.: "A case of ovarian endodermal sinus tumour associated with pregnancy". Exp. Med., 1984, 142, 183.

[11] Malone J.M., Gershenson D.M., Creasy R.K., Kavanaugh J.J., Silva E.G., Striner C.A.: "Endoderrnal sinus tumour of the ovary associated with pregnancy". Obstet. Gynecol., 1989, 68, 86S.

[12] Kirn D., Park M.: "Maternal and fetal survival following surgery and chemotherapy of endodermal sinus tumour of the ovary during pregnancy: a case report". Obstet. Gynecol., 1989, 73, 503.

[13] Metz S.A., Day T.G., Pursell S.H.: "Adjuvant chemotherapy in a pregnant patient with endoderrnal sinus tumour of the ovary". Gynecol. Oneal., 1989, 32, 371.

[14] Farahrnand S.M., Marchetti D.L., Asirwatharn J.E., Dewey M.R "Ovarian endodermal sinus tumor associated with pregnancy review of the literature". Gynecol. Oneal., 1991, 41, 156.

[15] Elit L.. Bocking A., Kenyon C., Natale R.: "An endodermal smus tumor diagnosed in pregnancy: case report and review of the literature". Gynecol. Oneal., 1999, 72, 123.

[16] Van der Zee A.G.J., Bruijin H.W.A., Bouma J., Aalders J.G., Oosterhuis J.W., de V ries E.G.E.: "Endoderrnal sinus tumour of the ovary during pregnancy: a case report". Arn. J. Obstet. Gynecol., 1991, 164, 504.

[17] Rajendran Hollingworth J., Scudamore I.:'·Endodermal sinus tumour of the ovary in pregnancy". Eur. J. Gynaecol. Oncol.. 1999, 20, 272.

[18] Arima N., Tanimoto A., Hayashi R., Hamada T., Sasaguri Y "Ovarian yolk sac tumor with virilization during pregnancy: immunohistochemical demonstration of Leydig cells as functioning stroma". Pathol. Int., 2000, 50, 520.

[19] Malhotra N., Sood M.: "Endodermal sinus tumor in pregnancy". Gynecol. Oneal., 2000, 78, 265.

[20] Cyganek A., Ejmocka-Ambroziak A., Wiczynska-Zajak A., Mananowski L.: "Ovarian endoderrnal sinus tumor associated with pregnancy - a case report". Ginekol. Pol., 2002, 73, 408.

[21] Shimizu Y., Komiyama S., Kobayashi T., Nakata K., Lida T.: "Suecessful management of endodermal sinus tumor of the ovary associated with pregnancy". Gynecol. Oneal., 2003, 88, 447.

[22] Han J.Y., Nava-Ocampo A.A., Kim T.J., Shim J.U., Park C.T : "Pregnancy outcome after prenatal exposure to bleomycin, etoposid and cisplatin for malignant ovarian germ cell tumors: report of two cases". Reprod. Toxicol., 2005, 19, 557.

[23] Aoki Y., Higashino M., Ishii S., Tanaka K.: "Yolk sac tumor of the ovary during pregnancy: a case report". Gynecol. Oncol., 2005. 99, 497.

[24] Bahador A., Lowe M.P., Cheng J., Roman L.D.: "Gynecologic cancer in pregnancy. In: D.M. Gershenson, W.P. McGuire. M. Gore, M.A. Quinn, G. Thomas (eds.). Gynecologic Cancer: Controversies in Management. Philadelphia, ChurchiII Livingstone, 2004, 921.

[25] Tewari K., Cappucini F., Disaia P.J.: "Malignant germ cell tumors of the ovary". Obstet. Gynecol., 2000, 95, 128.

[26] Pastorek J.G. II, Slocumb C.O.: "Malignant disease". In: James D.K., Steer P.J., Weiner C.P., Gonik B. (eds.). High Risk Pregnancy, 5'" edition, Philadelphia, W.B. Saunders Company Ltd 1996, 567.

(27] Chu C.S., Rubin S.C.: "Management of intestinal obstruction mthe terminal patient and management of ascites". In: D.M. Gershenson, W.P. McGuire, M. Gore, M.A. Quinn, G. Thomas (eds.) Gynecologic Cancer: Controversies in Management. Philadelphia, Churchill Livingstone, 2004, 727.

[28] Baykal C., Al A., Tulunay G., Ozer S. Kose M.F., Dolen I.: "Obstetric dilemma in an ovarian cancer patient". Acta Obstet. Gynecol. Scand., 2004, 83, 118.

[29] Berek J.S.: "Ovarian Cancer". In: Berek J.S. (eds.). Novak's Gynecology. 13th edition. Philadelphia, Lippincott Williams & Wilkins, 2002, 1245.

[30] Ayhan A., Taskiran C., Bozdag G., Altinbas S., Altinbas A., Yuce K.: "Endodermal sinus tumor of the ovary: the Hacettepe University experience". Eur. J. Obstet. Gynecol. Reprod. Biol., 2005, 123, 230.

[31] Sayar H., Lhomme C., Verschraegen C.F.: "Malignant adnexal masses in pregnancy". Obstet. Gynecol. Clin. North Am.. 2005, 32, 569.

[32] Talerman A., Haije G., Baggerman L.: "Serum alfafetoprotem (AFP) in diagnosis and management of endodermal sinus (yolk sac) tumor and mixed germ cell tumor of the ovary". Cancer, 1978, 41, 272.

[33] Zanagnolo V., Sartori E., Galleri G., Pasinetti B., Bianchi U. "Clinical review of 55 cases of malignant ovarian germ cell tumors". Eur. J. Gynaecol. Oncol., 2004, 25, 315.

[34] Tangir J., Zelterman D., Ma W., Schwartz P.E.: "Reproductive function after conservative surgery and chemotherapy for malignant germ cell tumors of the ovary". Obstet. Gynecol., 2003, 101, 251.