Ovarian yolk sac tumor (YST) in a postmenopausal patient: case report and review of the literature

Purpose: Report of one case of ovarian yolk sac tumor (YST) in a postmenopausal patient and review of the literature. Materials and Methods: The case the authors present is of a 77-year-old woman with ovarian YST along with a serous carcinoma and an endometriotic cyst component. They also review and summarize the findings of already reported cases. Results: Sixty cases of ovarian YSTs in postmenopausal patients have been described from 1976 to 2017, including the 23 found in the literature (PubMed and Elsevier) and the one reported in this article. The introduction of bleomycin/ etoposide/ cisplatin (BEP) chemotherapy for malignant germ cell tumors has improved outcomes in premenopausal women, but it does not have a similar impact on postmenopausal patients. Conclusions: The outcome for postmenopausal patients remains poor, even for those presenting with early stage disease or with pure YST. Further research is required to determine the pathogenesis and plan an effective therapy for this age group.

BEP; Malignant; Ovarian; Postmenopausal; Yolk sac tumor

[1] Prat J., Cao D., Garinelliu S.G., Nogales F.F., Vang R., Zaloudek C.J.: “Germ cell tumors”. In: Kurman R.J., Carangiou M..L, Herrington C.S., Young R.H. (eds). WHO classification of tumors of female reproductive organs. 4th ed. Lyon: IARC, 2014, 57.

[2] Rosai J.: “Ovary. Germ cell tumors”. In: Rosai and Ackerman’s surgical pathology. 10th ed. Endiburgh: Mosby Elsevier, 2011.

[3] McCarthy W.A., Masand R.P.: “Ovarian Yolk Sac Tumor With HighGrade Serous Carcinoma in a 62-Year-Old Woman.” Int. J. Surg. Pathol., 2016, 24, 360.

[4] Boussios S., Attygalle A., Hazel S., Moschetta M., McLachlan J., Okines A., Banerjee S.: “Malignant Ovarian Germ Cell Tumors in Postmenopausal Patients: The Royal Marsden Experience and Literature Review”. Anticancer Res., 2015, 35, 6713.

[5] Lange S., Livasy C., Tait D.L.: “Endodermal sinus tumor of the ovary in an 86 year old woman”. Gynecol. Oncol. Case Rep., 2012, 2, 65.

[6] Parker V.L., Sanderson P., Naik V., Quincey C., .Farag K.: “Postmenopausal presentation of yolk sac germ cell tumor”. Gynecol. Oncol. Case Rep., 2014, 11, 16.

[7] Koi C., Kurita T., Kagami S., Matsuyaya A., Hachisuga T.: “A case of ovarian yolk sac tumor associated with endometrioid adenocarcinoma”. Gynecol. Oncol. Case Rep., 2014, 9, 11.

[8] Roth L.M., Talerman A., Levy T., Sukmanov O., Czernobilsky B.: “Ovarian yolk sac tumors in older women arising from epithelial ovarian tumors or with no detectable epithelial component”. Int. J. Gynecol. Pathol., 2011, 30, 442.

[9] Bailey J., Church D.: “Management of germ cell tumors of the ovary. Rev. Gynaecol. Pract., 2005, 5, 201.

[10] Roma A.A., Przybycin C.G.: “Yolk sac tumor in postmenopausal patients: pure or associated with adenocarcinoma, a rare phenomenon”. Int. J. Gynecol. Pathol., 2014, 33, 477.

[11] Varia M., McCluggage W.G., Oommen R.: “High grade serous carcinoma of the ovary with a yolk sac tumor component in a postmenopausal woman: report of an extremely rare phenomenon”. J. Clin. Pathol., 2012, 65, 853.

[12] Damato S., Halda K, McCluggage W.G.: “Primary Endometrial Yolk Sac Tumor With Endodermal-Intestinal Differentiation Masquerading as Metastatic Colorectal Adenocarcinoma”. Int. J. Gynecol. Pathol., 2016, 35, 316.

[13] Brown J.R., Green J.D.: “Yolk sac carcinoma”. South Med. J., 1976, 69, 728.

[14] Ferracini R., Gardini G., Lanzanova G., Lorenzini P.: “Endodermal sinus tumor in a 63 year old female”. Pathologica, 1979, 71, 885.

[15] Cisło M., Wawrzkiewicz M., Rzucidlo Z., Kornafel J., Marczewski A., Blok K.: “Endodermal sinus tumor–a contribution to the clinical aspects of ovarian tumors”. Zentralbl Allg. Pathol., 1984, 129, 17.

[16] Rutgers J.L., Young R.H., Scully R.E.: “Ovarian yolk sac tumor arising from an endometrioid carcinoma”. Hum. Pathol., 1987, 18, 1296.

[17] Mazur M.T., Talbot W.H. Jr., Talerman A.: “Endodermal sinus tumor and mucinous cystadenofibroma of the ovary. Occurrence in an 82-year-old woman”. Cancer, 1988, 62, 2011.

[18] Kinoshita K.: “A 62-year-old woman with endodermal sinus tumor of the ovary”. Am. J. Obstet. Gynecol., 1990, 162, 760.

[19] Pliskow S.: “Endodermal sinus tumor of the ovary: review of 10 cases”. South Med J., 1993, 86, 187.

[20] Kammerer-Doak D., Baurick K., Black W., Barbo D.M., Smith H.O.: “Endodermal sinus tumor and embryonal carcinoma of the ovary in a 53-year-old woman”. Gynecol. Oncol., 1996, 63, 133.

[21] Takizawa K., Kawana T., Kakinoki S., Saito R., Takeda Y.: “Case report of a 69-year-old woman with double cancers: Primary yolk sac tumor of the right ovary and primary serous surface papillary carcinoma of the peritoneum”. Int. J. Clin. Oncol., 1996, 1, 190.

[22] Nogales F.F., Bergeron C., Carvia R.E., Alvaro T., Fulwood H.R.: “Ovarian endometrioid tumors with yolk sac tumor component, an unusual form of ovarian neoplasm. Analysis of six cases”. Am. J. Surg. Pathol., 1996, 20, 1056.

[23] Horiuchi A., Osada R., Nakayama K., Toki T., Nikaido T., Fujii S.: “Ovarian yolk sac tumor with endometrioid carcinoma arising from endometriosis in a postmenopausal woman, with special reference to expression of alpha fetoprotein, sex steroid receptors, and p53”. Gynecol. Oncol., 1998, 70, 295.

[24] Arai T., Kitayama Y., Koda K.: “Ovarian mucinous cystadenocarcinoma with yolk sac tumor in a 71-year-old woman”. Int. J. Gynecol. Pathol., 1999, 18, 277.

[25] Oh C., Kendler A., Hernandez E.: “Ovarian endodermal sinus tumor in a postmenopausal woman”. Gynecol. Oncol., 2001, 82, 392.

[26] Kamoi S, Ohaki Y, Mori O, Okada S, Seto M, Matsushita N., et al.: “A case of ovarian endometrioid adenocarcinoma with yolk sac tumor component in a postmenopausal woman”. APMIS, 2002, 110, 508.

[27] Lopez J.M., Malpica A., Deavers M.T., Ayala A.G.: “Ovarian yolk sac tumor associated with endometrioid carcinoma and mucinous cystadenoma of the ovary”. Ann. Diagn. Pathol., 2003, 7, 300

[28] Filiz G., Ozuysal S., Bilgin T.: “Ovarian endodermal sinus tumor in a 76-year-old woman”. J. Obstet. Gynaecol. Res., 2003; 29, 309.

[29] Abe A., Furumoto H., Yoshida K., Nishimura M., Irahara M., Kudo E., Sano T.: “A case of ovarian endometrioid adenocarcinoma with a yolk sac tumor component”. Int. J. Gynecol. Cancer, 2008, 18, 168.

[30] Garcia-Galvis O.F., Cabrera-Ozoria C., Fernandez J.A., Stolnicu S., Nogales F.F.: “Malignant Mullerian mixed tumor of the ovary associated with yolk sac tumor, neuroepithelial and trophoblastic differentiation (teratoid carcinosarcoma)”. Int. J. Gynecol. Pathol., 2008, 27, 515

[31] Zaloudek C.: “Yolk Sac Tumor of the Ovary and Extragonadal Sites in Females: Lessons Learned From an Unusual Case”. In: Soslow RA and Tornos C. (eds). “Diagnostic Pathology of Ovarian Tumors. New York: Springer Science + Business Media, LLC., 2011, 155.

[32] Giuliani J, Marzola M., Pizzutilo P.., Martinello R., Marzola A., Indelli M., Frassoldati A.: “Ovarian endometrioid adenocarcinoma with a yolk sac tumor component in a postmenopausal woman: case report and review of the literature”. Clin. Ovarian Gynecol. Cancer, 2012, 5, 31.

[33] Meguro S., Yasuda M.: “α-Fetoprotein-producing ovarian tumor in a postmenopausal woman with germ cell differentiation”. Ann. Diagn. Pathol., 2013, 17, 140.

[34] Sukumaran R., Somanathan T., Mathews A., Kattoor J.: “Primary extragonadal pure yolk sac tumor in a postmenopausal female”. South Asian J. Cancer, 2013, 2, 178.

[35] Ashihara T., Nakanishi K., Hashii K., Hashii K., Fujimoto M., Yasuhara Y., et al.: “Ovarian yolk sac tumor in a postmenopausal woman: case report and review of the literature”. International Cancer Conference Journal. 2012, 1, 96.

[36] Chen Q., Chen X.: “Bilateral ovarian mixed epithelial adenocarcinoma in a postmenopausal woman with unilateral ovarian yolk sac tumor component”. Int. J. Clin. Exp. Pathol., 2014, 7, 8259.

[37] Yu XJ, Zhang L, Liu ZP, Shi YQ, Liu YX. Ovarian malignant mixed germ cell tumor with clear cell carcinoma in a postmenopausal woman. Int. J. Clin. Exp. Pathol., 2014, 7, 8996.

[38] Wang X., He J., and Li Y.: “Ovarian yolk sac tumor in postmenopausal females: a report of five cases and a literature review”. Eur. J. Gynaecol. Oncol., 2016, 37, 374.

[39] McNamee T., Damato S., McCluggage W.G.: “Yolk sac tumors of the female genital tract in older adults derive commonly from somatic epithelial neoplasms: somatically derived yolk sac tumors”. Histopathology, 2016, 69, 739.

[40] Nogales F.F., Preda O., Nicolae A.: “Yolk sac tumors revisited. A review of their many faces and names”. Histopathology, 2012, 60, 1023.

[41] Shojaei H., Hong H., Redline R.W.: “High-level expression of divergent endodermal lineage markers in gonadal and extra-gonadal yolk sac tumors”. Mod. Pathol., 2016, 29, 1278.

[42] Nogales F.F., Quinonez E., Lopez-Marin L., Dulcey I., Preda O.: “A diagnostic immunohistochemical panel for yolk sac (primitive endodermal) tumors based on an immunohistochemical comparison with the human yolk sac”. Histopathology, 2014, 65, 51.

[43] Nogales F.F., Dulcey I., Preda O.: “Germ cell tumors of the ovary: an update”. Arch. Pathol. Lab. Med., 2014, 138, 351.

[44] Esheba G.E., Pate L.L., Longacre T.A.: “Oncofetal protein glypican3 distinguishes yolk sac tumor from clear cell carcinoma of the ovary”. Am. J. Surg. Pathol., 2008, 32, 600.

[45] Cicin I., Saip P., Guney N., Eralp Y., Ayan I., Kebudi R., Topuz E.: “Yolk sac tumors of the ovary: evaluation of clinicopathological features and prognostic factors”. Eur. J. Obstet. Gynecol. Reprod. Biol., 2009, 146, 210.

[46] Cao D., Guo S., Allan R.W., Molberg K.H., Peng Y.: “SALL4 is a novel sensitive and specific marker of ovarian primitive germ cell tumors and is particularly useful in distinguishing yolk sac tumor from clear cell carcinoma”. Am. J. Surg. Pathol., 2009, 33, 894.

[47]Kaspar H.G., Crum C.P.: “The utility of immunohistochemistry in the differential diagnosis of gynecologic disorders”. Arch. Pathol. Lab. Med., 2015, 139, 39.

[48] Ramalingam P., Malpica A., Silva E.G., Gershenson D.M., Liu J.L., Deavers M.T.: “The use of cytokeratin 7 and EMA in differentiating ovarian yolk sac tumors from endometrioid and clear cell carcinomas”. Am. J. Surg. Pathol., 2004, 28, 1499.

[49] Köbel M., Bak J., Bertelsen B.I,. Carpen O., Grove A., Hansen E.S., et al.: “Ovarian carcinoma histotype determination is highly reproducible, and is improved through the use of immunohistochemistry”. Histopathology, 2014, 64, 1004.

[50] Kurman R.J., Shih I.M.: “The origin and pathogenesis of epithelial ovarian cancer: a proposed unifying theory”. Am. J. Surg. Pathol., 2010, 34, 433.

[51] Solheim O., Gershenson D.M., Tropé C.G., Rokkones E., Sun C.C., Weedon-Fekjaer H., Fosså S.D.: “Prognostic factors in malignant ovarian germ cell tumors (The Surveillance, Epidemiology and End Results experience 1978–2010)”. Eur. J. Cancer, 2014, 50, 1942

[52] Nawa A., Obata N., Kikkawa F., Kawai M., Nagasaka T., Goto S., et al.: “Prognostic factors of patients with yolk sac tumors of the ovary. Am. J. Obstet. Gynecol., 2001, 184, 1182.