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CASE REPORT |
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| Year : 2018 | Volume
: 23
| Issue : 4 | Page : 232-233 |
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Yolk sac tumor of stomach: Case report and review of literature
Ankur Mandelia1, Nijagal Mutt1, Richa Lal1, Raghunandan Prasad2
1 Department of Paediatric Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
2 Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| Date of Web Publication | 4-Oct-2018 |
Correspondence Address:
Dr. Ankur Mandelia
Department of Pediatric Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow - 226 014, Uttar Pradesh
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jiaps.JIAPS_17_18
 Abstract | | |
Gastric yolk sac tumors (YSTs) are very rare. Only seven cases of pure YST of the stomach, with a median age of 65 years, and five cases of YST combined with adenocarcinoma have been reported. We report a 3-year-old boy who presented to us with recurrent episodes of melena and anemia of 2 months' duration. Upper gastrointestinal endoscopy revealed a deeply excavated ulcer on the lesser curvature, 4 cm from the gastroesophageal junction. Computed tomography (CT) abdomen revealed large heterogeneously enhancing soft-tissue mass lesion in the lesser sac with indistinct fat planes with the lesser curvature of the stomach with multiple peripherally enhancing lesions in both lobes of liver and omentum, suggestive of metastasis. Serum alpha-fetoprotein (AFP) was 21,000 ng/ml. Tru-cut biopsy from the mass was suggestive of YST. Following three courses of chemotherapy based on Cisplatin, Etoposide and Bleomycin (PEB), sleeve gastrectomy with excision of the mass with omentectomy with biopsy of the liver nodules with a sampling of perigastric lymph nodes was done. Histopathology revealed only necrotic tissue with no evidence of residual malignancy. Three-month follow-up CT revealed no residual mass with AFP of 3 ng/ml.
Keywords: Malignant germ cell tumor, stomach, yolk sac tumor
How to cite this article:
Mandelia A, Mutt N, Lal R, Prasad R. Yolk sac tumor of stomach: Case report and review of literature. J Indian Assoc Pediatr Surg 2018;23:232-3 |
How to cite this URL:
Mandelia A, Mutt N, Lal R, Prasad R. Yolk sac tumor of stomach: Case report and review of literature. J Indian Assoc Pediatr Surg [serial online] 2018 [cited 2020 Nov 30];23:232-3. Available from: https://www.jiaps.com/text.asp?2018/23/4/232/242709 |
| Introduction | |  |
Gastric yolk sac tumors (YSTs) are very rare. Only seven cases of pure YST of the stomach, with a median age of 65 years, and five cases of YST combined with adenocarcinoma have been reported.[1] To the best of our knowledge, this is the first case of primary pure YST of the stomach in the pediatric population.
| Case Report | | |
A 3-year-old boy presented to us with recurrent episodes of melena and anemia of 2-months duration. He also had progressive abdominal distension and low-grade fever. A hard mass was palpable in the epigastrium, measuring 7 cm × 8 cm with ill-defined margins. Upper gastrointestinal endoscopy revealed deep excavated ulcer with necrotic slough at base and surrounding thick hyperemic folds on the lesser curvature, 4 cm from gastroesophageal (GE) junction [Figure 1]a. | Figure 1: (a) Upper gastrointestinal endoscopy picture showing deep excavated ulcer with necrotic slough at base and surrounding thick hyperemic folds on the lesser curvature of stomach, (b) computed tomography scan of abdomen showing large heterogeneously enhancing soft-tissue attenuation mass lesion in the lesser sac with indistinct fat planes with the lesser curvature of stomach with multiple liver metastasis
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Computed tomography (CT) scan of abdomen revealed large heterogeneously enhancing soft-tissue attenuated mass lesion in the lesser sac with indistinct fat planes with the lesser curvature of stomach [Figure 1]b. Nodular heterogeneously enhancing lesions were seen in the omentum. Multiple small to moderate sized, oval and rounded, peripherally enhancing lesions were seen in both lobes of liver, suggestive of metastasis. Serum alpha-fetoprotein (AFP) was 21,000 ng/ml. Tru-cut biopsy from the mass was suggestive of YST [Figure 2]. | Figure 2: (a) Histopathology sections showing tumor disposed in broken papillae and cords along with loose connective tissue. The tumor cells show round hyperchromatic nuclei, inconspicuous nucleoli, and moderate amount of cytoplasm, (b) immunohistochemistry showing tumor cells with strong cytoplasmic positivity for alpha-fetoprotein and cytokeratin
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The patient was started on 3 weekly chemotherapy based on cisplatin, etoposide, and bleomycin (PEB). Following three courses of PEB, CT revealed a significant reduction in size of the mass and liver nodules. AFP was 10.1 ng/ml. Laparotomy revealed mass on the lesser curvature of the stomach of size 5 cm × 4 cm near the GE junction. There were multiple fibrotic omental nodules and nodules in both lobes of the liver. Sleeve gastrectomy with excision of the mass with omentectomy with biopsy of the liver nodules with a sampling of perigastric lymph nodes was done. The postoperative course was uneventful. Histopathology of the specimen and biopsies revealed only necrotic tissue with no evidence of residual malignancy. Three-month follow-up CT revealed no residual mass with AFP of 3 ng/ml.
| Discussion | | |
Gastric YSTs are very rare. Only seven cases of pure YST of the stomach, with a median age of 65 years, and five cases of YST combined with adenocarcinoma have been reported.[1] To the best of our knowledge, this is the first case of primary pure YST of stomach in the pediatric population. Ukiyama et al. described the recurrence of a YST following resection of a neonatal immature gastric teratoma.[2] All other cases of gastric YST have been described in the adult population.[1]
The origin of gastric YST is undetermined. Most authors have proposed that retrodifferentiation of adenocarcinoma may result in the development of the gastric YSTs because most of the gastric YSTs are accompanied by adenocarcinomatous components.[3],[4] The same pattern of p53 mutation in the adenocarcinomatous and yolk sac components by genotyping analysis also supports this hypothesis. Another hypothesis is that gastric YSTs may arise from migrating germ cells during embryonal development similar to other gonadal germ cell tumors.[5] Because no adenocarcinomatous components were observed in our case, the gastric YST of our patient may have been derived from migrating germ cells.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Magni E, Sonzogni A, Zampino MG. Primary pure gastric yolk sac tumor. Rare Tumors 2010;2:e10.  |
| 2. | Ukiyama E, Endo M, Yoshida F, Tezuka T, Kudo K, Sato S, et al. Recurrent yolk sac tumor following resection of a neonatal immature gastric teratoma. Pediatr Surg Int 2005;21:585-8. |
| 3. | Wang L, Tabbarah HJ, Gulati P, Rice S, French SW. Gastric adenocarcinoma with a yolk sac component: A case report and review of the literature. J Clin Gastroenterol 2000;31:85-8. |
| 4. | Puglisi F, Damante G, Pizzolitto S, Mariuzzi L, Guerra S, Pellizzari L, et al. Combined yolk sac tumor and adenocarcinoma in a gastric stump: Molecular evidence of clonality. Cancer 1999;85:1910-6. |
| 5. | Jindrak K, Bochetto JF, Alpert LI. Primary gastric choriocarcinoma: Case report with review of world literature. Hum Pathol 1976;7:595-604. |
[Figure 1], [Figure 2]
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