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OVARIAN YOLK SAC TUMOR: CASE REPORT
Apresentação do caso
A 59 years old female, started with severe abdominal pain in the right lower quadrant and appetite loss; physical examination showed a mass in the pelvis. She denied fever, vomiting, diarrhea, weight loss, comorbidities, family history of cancer, alcoholism and smoking. The blood test indicated a slightly increase on hematocrit (48.1%) and leukocytosis (13,910 / mm3). The abdominal computed tomography (CT) detected an expansive heterogeneous mass in the right median/paramedian pelvis, measuring 10.9x8.1cm, conditioning extrinsic pressure of the right middle/distal ureter and dilatation of the upstream collecting system, increased renal dimensions and densification of perirenal and periureteral fat. The chest CT scan exhibited pulmonary nodules measuring respectively seven and five millimeters, in the middle and right lower lobes. Hence, the patient was taken to surgical approach and the medical team performed total hysterectomy, appendectomy, pelvic and retroperitoneal lymphadenectomy and omentectomy. The immunohistochemistry revealed Yolk Sac Tumor (YST) on the right ovary. The histopathological report of the other resections did not express relevant characteristics. The medical team requested adjuvant chemotherapy, but the patient did not have adherence to treatment due social reasons.
YST is a rare, malignant germinative cell neoplasm with poor prognosis. It usually secretes alpha-fetoprotein (AFP), which levels can help with diagnosis and follow-up. It can be pure or mixed with other germinative cells, or even epithelial cells. The most common mixed component is endometrioid adenocarcinoma, which increases the difficulty in differential diagnosis and management; adequate sampling is important for a comprehensive and accurate diagnosis, due the existence of the inherent heterogeneity of this tumor. Prognostic factors include: stage, ascites, decline in AFP serum levels, residual tumor, and chemotherapy. It is the second most common histological type of germinative ovarian tumors, prevalent in adolescents and young women, and rarely seen in postmenopausal women, as in this case.
Due to the particularity of the patient’s age, little is known about treatment and prognosis, and more case reports can be necessary to the knowledge of this pathology in postmenopausal women.
Yolk Sac Tumor, Ovarian Tumor, Gynecologic Oncology
LAVÍNIA BARCELLOS ARAÚJO, ÉRICA MEDEIROS GOMES, BRUNO AQUINO MARCELINO, CAIQUE RODRIGUES DOS SANTOS, JACYARA RIBEIRO VARGAS, DANIEL DE CHRISTO ESTEVES, PÂMELA AMARAL, THAIS BARBOSA ALVES, MARCELLA CABIDO RUFFO