Endodermal sinus tumor of the ovary.A clinical and pathologic analysis of 71 cases

Abstract

The clinical and pathologic features of 71 endodermal sinus tumors of the ovary were studied in an effort to delineate the histogenesis and biologic behavior of this neoplasm and to evaluate the efficacy of different forms of treatment. Alpha-fetoprotein (AFP) was idenitified in hyaline droplets, cell cytoplasm, and intercellular spaces of all 15 tumors examined by an immunoperoxidase technique; this supports the view that the neoplasm simulates yolk sac endoderm. There were only nine survivors among 65 patients on whom follow-up information was available; the actuarial survival was 13% at 3 years. Of the neoplasms that recurred, 93% did so within 1 year, and of those patients who died, 93% did so within 2 years. The size a n d stage of the tumor had prognostic significance, but the patient's age, the mitotic activity, and histologic pattern did not. Although 71% of the patients had Stage I tumors at the time of diagnosis, subclinical metastasis was present in 84% of Stage I patients. Triple chemotherapy (vincristine, actinomycin D, and cyclophosphamide (VAC)) employed after unilateral salpingo-oophorectomy in four patients with Stage I tumors resulted in three long-term survivals (75%). In contrast, there were only five survivors among 27 patients (19%) with Stage I neoplasms treated by surgery alone,and no survivors among 12 Stage I patients treated with combined surgery and radiation. The finding of AFP i n all tumors in which this was evaluated suggests that serum radioimmunoassay might be useful to monitor response to therapy.Cancer 38:2404-2419 1976. NDOI)l.RSIAI. SINtIS TUMOR IS ALMOST AS C O M -E mon as dysgerminoma in girls and young women,14 but because of its relative rarity and comparatively late recognition as a specific entity, only a few small series1,9.11~16~21~37 and :;Poradie case reports3s4 describing its behavior have been published. T h e limited number of patients and the inclusion of mixtures of other types of germ cell neoplasms have precluded accumulation of extensive experience with pure endoderma1 sinus tumors. In view of their very poor prognosis when treated by surgery and radiation, a basis for comparison is necessary in the liyht of recent reports of long-term survival with surgery a n d triple ~h e r n o t h e r a p y .~~~~~~~ Evaluation of the relationship of alpha-fetoprotein is also necessary in light of the recent demonstra-

Application of tumor markers in ovarian malignancies

“…For example, Adenocarcinoma of ovary could be frequently positive for CA 125 and rarely positive for Carcinoembryonic Antigen (CEA). The endodermal sinus tumors of ovary invariably show positivity for AFP and Choriocarcinoma for hCG (7)(8)(9)(10).…”

Prognostic significance of histopathological subtypes in stage I pure yolk sac tumour of the ovary

“…All patients had primary surgery performed prior to chemotherapy or irradiation from 1963 to 1989. The 35 patients were all (Teilum, 1959(Teilum, , 1976), Kurman's (Kurman & Norris, 1976) and Ulbright's methods (Ulbright et al, 1986), which was composed of ES, PV, G and H subtypes. The ES subtype is consistent with Kurman's reticular subtype containing Schillar-Duval bodies (Figure 1) (Kurman & Norris, 1976).…”

“…Yolk sac tumours exhibit a wide range of histological subtypes that differ considerably from each other and, although all the different subtypes are frequently observed in the same tumour, one or two may predominate (Teilum, 1965(Teilum, , 1968(Teilum, , 1976Duval, 1891;Jimerson & Woodruff, 1977). The majority of ovarian yolk sac tumours show a distinctive subtype with differentiation towards yolk sac or vitelline structures (Teilum, 1959;Kurman & Norris, 1976;Huntingdon & Bullock, 1970), and should be termed yolk sac tumour. During embryogenesis, the primary yolk sac differentiates during the second week of gestation, the secondary yolk sac in the third week and the primitive gut and liver tissues in the fourth to fifth weeks of gestation.…”

“…Therefore, yolk sac tumours with glandular or hepatoid subtypes reflect more advanced stages of differentiation than those with pure endodermal sinus subtypes. Kurman and Norris (1976) dividied the components of endodermal sinus tumour into five main histological subtypes, but they were unable to determine any correlation of these with prognosis. YST of the ovary is a highly malignant neoplasm, metastasising early and invading the surrounding structures and organs.…”

“…The tumour is very aggressive locally, and spread beyond the ovary is observed in a number of patients at the time of operation. Recurrences in the pelvis are very frequent, even when the tumour and the affected adnexa have been excised completely (Huntington et al, 1963;Kurman & Norris, 1976;Huntington, 1970;Neubeccker & Breen, 1962;Talerman et al, 1978). In recent years there has been marked improvement in prognosis with adjuvant multiagent combination chemotherapy.…”