Mediastinal Yolk Sac Tumor Infiltrating the Heart

Abstract

Background: As a rare tumor, yolk sac tumor is a type of neoplasm that appears like the yolk sac, extraembryonic mesenchyme, and allantois. The mediastinum is the second most frequent area after the gonadal area. Case report: We present an extremely rare case of 15 years old boy with mediastinal yolk sac tumor. The boy came with the chief complaint of swelling of the neck and face. Computed tomography scan of the chest revealed bulky mass with a cystic component that infiltrated the heart. The diagnosis of mediastinal yolk sac tumor was made after core needle biopsy. Histopathologic analysis revealed tumor mass with solid and microcystic structure and pleomorphic nucleus within the tumor cells. Laboratory finding showed elevated serum alpha-fetoprotein level reaching more than 8000 ng/ml. Echocardiography revealed a mass in the right atrium. The patient condition was rapidly deteriorated due to his vena cava superior syndrome. Unfortunately, the patient died two days after diagnosis and we did not have the chance to do the therapy. Conclusion: Mediastinal yolk sac tumor is a rare malignancy that requires comprehensive management. The diagnosis should be made based on histopathological findings with the addition of thoracic computer tomography scan to assess the degree of infiltration to surrounding organ. A life-threatening condition such as vena cava superior syndrome should be assessed promptly to allow for immediate treatment.

Primary mediastinal yolk sac tumor: A case report and literature review

“…12,18,24 In this literature review, only one patient (1.9%) received radiation therapy alone. 12 It is difficult to assess the efficacy of radiotherapy. But the prognosis of this patients was discouraging.…”

“…He is 15‐year‐old male patient of PMYST with superior vena cava syndrome. No evidence of tumor atrophy was found, and the patient died soon after radiotherapy, lost the chance for further chemotherapy or surgery 12 . Bilgehan et al reported that combined treatment of radiotherapy together with surgery and chemotherapy provided more than 284 months survival for a 2‐year‐old female patient 24 .…”

“…In PubMed, the English case reports and case series of PMYST during the past decade were searched. The following key words were used for the database search: “yolk sac tumor,” “mediastinum,” “mediastinal.” A total of 73 articles were retrieved, in which 22 articles on the therapy and prognosis of PMYST were extracted, including 16 case reports and 6 case series, involving 52 patients in total 5–26 . Out of all the patients, only six female cases were reported.…”

Multimodal imaging changed clinical decision‐making: A rare mediastinal yolk sac tumor infiltrating the heart and follow‐up

“…The mediastinum is the second most frequent area after the gonadal area. 1,2 Primary mediastinal yolk sac tumor is rare and carries a grave prognosis. Most patients are young and male.…”

“…The tumor is usually located in the gonadal site, and may occur along the midline route of the reproductive crest as the germ cells migrate from the yolk sac. The mediastinum is the second most frequent area after the gonadal area 1,2 . Primary mediastinal yolk sac tumor is rare and carries a grave prognosis.…”