New perspectives on therapy for vaginal endodermal sinus tumors

Abstract

Endodermal sinus tumor of the vagina is rare. All of our patients presented with painless bleeding of no obvious source. In such cases one must maintain a high index of suspicion for possible underlying pathological conditions even if ultrasound is negative. Evaluation must include endoscopic examination of the lower genitourinary tract. Bone marrow transplant should be considered as a last therapeutic resort in salvage cases of unresponsive vaginal endodermal sinus tumor.

SUCCESSFUL TREATMENT OF AN ENDODERMAL SINUS TUMOR OF THE VAGINA BY CHEMOTHERAPY ALONE: A Rare Case of an Infant Diagnosed by Pathological Examination of Discharged Tumor Fragment

“…A hobnail pattern, Schiller-Duval bodies, and the immuohistochemical demonstration of AFP have been recognized as histological features of EST [14]. Usually, in cases of EST of the vagina, it is necessary to perform vaginoscopy and vaginal biopsy under general anesthesia to make a diagnosis.…”

“…This can be attributed to the advent of effective chemotherapeutic agents. Previous reports described that EST of the vagina, like gonadal EST [16][17][18], responded to combination chemotherapy, VAC (VCR, actinomycin-D, and CPA) [5,7], and cisplatin-containing combination chemotherapy that included BVP (cisplatin, bleomycin, and vinblastine sulfate) or PEB (cisplatin, VP-16, and bleomycin) [6,14]. Additionally, the success of chemotherapy has allowed a more conservative surgical approach to these tumors [9].…”

Endodermal Sinus Tumor of the Infant Vagina Treated Exclusively With Chemotherapy

“…2 Only 8% of EST in females occur in the vagina. 3 Historically, the typical treatment protocol has consisted of operative excision with adjuvant radiation therapy and/or chemotherapy. More recently, cases have been reported that involve the use of chemotherapy alone, leaving surgical intervention as a last resort in an attempt to maintain fertility and sexual function for the future.…”

“…More recently, cases have been reported that involve the use of chemotherapy alone, leaving surgical intervention as a last resort in an attempt to maintain fertility and sexual function for the future. [3][4][5][6] We present a case of vaginal EST in an infant where chemotherapy as a single modality of treatment has resulted in normalization of the serum alpha-fetoprotein (AFP) level, no pathologic evidence of malignancy confirmed by repeat vaginal biopsies, and potential preservation of sexual and reproductive function. To the best of our knowledge, of the known 69 cases of EST of the vagina reported in the literature, only 3 cases are reported to have used cisplatin, etoposide, and bleomycin (PEB) chemotherapy alone (Table 1).…”

“…However, varying combinations of cisplatin, vinblastine, etoposide, ifosfamide, and bleomycin (MAKEI) were used in these cases. 8,9 Handel et al, 3 was the first to use solely a combination of cisplatin, etoposide, and bleomycin (PEB) in 2 cases in 2002. We believe that PEB chemotherapy alone, for the treatment of vaginal EST in the infant, should be considered.…”