Ovarian Endometrioid Tumors with Yolk Sac Tumor Component, an Unusual Form of Ovarian Neoplasm

Abstract

The clinical, morphological, and immunohistochemical findings in six cases of ovarian endometrioid tumors (five endometrioid carcinomas and one carcinosarcoma) with a yolk sac tumor (YST) component are described. The age of the patients ranged from 31 to 73 years (average, 53), and only two patients were premenopausal. Two cases were stage Ia tumors, three stage III, and one stage IV. A substantial postoperative elevation of alpha-fetoprotein (AFP) was seen in two patients and a mild increase in another two. All six patients had surgery and postoperative cisplatin-based chemotherapy regimens, four of whom died of tumor 3 to 14 months after surgery without response to treatment. Only a stage Ia patient is alive and well 1 year after surgery. The tumors were large (average, 17 cm). Benign endometrioid lesions were found in the homolateral ovary in two cases and in the contralateral ovary in another two. All cases had endometrioid ovarian carcinomas (EOC) of various types admixed with typical YST components. Immunohistochemically, EOC areas differed from YST in their positivity for OC 125, CA 19.9, and nuclear estrogen and progesterone receptors and in their negativity for AFP, which was conspicuously positive in the YST areas. The clinicopathological profile of ovarian endometrioid tumors with YST also differs from that of YST in that it occurs in the same age range as EOC, it shows coexistence of benign endometrioid lesions, and it has a poor response to chemotherapy. The histological pattern in transitional areas may be difficult to differentiate from "endometrioid-like" (enteroblastic) YST and clear cell tumors. Ovarian endometrioid tumors with YST component should be considered a variant of endometrial carcinoma. Its recognition is necessary in view of its unusually aggressive behavior and poor prognosis.

Germ cell tumors of the gonads: a selective review emphasizing problems in differential diagnosis, newly appreciated, and controversial issues

“…6 The frequently elevated serum AFP level in patients with glandular yolk sac tumors 116 contrasts with the normal level in cases of endometrioid adenocarcinomas. This differential is complicated by the fact that rarely yolk sac tumor arises on the background of a somatic ovarian neoplasm, which is most commonly endometrioid adenocarcinoma, 118 but these tumors occur in an older age group than yolk sac tumors and have a number of helpful pathological distinguishing features, most important of which is the associated conventional carcinoma. The differential of a purely glandular testicular yolk sac tumor is limited, mainly being with a rare adenocarcinoma that has developed from pre-existing teratoma.…”

Urothelial carcinoma of the renal pelvis with simultaneous trophoblastic and malignant clear cell endodermal-type differentiation

“…Both antibodies are always co-expressed in yolk sac tumours [7]. The primitive malignant endodermal or YST-type differentiation may be present in somatic, non-embryonal tumours of the female genital tract [8,9], although it can also develop in the sinonasal area, stomach, colon, etc., where it is also associated with both high-grade tumours and a poor prognosis [7]. In the urinary tract, this association has been reported in rare, isolated cases of AFP-producing adeno-or transitional cell carcinomas and demonstrated by AFP stains only.…”

Alpha-fetoprotein (AFP)-producing ovarian tumor in an elderly woman

“…Between these two distinct areas, there seemed to be a transition with clear histochemical differences; however, there were areas that were extremely diffi cult to differentiate from an epithelial ovarian carcinoma, as they had a hybrid morphology between endometrioid-type glands and the glands or papillae that characterize glandular YST. [8][9][10] Clear cell carcinomas may resemble hepatoid carcinomas, especially when they are composed of large polyhedral cells with eosinophilic cytoplasm. However, other characteristic patterns of clear cell carcinoma are mostly present in such cases, and clear cell carcinomas rarely stain for AFP.…”