TITLE:
Yolk Sac Tumor of the Ovary in 18 Egyptian Cases: Does It Really Differ?
AUTHORS:
Ahmed Elsayed Fathalla, Hala Aziz Shokralla
KEYWORDS:
Yolk Sac Tumor, Ovary, Outcomes
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.7 No.4,
April
7,
2016
ABSTRACT: Background: Ovarian Yolk sac tumor (OYST) is a rare
entity of malignant ovarian germ cell tumors (MOGCT). Abdominal pain, a rapidly
growing distending mass or irregular vaginal bleeding is the main presentation.
Serum AFP is elevated in nearly all cases. The standard management is fertility
preserving surgery with adjuvant chemotherapy. Aim of Work: To report and
analyze retrospectively recorded cases that were either treated at National
Cancer Institute/Egypt or referred there for advice about therapy. Materials
and Methods: This is a retrospective single-institutional analysis of 18 cases
of OYST treated at National Cancer Institute-Cairo University from January 2011
till December 2015. The clinical and pathological characteristics, treatment,
and outcomes of these patients were analyzed. Results: Data from eighteen
patients were obtained. The median age was 18 years (range: 15 - 22). Abdominal
pain was the most common presentation (89%). The mean tumor size was 21cm
(range: 8 - 30 cm). Eleven of our cases (61%) were stage I, seven cases and
(39%) were stage IV at presentation. Fifteen cases (83%) underwent fertility
preserving procedure & the standard surgical staging. Panhysterectomy &
formal staging procedure was done only in two cases (11%). One case (6%)
underwent bilateral salpingo-oophorectomy. 2 cases (11.1%) only underwent lymph
node biopsy. 11 patient (61.1%) showed pure type YST while mixed type was
present in the remaining 7 cases (38.8%): Dysgerminoma (one case, 5.6%),
Dysgerminoma + immature teratoma (one case, 5.6%), Immature teratoma (2 cases,
11.1%) and Teratoma (3 cases, 16.7%). AFP was extremely elevated in all cases
at presentation (median 4191 ng/mL; ranging: 725 ng/mL - 402,908 ng/mL). It
showed decreased level after surgery (median 145 ng/ mL; ranging: 2 ng/mL - 38,000
ng/mL) & normalized after chemotherapy except for progressive disease. All
cases started BEP regimen after surgery with complete remission in twelve
cases. In follow up period (median 17 months; ranging: 2 - 48 months) two
patients relapsed; the mean overall survival time was 34.2 and progression free
survival was 33.84 months respectively. Conclusion: Ovarian yolk sac tumors are
rare neoplasms. Surgery with adjuvant chemotherapy is the standard management.
AFP is important for diagnosis, monitoring response to treatment and predicting
relapse.