Investig Magn Reson Imaging.  2019 Dec;23(4):367-373. 10.13104/imri.2019.23.4.367.

Primary Pelvic Peritoneal Yolk Sac Tumor in the Post-Pubertal Female: a Case Report with Literature Review

• Kim M
• Lee EJ
• Hwang J
• Hong SS
• Chang YW
• Oh E
• Nam BD
• Choi I
• Kim JS

• KMID: 2468054
• DOI: http://doi.org/10.13104/imri.2019.23.4.367

Abstract

Yolk sac tumors are rare malignant germ cell neoplasms that usually arise from the gonads. Extragonadal yolk sac tumors (EGYSTs) frequently occur in the mediastinum in post-pubertal females. EGYSTs in the pelvis are extremely rare, and to date, only thirteen cases have been reported in the English literature. Among them, the primary EGYST of the pelvic peritoneum in post-pubertal females has only been reported in ten cases. The present case describes a 26-year-old female diagnosed with primary peritoneal yolk sac tumor located in the rectouterine pouch. We report clinical and tumor imaging features, including ultrasound, computed tomography (CT), magnetic resonance images (MRI), positron emission tomography-computed tomography (PET-CT), and present a review of the literature.

Keyword

Primary peritoneal yolk sac tumor; Germ cell tumor; CT; MRI; PET-CT; AFP

MeSH Terms

Adult
Douglas' Pouch
Electrons
Endodermal Sinus Tumor*
Female*
Gonads
Humans
Magnetic Resonance Imaging
Mediastinum
Neoplasms, Germ Cell and Embryonal
Pelvis
Peritoneum
Ultrasonography
Yolk Sac*

Figure

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  Fig. 1 On transvaginal ultrasound, a 9.5 × 6.1 cm-sized, well-defined, solid mass with heterogeneous echogenicity and a small central anechoic component (white arrow) was seen in the pelvic cavity.

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  Fig. 2 Axial contrast-enhanced computed tomography scan revealed a 9.3 × 7.0 cm-sized predominantly solid mass in the rectouterine pouch with heterogeneous enhancement. The mass closely abutted the posterior aspect of the uterus (white solid arrow) and right adnexa (dashed white arrow).

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  Fig. 3 Dynamic contrast-enhanced pelvic magnetic resonance images showing the mass located in the cul-de-sac that appeared predominantly solid with intermediate-to-high signal intensity on a sagittal T2-weighted image (a). Note that both normal ovaries are observed as separate from the mass on a coronal T2-weighted image (b, white arrows). There is a central focal area of high signal intensity on both T1- and T2-weighted images with diffusion restriction (white arrowheads in a, c, d), suggesting hemorrhage.

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  Fig. 4 Avid uptake of the pelvic mass was noted on the 18F-fluorodeoxyglucose positron emission tomography-computed tomography scan (maximum standardized uptake value, SUVmax: 6.2).

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  Fig. 5 (a) On the histological examination, the mass was predominantly composed of a loose network of anastomosing channels or micro cysts consisting of tumor cells with varying amounts of clear or eosinophilic cytoplasm. Many Schiller-Duval bodies (black arrows) were present (Hematoxylin and Eosin staining, × 100). (b) The tumor cells were positive for alpha-fetoprotein (AFP, × 100).

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