Journal of Pathology and Translational Medicine

Case Study

A sinonasal yolk sac tumor in an adult: Jaehoon Shin, Ji Heui Kim, Kyeong Cheon Jung, Kyung-Ja Cho; J Pathol Transl Med. 2022;56(3):152-156. Published online January 26, 2022; DOI: https://doi.org/10.4132/jptm.2021.12.09

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Yolk sac tumors (YSTs), which are also called endodermal sinus tumors, are malignant tumors of germ cell origin. These tumors usually occur in the gonads, but 20% of cases have been reported at extragonadal sites. The head and neck is a rarely affected region that accounts for just 1% of all malignant tumors of germ cell origin. In addition, YSTs arise mostly in childhood. We present a rare pathologically pure case of primary adult YST in the sinonasal area. A 45-year-old male patient presented with a rapidly growing mass in the nasal cavity, which caused nasal obstruction and bloody post-nasal drip. The histopathologic features indicated pure YST, and immunohistochemical analysis revealed positive reactivity for Sal-like protein 4 and alpha-fetoprotein. Herein, we discuss the clinical, radiologic, and histologic features of this YST and review other cases of sinonasal YST in adults.

Citations

Citations to this article as recorded by

SMARCB1-deficient Sinonasal Carcinoma
Neha Mittal, Saurabh Nagar, Asawari Patil, Swapnil Ulhas Rane, Palgun Nisarga, Katha Rabade, Amit Janu, Deepa Nair, Shiva Thiagarajan, Sarbani Ghosh Laskar, Kumar Prabhash, Munita Bal
American Journal of Surgical Pathology.2025; 49(4): 381. CrossRef
International Consensus Statement on Allergy and Rhinology: Sinonasal Tumors
Edward C. Kuan, Eric W. Wang, Nithin D. Adappa, Daniel M. Beswick, Nyall R. London, Shirley Y. Su, Marilene B. Wang, Waleed M. Abuzeid, Borislav Alexiev, Jeremiah A. Alt, Paolo Antognoni, Michelle Alonso‐Basanta, Pete S. Batra, Mihir Bhayani, Diana Bell,
International Forum of Allergy & Rhinology.2024; 14(2): 149. CrossRef
Yolk sac tumor of postpubertal-type does not exhibit immunohistochemical loss of SMARCB1/INI1 and SMARCA4/BRG1…but choriocarcinoma?
Costantino Ricci, Francesca Ambrosi, Tania Franceschini, Francesca Giunchi, Eugenia Franchini, Francesco Massari, Veronica Mollica, Federico Mineo Bianchi, Maurizio Colecchia, Andres Martin Acosta, Michelangelo Fiorentino
Pathology - Research and Practice.2023; 241: 154269. CrossRef
Pure yolk sac tumor primarily in the nasal cavity: A case report
Zijun Liu, Baohong Wen, Yan Zhang
Asian Journal of Surgery.2023; 46(10): 4712. CrossRef
A case of Yolk sac tumor arising from paranasal sinus
Kaori Shinomura, Munehito Moriyama, Keigo Fujita, Takashi Hirano, Masashi Suzuki
JOURNAL OF JAPAN SOCIETY FOR HEAD AND NECK SURGERY.2023; 33(1): 41. CrossRef
A Novel Successful Case of Nasal and Sinus Yolk Sac Tumor With SMARCB1 (INI-1) Deficiency: A Case Report
Tianyu He, Zhiyu Wang, Hongbo Su, Sihan Li, Zheng He
Cureus.2022;[Epub] CrossRef

Case Reports

Ovarian Endometrioid Adenocarcinoma with a Yolk Sac Tumor Component.: Dong Hae Chung, Sanghui Park, Hee Eun Kyung, Na Rae Kim, Seung Yeon Ha, Soyi Lim, Hyun Yee Cho; Korean J Pathol. 2009;43(6):570-574.; DOI: https://doi.org/10.4132/KoreanJPathol.2009.43.6.570

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Abstract PDF: Ovarian endometrioid adenocarcinoma (EAC) with a yolk sac tumor (YST) component is extremely rare. Only twelve cases have been reported in the English literature. We report here two additional cases of this rare tumor. The YST component showed classic microscopic features, and immunohistochemically stained positive for alpha-fetoprotein (AFP), but negative for cytokeratin 7 (CK7), epithelial membrane antigen (EMA), estrogen receptor (ER) and progesterone receptor (PR). The EAC appeared to blend into the YST in several areas and immunohistochemically stained positive for CK7, EMA, ER, and PR, but negative for AFP.

Suprasellar Endodermal Sinus Tumor Presenting with Tonic-Clonic Seizure: An Autopsy Case Report.: Min Jin Lee, Hea Soo Koo, Woon Sup Han, Sun Hee Sung, Yong Jae Kim, Hye Young Choi; Korean J Pathol. 2002;36(6):433-439.

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Abstract PDF: We report the clinical course and autopsy findings of a 19-year-old girl with endodermal sinus tumor involving the thalamus, hypothalamus, and basal ganglia. The patient initially had tonic-clonic seizures with abnormal signal involving the right hippocampus, amygdala, basal ganglia, putamen, and dentate gyrus. The signal intensity of the posterior pituitary on T1-weighted images was decreased at the time of admission, which was not associated with clinical symptoms of diabetes insipidus (DI). A huge tumor mass as well as central DI developed within 10 months. The postmortem examination showed gliosis with calcification involving the right basal ganglia, internal capsule, and white matter, in addition to a tumor mass involving the thalamus, hypothalamus, and basal ganglia. Dissemination of tumor cells in the leptomeninges and the gliotic area and hydrocephalus were also noted.

Fine Needle Aspiration Cytology of Endodermal Sinus Tumor of the Ovary: A Case Report.: Jin Man Kim, Dae Young Kang; Korean J Cytopathol. 1995;6(1):54-57.

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Abstract PDF: We report a case of fine needle aspiration cytology of endodermal sinus tumor of the ovary. A 13-year-old girl complained of abdominal mass and pain. The abdominal sonography revealed a well-demarcated huge mass, which was solid and multiseptated. Percutaneous fine needle aspiration was performed from the mass. The smears revealed moderate cellularity, which was arranged in sheets or clumps of pleomorphic malignant cells on mucoid background. The valuable characteristic features of tumor cells were papillary configuration, vacuolated cytoplasm and intracellular and extracellular hyaline globules. The diagnosis was confirmed later by histologic study of surgical resection of the specimen.

Cytologic Features of Endodermal Sinus Tumor of Ovary in the Ascitic Fluid: Report of a Cases.: Eun Sun Jeong, Young Shin Kim, Chang Suk Kang, Sang In Shim; Korean J Cytopathol. 1995;6(2):204-208.

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Abstract PDF: The cytologic findings of endodermal sinus tumor of the ovary are reported. The cytologic preperations were obtained from ascitic specimens. The findings on Papanicolaou-stained smears included a clean background and poorly preserved atypical cells loosely arranged in irregular or papillary groups. At high magnification, the cells had ill-defined and microvacuolated cytoplasms, with an increased nuclear-cytoplasmic ratio and prominent nucleoli. Hyaline globules characteristic of the alpha-fetoprotein (AFP)-synthesizing cells of endodermal sinus tumor were observed within the cells with periodic-acid-Schiff (PAS) stain. The presence of PAS - positive hyaline globules can be regarded, therefore, as a diagnostic clue to endodermal sinus tumor in an appropriate clinical setting and in the presence of AFP production. The cytologic findings in a cell block is important, in addition to smears, to obtain more diagnostic clues. A preliminary cytomorphologic diagnosis of this highly malignant tumor is valuable as a guide in planning further immunocytochemical and serologic studies.

Original Articles

Diagnostic Accuracy of Fine Needle Aspiration Cytology in Thyroid Lesions: Analysis of Histologically Confirmed 153 Cases.: Kyeong Mee Park, Ill Hyang Ko; Korean J Cytopathol. 1996;7(2):122-133.

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Abstract PDF: This is a retrospective review of fine-needle aspiration cytology(FNAC) smears of 153 cases of thyroid disease performed during August 1989 to July 1995, which were confirmed histologically following surgical operations. FNAC results showed 63 cases(41.2%) of adenomatous goiter, 45 cases(29.4%) of papillary carcinoma, 29 cases(19.0%) of follicular neoplasm, 4 cases(2.6%) of follicular variant of papillary carcinoma, 4 cases(2.6%) of Hashimoto's thyroiditis, 4 cases(2.6%) of Hurthle cell neoplasm, 2 cases(1.3%) of medullary carcinoma and one case(O.7%) each of subacute thyroiditis and of anaplastic carcinoma. The overall accuracy of cytological diagnosis was 83.7%. These data strongly suggest thyroid FNAC is a reliable preoperative diagnostic tool, but FNAC has been less valuable in the diagnosis of follicular lesions than any other disease of the thyroid. Adenomatous goiter was not infrequently interpreted as follicular neoplasia that requires surgery for diagnostic .conformation and vice versa. The following findings are considered to be compatible with follicular neoplasm: 1) microfolticles, 2) nuclear grooving, 3) irregularity of nuclear membrane, and 4) irregular arrangement or crowding of follicular cells in groups. The FNAC criteria of adenomatous goiter are as follows: 1) atrophic follicular cells, 2) presence of macrophages, 3) abundant colloid, and 4) large follicles. It is recommended that aspiration of thyroid lesions in order to analyse with critical clinico pathological approach and surgery is considered only for nodules that are clinically suspicious or unresponsive to hormone therapy or when a diagnosis of follicular neoplasm is made.

Cytologic Features of Intracranial Germ Cell Tumors in Crush Preparation.: Hyunee Yim, Jung Sun Kim, Chul Shim; Korean J Cytopathol. 1996;7(2):177-184.

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Abstract PDF: Intraoperative cytologic examination of intracranial tumors using crush preparation provides useful information in operative decision making. The diminutive nature of many biopsy specimens, particularly those obtained by stereotactic neurosurgical procedures emphasizes the importance of combining the cytologic smear method with conventional frozen section interpretation. The great advantage of the cytologic smear method resides in its suitability for the study of minute fragments of tissue, allowing retention of the majority of the specimen for optimal processing. We present the cytologic features of 3 cases of intracranial germ cell tumors(2 germinomas and 1 endodermal sinus tumor), using crush preparation during intrao perative diagnosis and compare them with histologic findings. The cytologic features of the germ cell tumors were similar to those of the respective gonadal counterparts. The cytologic differential diagnosis of both types of germ cell tumors is described.

Gastric Choriocarcinoma and Endodermal Sinus Tumor in Collision Tumor.: Eun Kyung Kim, Eun Kyung Hong, Kwang Soo Lee, Jung Dal Lee; Korean J Pathol. 1992;26(4):405-410.

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Abstract PDF: Both primary choriocarcinoma and endodermal sinus tumor of the stomach are very rare entities. Combination of these two tumors is even rarer, and only a single such case has been reported in English literature. The case had gastric adenocarcinoma in addition to these tumors. We experienced a case of combined, pure choriocarcinoma and endodermal sinus tumor in the stomach of a 74 year-old man. He had no gonadal or any other primary tumor. Huge exophytic tumor was located in the lesser curvature of the body. Two components of the tumor was separated and clearly defined. Human chorionic gonadotropin(HCG) was demonstrated in serum and in tissue sections. Alpha-fetoprotein(alpha-FP) was also demonstrated in serum and in tissue sections. Alpha-fetoprotein(alpha-FP) was also elevated in the serum. Possible tumor origin was speculated.

Endodermal Sinus Tumor of the Orbit.: Dae Hyun Back, Jin Man Kim, Kwang Sun Suh, Kyu Sang Song, Choong Sik Lee, Dae Young Kang; Korean J Pathol. 1989;23(3):392-395.

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Abstract PDF: An endodermal sinus tumor is a malignant germ cell tumor that usually arises in the gonads, but on rare occasion occurs in extragonadal locations. Our case was that of a 3 year old girl who complained of a rapid growing orbital mass. On histologic examination it revealed the typical picture of an endodermal sinus tumor and it also disclosed a positive reaction for alphafetoprotein using an immunoperoxidase technique. An orbital exenteration was performed followed by chemotheraphy, but the patient died 5 months after the onset of the disease.

Malignant Teratoma in the Mediastinum Associated with Endodermal Sinus Tumor and Squamous Cell Carcinoma.: Keun Hong Kee, Ho Jong Chun, Chae Hong Suh, Hae Sook Song; Korean J Pathol. 1988;22(1):82-87.

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Abstract PDF: Anterior mediastinal teratoma was removed from the right hemithorax of a 15-year-old male patient presenting initially with right chest discomfort and hemoptysis. He was died following precipitous clinical deterioration, 2 months after open thoracotomy. The true malignant nature of this tumor, that there are endodermal sinus tumor and squamous cell carcinoma, was apparent on resection specimen. The former had metastasized to right supraclavicular lymph node. A similar case has not been reported previously on the review of the pertinent literature on malignant mediastinal teratoma.

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