A Case of Primary Endometrial Yolk Sac Tumor in A Postmenopausal Woman

doi:10.12280/gjszjk.20240256

Abstract

Abstract:

One case of yolk sac tumor with primary endometrium in a postmenopausal woman was reported. The patient was a 57-year-old woman with postmenopausal vaginal bleeding, accompanied by the elevated level of serum tumor marker alpha-feto protein(AFP). Gynecological ultrasound showed the thickening endometrium and uneven echo, abundant blood flow, and a right uterine cavity mass lesion. Pelvic magnetic resonance imaging showed the abnormal signal shadows in the myometrium and intrauterine cavity. On January 2, 2024, the patient underwent transabdominal total hysterectomy + double salpingectomy + pelvic and abdominal para-aortic lymph node dissection + omentectomy, and the postoperative pathological results suggested endometrial yolk sac tumor. As of May 2024, the patient has undergone 6 rounds of chemotherapy and is generally in good condition, with no recurrence or metastasis. The primary endometrial yolk sac tumor in postmenopausal women is highly malignant, with poor prognosis and the non-specific clinical manifestations. The diagnosis mainly depends on pathological examination and immunohistochemical examination. The early detection, early diagnosis and individualized treatment plan are the key factors to improve the prognosis of patients.

Key words: Postmenopause, Endodermal sinus tumor, Alpha-fetoproteins, Immunohistochemistry, Neoadjuvant therapy

SHI Hong-li, XU Li-xin, LIAN Hong-mei. A Case of Primary Endometrial Yolk Sac Tumor in A Postmenopausal Woman[J]. Journal of International Reproductive Health/Family Planning, 2024, 43(6): 479-484.

Figures/Tables 4

References 28

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序号及文献	年龄（岁）	临床表现	手术方式	病理	分期	辅助治疗	复发部位及治疗	总生存期（个月）
1^[6]	49	阴道出血	TAH+BSO+iliac LND	YST	ⅠA	放疗	无	>28
2^[6]	59	阴道出血	TAH+BSO+PLND+ omentectomy	YST	ⅠB	放疗	肝脏，横膈膜， BEP×4，EP×2	>30
3^[6]	65	水样分泌物	第1次：MRAH+BSO+ PLND，第2次：PALND	YST+子宫癌肉瘤	ⅢC	TC×5	无	不详
4^[6]	57	腹痛	TAH+BSO+PPALND+ omentectomy	YST	ⅣB	BEP	术后因感染性休克死亡	死亡，<1
5^[6]	63	阴道出血	TAH+LSO+omentectomy+ appendectomy	YST+子宫内膜样腺癌	ⅣB	BEP×3	肝脏、肺、腹腔	不详
6^[6]	71	未报告	不详	YST+浆液性癌	ⅢA	不详	不详	死亡，19
7^[6]	55	未报告	不详	YST+复杂非典型增生	Ⅱ	放化疗	不详	死亡，16
8^[6]	59	未报告	未做	YST	不详	不详	不详	失访
9^[6]	68	未报告	不详	YST	Ⅳ	化疗	不详	死亡，14
10^[6]	77	未报告	不详	YST+子宫内膜样癌+未分化癌	ⅢC	放化疗	不详	失访
11^[6]	64	未报告	不详	YST+腺癌+未分类肿瘤	ⅢA	放化疗	不详	死亡，23
12^[6]	87	未报告	不详	YST+腺癌+未分类肿瘤	Ⅱ	化疗	不详	7
13^[6]	61	未报告	不详	YST	ⅠA	化疗	不详	8
14^[6]	63	未报告	不详	YST+恶性混合型米勒管瘤	ⅢC1	放化疗	不详	5
15^[6]	62	未报告	不详	YST+浆液性癌	ⅠB	化疗	不详	30
16^[6]	77	未报告	不详	YST+浆液性癌、透明细胞癌、未分化癌	ⅢC2	化疗	不详	17
17^[6]	68	阴道出血	TAH+BSO+PPALND+ omentectomy	YST	Ⅱ	BEP×6	无	>6
18^[6]	65	阴道出血	TAB+BSO	YST+胚胎癌、局灶性未成熟畸胎瘤、成熟畸胎瘤	ⅠA	BEP×3	无	>15
19^[6]	73	腹胀	TAH+BSO+PPALND+ partial omentectomy	YST	ⅢA	EP×4	无	>14
20^[7]	54	阴道出血	TAH+BSO+radical right hemicolectomy	YST	不详	BEP×3	无	>6
21^[8]	68	尿频、尿急、血尿	TAH+BSO+omentectomy+ PPALND	YST+浆液性癌	ⅢA	TC×3	无	>3
22^[9]	不详（已绝经）	阴道出血	TAH+BSO+omentectomy+ partial appendectomy+ resection of mesenteric mass	YST	ⅠB	BEP，放疗	无	>24
23^[10]	65	腹股沟包块	TAH+BSO+PLND	YST+浆液性乳头状癌、透明细胞癌	ⅣB	化疗	肺	死亡，4
24^[11]	69	阴道出血	TAH+BSO+PPALND	YST+浆液性腺癌	ⅢC	TC×1，放疗	骨，BEP×2	死亡，12
25^[12]	58	阴道出血	TAH+BSO+PLND	YST	不详	不详	无	不详
本例	57	阴道出血	TAH+BSO+PPALND+ omentectomy	YST	ⅠB	BEP×6	无	>6

序号及文献	年龄（岁）	临床表现	手术方式	病理	分期	辅助治疗	复发部位及治疗	总生存期（个月）
1^[6]	49	阴道出血	TAH+BSO+iliac LND	YST	ⅠA	放疗	无	>28
2^[6]	59	阴道出血	TAH+BSO+PLND+ omentectomy	YST	ⅠB	放疗	肝脏，横膈膜， BEP×4，EP×2	>30
3^[6]	65	水样分泌物	第1次：MRAH+BSO+ PLND，第2次：PALND	YST+子宫癌肉瘤	ⅢC	TC×5	无	不详
4^[6]	57	腹痛	TAH+BSO+PPALND+ omentectomy	YST	ⅣB	BEP	术后因感染性休克死亡	死亡，<1
5^[6]	63	阴道出血	TAH+LSO+omentectomy+ appendectomy	YST+子宫内膜样腺癌	ⅣB	BEP×3	肝脏、肺、腹腔	不详
6^[6]	71	未报告	不详	YST+浆液性癌	ⅢA	不详	不详	死亡，19
7^[6]	55	未报告	不详	YST+复杂非典型增生	Ⅱ	放化疗	不详	死亡，16
8^[6]	59	未报告	未做	YST	不详	不详	不详	失访
9^[6]	68	未报告	不详	YST	Ⅳ	化疗	不详	死亡，14
10^[6]	77	未报告	不详	YST+子宫内膜样癌+未分化癌	ⅢC	放化疗	不详	失访
11^[6]	64	未报告	不详	YST+腺癌+未分类肿瘤	ⅢA	放化疗	不详	死亡，23
12^[6]	87	未报告	不详	YST+腺癌+未分类肿瘤	Ⅱ	化疗	不详	7
13^[6]	61	未报告	不详	YST	ⅠA	化疗	不详	8
14^[6]	63	未报告	不详	YST+恶性混合型米勒管瘤	ⅢC1	放化疗	不详	5
15^[6]	62	未报告	不详	YST+浆液性癌	ⅠB	化疗	不详	30
16^[6]	77	未报告	不详	YST+浆液性癌、透明细胞癌、未分化癌	ⅢC2	化疗	不详	17
17^[6]	68	阴道出血	TAH+BSO+PPALND+ omentectomy	YST	Ⅱ	BEP×6	无	>6
18^[6]	65	阴道出血	TAB+BSO	YST+胚胎癌、局灶性未成熟畸胎瘤、成熟畸胎瘤	ⅠA	BEP×3	无	>15
19^[6]	73	腹胀	TAH+BSO+PPALND+ partial omentectomy	YST	ⅢA	EP×4	无	>14
20^[7]	54	阴道出血	TAH+BSO+radical right hemicolectomy	YST	不详	BEP×3	无	>6
21^[8]	68	尿频、尿急、血尿	TAH+BSO+omentectomy+ PPALND	YST+浆液性癌	ⅢA	TC×3	无	>3
22^[9]	不详（已绝经）	阴道出血	TAH+BSO+omentectomy+ partial appendectomy+ resection of mesenteric mass	YST	ⅠB	BEP，放疗	无	>24
23^[10]	65	腹股沟包块	TAH+BSO+PLND	YST+浆液性乳头状癌、透明细胞癌	ⅣB	化疗	肺	死亡，4
24^[11]	69	阴道出血	TAH+BSO+PPALND	YST+浆液性腺癌	ⅢC	TC×1，放疗	骨，BEP×2	死亡，12
25^[12]	58	阴道出血	TAH+BSO+PLND	YST	不详	不详	无	不详
本例	57	阴道出血	TAH+BSO+PPALND+ omentectomy	YST	ⅠB	BEP×6	无	>6