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721 Yolk sac ovarian tumor, is always fertility preservation possible?, Report of three cases and review of literature
  1. F Behnamfar1,
  2. M Nazemi1 and
  3. B Mohamadi2
  1. 1Isfahan University of Medical Sciences, Women’s oncology, Isfahan, Iran
  2. 2Isfahan University of Medical Sciences, Pathology, Isfahan, Iran


Introduction/Background*Yolk sac ovarian tumors are rare, 2].Surgery is required for diagnosis, staging, and treatment. Yolk sac tumor was universally life-threatening before the development of combination chemotherapy. With the introduction of novel chemotherapeutic regimens,.especially adding cisplatin to combination therapies, prognosis of the patients reached excellent values, even for patients with advanced stages .

Result(s)*Case 1:A 12 years old girl presented in march 2018 with complain of abdominal pain. The ultrasonography (US) showed a huge pelvic solid tumor . AFP level was high (1200 mg/ml).Right salpingoophorectomy and pelvic lymphadenectomy were done.Histopathology revealed Yolk sac tumor limited to the ovary. Rising of AFP happened four months after the surgery and normalization of the marker. Imaging showed no gross disease .She received 3 courses of (Bleomycin,Etoposide and Cisplatin) and has been in remission . Menses restarted after six months of the last course of chemotherapy.

Case 2:A 25 years old woman G2Ab1L1 presented in May 2016 with severe abdominal pain and distension .The abdominal ultrasonography showed a huge heterogeneous solid cystic lesion and free fluid. AFP level was 1000 mg/ml..Laparotmy was done. Ruptured fragmented right ovarian tumor , hemoperitoneum and tumor involving omentum and appendix were found. Right salpingoophorectomy ,omentectomy,appendectomy and tumor debulkimg was done. Histopathology revealed Yolk sac tumor She received four cycles of BEP . AFP level decreased to normal after the fourth cycle. She has been in remission,normally menstruating in the past five years.

Case 3:A 21 years old girl presented in Sepember 2020 with complain of abdominal pain. The ultrasonography (US) showed a large solid pelvic tumor originating from right adnexa . AFP level was high(8700mg/ml Rt salpingoophorectomy , pelvic and paraaortic lymphadenectomy were done. Tumor was ruptured intraoperatively.

Histopathology report revealed Yolk sac tumor limited to ovary. She received 3 courses of BEP regimen .Her menses resumed five monthes after the last chemotherapy course and has been in remission .

Conclusion*These cases remind us , in adolescence and young age with solid high AFP levels and rapidly growing ovarian mass, diagnosis of the Yolk sac tumor has to be kept in mind. Long term remission and preservation of fertility seem to be possible when definite surgery and \chemotherapy with BEP regimen is used.

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