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27-year-old young woman with mucinous cystadenocarcinoma. The tumor shows oval shape, predominantly cystic nature, heterogeneous moderate to marked enhancement (white arrow) and intratumoral papillary projection (white arrow). Ascites is also detected (white arrow).
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Ovarian yolk sac tumors (YSTs) are rare neoplasms. No radiological study has been done to compare the imaging findings between this type of tumor and other ovarian tumors. Here we analyzed the CT findings of 11 pathologically proven ovarian YSTs and compared their imaging findings with 18 other types of ovarian tumors in the same age range. Patient...
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Objective
The aim of this study was to investigate the preoperative characteristics of benign mature cystic teratoma (MCT) and struma ovarii and their risk factors associated malignancies, and determine the appropriate treatment options for these tumors.
Methods
This was a retrospective study on 248 patients who were pathologically diagnosed with...
Malignant struma ovarii (SO) is a rare tumor, and as a consequence, treatments and follow-up procedures are not clearly established. Presented in this study are two cases of suspicious ovarian masses, resected and corresponding to malignant SO on histopathology. Similar to thyroid cancer, we proposed complementary radioiodine therapy (131I) after t...
We describe a case of a mature cystic teratoma of the ovary with high proportion of solid thyroid tissue (< 50% of the entire tumor) in a childbearing woman. The patient presented with non-specific abdominal bloating. Pelvic ultrasound and magnetic resonance imaging revealed a complex cystic-solid tumor confined to the left ovary with an anterior f...
Citations
... EST shows up as an enhancing solid cystic mass on CT and MR studies (5)(6)(7)(8). In this case, the boundary of the EST was relatively clear, and an enhanced capsule could be seen. ...
Background
Endodermal sinus tumors are rare, especially extragonadal endodermal sinus tumors, which often occur in the midline of the brain, neck, chest, and abdomen.
Case summary
We present the case of a 37-year-old woman with a mass on the right edge of the liver. Color Doppler ultrasound, computed tomography, and magnetic resonance imaging examinations were performed before the operation. Given these results and the elevation of alpha-fetoprotein, the diagnosis of hepatocellular carcinoma was made. Postoperative pathological examination indicated an endodermal sinus tumor on the abdominal wall near the right liver. The causes of misdiagnosis were analyzed, and the related literature was reviewed.
Conclusion
Primary endodermal sinus tumors on the abdominal wall near the right liver are easily misdiagnosed as hepatocellular carcinoma due to liver compression and elevated alpha-fetoprotein. The key point of differentiation is the wide basal connection between the tumor and the abdominal wall near the liver. In addition, the enhancement mode of endodermal sinus tumors is different from the enhancement pattern of hepatocellular carcinoma.
Core tip
Extragonadal endodermal sinus tumors often occur in the midline of the body. Here, we present a case of a primary endodermal sinus tumor on the abdominal wall near the right liver for the first time.
... On MRI, EST may show areas of hemorrhage and are valuable in assessing the presence of metastases to the lymph nodes, greater omentum, lung, liver, or bone [8]. Recently, Li et al. [9,10] investigated CT images of ovarian EST, extra-gonadal EST and other ovarian malignancies the result showed that most of the ovarian endodermal sinus tumors appearanced large, well-defined solid-cystic masses, intra-tumor hemorrhage, marked heterogeneous enhancement, and enlarged intratumoral vessels. Among them, the intratumoral vascular enlargement with diagnostic specificity was also called "bright dot sign". ...
Background
Endodermal sinus tumor (EST) is a malignant tumor originating from the ovary or testis. In most case, ultrasound examination shows ovarian mass. But there is a special kind of extra-gonadal endodermal sinus tumor, which occur in organs other than gonads with insidious onset. Here we reported a case of endodermal sinus tumor, which originated from the sacral ligament presenting as an acute lower abdominal pain.
Case presentation
A 14-year-old girl was admitted to the hospital because of acute lower abdominal pain. The ultrasound showed a mass with 72 mm × 64 mm × 50 mm in Douglas, and there was no abnormality in bilateral ovaries and fallopian tubes. Laparoscopic exploration showed a large amount of blood clots in the pelvic cavity. After removal of the blood, we found rotten fish-like tissue in the left sacral ligament, rapid pathology suggested endodermal sinus tumor. After the operation, we retrospectively examined the value of alpha-fetoprotein (AFP), which was found to be elevated, and post-operative paraffin pathology confirmed the diagnosis. After four cycles of BEP chemotherapy, exploratory laparotomy was performed to remove the visible lesion, but postoperative pathology showed no abnormality. At the one-year follow-up, the patient remained recurrence-free.
Conclusion
Extra-gonadal germ cell tumors are rarely reported. When young teenagers complain of acute lower abdominal pain with elevated AFP, but there was no lesion in bilateral ovaries and fallopian tubes, we must think about the possibility of endodermal sinus tumors. Accurate diagnosis facilitates complete resection of lesions and improves patient’s outcomes.
... Yolk sac tumors radiologically appear as heterogenous, large, mixed solid and cystic masses with intratumoral hemorrhage, necrosis and striking enhancement [109][110][111][112]. The internal hemorrhage and intense enhancement reflect the rich vascularity of the neoplasm [3]. ...
Most abdominal masses in the pediatric population derive from the ovaries. Ovarian masses can occur in all ages, although their incidence, clinical presentation and histological distribution vary among different age groups. Children and adolescents may develop non-neoplastic ovarian lesions, such as functional cysts, endometrioma, torsion, abscess and lymphangioma as well as neoplasms, which are divided into germ cell, epithelial, sex-cord stromal and miscellaneous tumors. Germ cell tumors account for the majority of ovarian neoplasms in the pediatric population, while adults most frequently present with epithelial tumors. Mature teratoma is the most common ovarian neoplasm in children and adolescents, whereas dysgerminoma constitutes the most frequent ovarian malignancy. Clinical manifestations generally include abdominal pain, palpable mass, nausea/vomiting and endocrine alterations, such as menstrual abnormalities, precocious puberty and virilization. During the investigation of pediatric ovarian masses, the most important objective is to evaluate the likelihood of malignancy since the management of benign and malignant lesions is fundamentally different. The presence of solid components, large size and heterogenous appearance on transabdominal ultrasonography, magnetic resonance imaging and computed tomography indicate an increased risk of malignancy. Useful tumor markers that raise concern for ovarian cancer in children and adolescents include alpha-fetoprotein, lactate dehydrogenase, beta subunit of human chorionic gonadotropin, cancer antigen 125 and inhibin. However, their serum levels can neither confirm nor exclude malignancy. Management of pediatric ovarian masses needs to be curative and, when feasible, function-preserving and minimally invasive. Children and adolescents with an ovarian mass should be treated in specialized centers to avoid unnecessary oophorectomies and ensure the best possible outcome.
... Yolk sac tumors are also described in humans, mainly reported in testicular and ovarian cancer and commonly observed in young children (Kattuoa and Kumar, 2021). The ovarian yolk sac tumor is described as large and oval with defined margins and a mixed solid/cystic nature, intratumoral hemorrhage and enlarged intratumoral vessels (Li et al., 2015). The cystic areas are histologically comparable to the mesenchyme of the primitive yolk sac (Kattuoa and Kumar, 2021). ...
Clinical presentations of umbilical outpouchings (UOs) in pigs cover a variety of pathological manifestations. Pigs with UOs often do not reach the abattoir as they die due to complications or are euthanized for welfare concerns. The primary objective was to characterize the gross appearance of UOs in pigs with respect to the different types of pathological manifestations. Also the association between the pathological manifestation and presence of a wound on the UO was evaluated. Pigs (in different age groups, n = 444) with an UO were sampled in Denmark from different locations (two herds and at an abattoir) and examined post mortem. Tissue samples from animals with an enterocystoma or internal umbilical proliferations were collected for histological and immunohistochemical characterization. Hernia umbilicalis was the most frequent cause (72%, n = 320) of the UOs. It was the only diagnosis in 57% (n = 254) of the pigs, and in 15% (n =66) of the pigs the hernia appeared in combination with other manifestations. Thus, 28% (n = 124) of the pigs were diagnosed with an enterocystoma, internal umbilical proliferations, subcutaneous abscess/ fibrosis or another diagnosis, presented alone or in combination. The distribution of diagnoses varied in the different age groups. Overall, 38% (110/291) of the pigs presented a wound on the UOs post mortem. The age of the pigs confounded the relation between the pathological manifestation and the presence of a wound. The odds that an UO had a wound were lower among pigs with a subcutaneous abscess/ fibrosis compared to pigs diagnosed with an umbilical hernia or enterocystoma (OR, 0.3; 95% Cl, 0.1-0.7). The odds of wounds were higher among weaners (OR, 4.3; 95% Cl 2.3-8.3) and finishers (OR, 6.5; 95% Cl, 3.4-12.7) compared with piglets from the farrowing unit. The area of wounds ranged from 0.03-78.5 cm² and increased with age (P <0.001). Histologically and immunohistochemically the enterocystomas and internal umbilical proliferations seemed to be lined with mesothelial cells and both had a content comparable with mesenchymal embryonic connective tissue. However, only the cavities of the enterocystomas were also lined with mesothelial cells. In conclusion, UOs in pigs are caused by complex pathological conditions with hernia umbilicalis as the dominating diagnosis. Knowledge clarifying the different pathological manifestations causing an UO and the presence of wounds on the UOs is essential for future prevention strategies.
... Yolk sac tumors are also described in humans, mainly reported in testicular and ovarian cancer and commonly observed in young children (Kattuoa and Kumar, 2021). The ovarian yolk sac tumor is described as large and oval with defined margins and a mixed solid/cystic nature, intratumoral hemorrhage and enlarged intratumoral vessels (Li et al., 2015). The cystic areas are histologically comparable to the mesenchyme of the primitive yolk sac (Kattuoa and Kumar, 2021). ...
... As far as we know, ADC value of ovarian dysgerminoma has not been reported in previous study. Unlike yolk sac tumor, ovarian dysgerminomas usually have an enhancement lower than myometrium on contrast-enhanced CT and MR images [10]. ...
Background:
To investigate the spectrum of CT and MRI findings of dysgerminoma of the ovary.
Methods:
CT and MRI imaging of 12 patients with 13 histologically proven dysgerminomas of the ovary were retrospectively reviewed. Patients, ages ranged from 6 ~ 27 years (mean, 17.2 years). Two observers evaluated the following CT and MRI features of the tumor by consensus: (i) location, shape, and size; (ii) attenuation, T2 signal intensity, and ADC value; (iii) patterns of contrast enhancement; (iv) presence of fibrovascular septa; (v) presence of necrosis, hemorrhage, and calcification; (vi) presence of "ovarian vascular pedicle" sign. We also noted the extent or stage of the tumors.
Results:
75% lesions arised in the right ovary. Bilateral ovaries were involved in one case. Tumors displayed as a purely or predominantly solid mass (mean size, 17.0 ± 7.8 cm). Ten tumors were shaped multilobulated. The mean ADC value of lesions was 0.830 ± 0.154 × 10- 3 mm2/s. Characteristic fibrovascular septa were observed in all lesions. Among them, classic septa were present in 69% lesions. They were thin, hypointense on T2WI with a linear intense enhancement indicating the blood vessels in septa. Due to the stromal edema, fibrovascular septa may become thick even amorphous in shape, hyperintense on T2WI and even low attenuation on CT with a slight enhancement except for a bright blood vessel on the edge. Massive necrosis was observed only in one lesion. Calcification was present in 3 of the 5 tumors on CT. "Ovarian vascular pedicle" sign was present in 12 lesions. Lymphadenopathy, retroperitoneal spread, and distant metastases combined with an implantation in Douglas' cul-de-sac were present in one patient respectively.
Conclusion:
On CT and MR images, ovarian dysgerminoma often appears as a large solid mass. The edematous condition of characteristic fibrovascular septa can be well displayed by imaging which then can guide the radiologists to make an accurate diagnosis. Calcifications often occur in the tumor. Nonspecific low ADC value and "ovarian vascular pedicle" sign may narrow the differential diagnosis.
... Due to the abundance of tumor blood vessels, the solid components of the enhanced scan showed obvious uneven enhancement, and the delay period continued to strengthen. The characteristic manifestation of the disease was both cystic change and obvious enhancement [8][9][10]. A significant increase in AFP is a characteristic manifestation of the disease. ...
Background: Yolk sac tumor (YST), also known as endodermal sinus tumor, is a highly malignant germ cell-derived tumor. As a rare disease, the diagnosis, prognostic factors, and optimal management of yolk sac tumor are difficult. The present study aims to investigate the clinicopathological features and optimal management strategies of yolk sac tumor.
Results: We retrospectively investigated seventeen patients with yolk sac tumor in our institute between January 2010 to December 2019. The median age of the study population was 24 years (range 6–50 years). Most cases were female (11/17, 64.7%). Among the seventeen cases of YSTs, 8 cases were ovarian YSTs, 3 cases were mediastinum YSTs, 2 cases were testis YSTs. 94.1% patients had a markedly raised AFP. Surgery and chemotherapy were the main treatment methods for YST and improved the prognosis of patients.
Conclusions: YST is a highly malignant and rare germ cell tumor, ovarian YST is the most common type. Early diagnosis and reasonable treatment can improve the prognosis of YST. These cases highlight the tumor’s characteristics. As more experience is gathered with this rare malignant tumor, the more likely we are to cure this disease.
... In this regard, malignancy should be considered when confronted with a large tumor, hyper-vascularization, ascites, or metastasis. There are also more specific features for the diagnosis of YST, such as mixed composition (predominantly cystic), oval shape and well-defined margins, heterogeneous enhancement, and absence of fatty components [1]. Above all these signs, enlarged intra-tumoral vessels is highly suggestive for YST, especially in association with raised blood levels of AFP as in our case [1]. ...
... There are also more specific features for the diagnosis of YST, such as mixed composition (predominantly cystic), oval shape and well-defined margins, heterogeneous enhancement, and absence of fatty components [1]. Above all these signs, enlarged intra-tumoral vessels is highly suggestive for YST, especially in association with raised blood levels of AFP as in our case [1]. ...
... It is the second most common malignant germ cell tumor of the ovary in pediatrics, usually occurring in the second decade of life [43,44]. Yolk sac tumors are typically large masses on presentation and can have peritoneal, hematogenous or lymphatic metastases [45]. By MRI, they are typically heterogeneous, mixed solid and cystic, with hemorrhage, necrosis and striking enhancement that is greater than myometrium [45][46][47][48] (Fig. 3). ...
... Yolk sac tumors are typically large masses on presentation and can have peritoneal, hematogenous or lymphatic metastases [45]. By MRI, they are typically heterogeneous, mixed solid and cystic, with hemorrhage, necrosis and striking enhancement that is greater than myometrium [45][46][47][48] (Fig. 3). The intratumoral hemorrhage and marked enhancement reflect the rich vascularity of the tumor [45][46][47]. ...
... By MRI, they are typically heterogeneous, mixed solid and cystic, with hemorrhage, necrosis and striking enhancement that is greater than myometrium [45][46][47][48] (Fig. 3). The intratumoral hemorrhage and marked enhancement reflect the rich vascularity of the tumor [45][46][47]. In this regard, a particularly characteristic sign for yolk sac tumors is visualization of large dilated intratumoral vessels or vascular aneurysms, which can be seen by MRI as signal voids on spin-echo imaging, or directly following contrast agent administration [45][46][47]. ...
Evaluation of adnexal masses in children and adolescents relies on imaging for appropriate diagnosis and management. Pelvic MRI is indicated and adds value for all adnexal masses when surgery is considered or when ultrasound findings are indeterminate. Specifically, features on MR imaging can help distinguish between benign and malignant lesions, which not only influences the decision between surgery and conservative treatment, but also the type of surgery to be performed, including potential use of fertility-sparing approaches with minimally invasive techniques. Larger size, younger age, presentation with precocious puberty or virilization, restricted diffusion in a solid mass, and rapid and strong enhancement of solid components are all features concerning for malignancy. In addition, distinctive MR imaging features of adnexal masses, combined with clinical and laboratory biomarkers, might suggest a specific histological diagnosis.
... [13,14] The radiological features of YST are not specific; however, familiarity with its imaging characteristics can enable preoperative diagnosis, improve surgical planning and assess effects of treatment. [15][16][17][18][19] The CT findings in two cohorts with a combined total of 31 YSTs (age range: 1-31 years) documented that lesions ranged from 5-24 cm and most were well-circumscribed with defined borders. [15,16] Intralesional calcification was rare; however, intratumoral hemorrhage, ascites and marked enhancement were common findings. ...
... [15][16][17][18][19] The CT findings in two cohorts with a combined total of 31 YSTs (age range: 1-31 years) documented that lesions ranged from 5-24 cm and most were well-circumscribed with defined borders. [15,16] Intralesional calcification was rare; however, intratumoral hemorrhage, ascites and marked enhancement were common findings. [15,16] Further, enhancement of intratumoral vessels was detected in 90% of cases. ...
... [15,16] Intralesional calcification was rare; however, intratumoral hemorrhage, ascites and marked enhancement were common findings. [15,16] Further, enhancement of intratumoral vessels was detected in 90% of cases. [15,16] These vessels typically contain a dilated lumen that on postcontrast imaging display a "bright dot" sign, considered a classical imaging feature of this entity. ...
Germ cell tumors in extragonadal sites are uncommon; those arising in the urachus are exceedingly rare and limited to a few anecdotal reports. Herein we document an occurrence of yolk sac tumor in a 9-month-old male who presented with abdominal distension. Laboratory investigation revealed elevated lactate dehydrogenase and α-fetoprotein levels; imaging studies were inconclusive as to tumor type or site of origin. The tumor was resected from the base of the umbilicus and histologic examination revealed neoplastic cells arranged in solid nests or microcystic patterns in a fibromyxoid stroma. Schiller-Duval bodies were conspicuous. Immunohistochemical analysis showed lesional cells reactive to α-fetoprotein, SALL4, placental alkaline phosphatase, Glypican-3 and CD117. No teratomatous or other germ cell elements were identified. These findings supported a diagnosis of pure yolk sac tumor arising from the urachus; the clinical, radiological and pathological findings are discussed.DOI:10.276/APALM.1832
