Massive pure gastric yolk sac tumour: a unique presentation of a rare pathology

Abstract

Massive pure gastric yolk sac tumour: a unique presentation of a rare pathology An 86-year-old lady presented to our emergency department with a large central abdominal mass growing in size over a 4-month period, associated with a decreasing appetite and weight loss. She reported no pain, was tolerating oral intake and passing bowel motions daily. Her past medical history was significant for colorectal cancer in 2012, for which she had a right hemicolectomy and remained in remission.Observations were stable, and focussed abdominal examination revealed a central, firm and immobile mass, measuring approximately 20 cm in diameter and palpable throughout the entire abdomen. The abdomen was not tender to palpation.Computed tomography (CT) scan of the abdomen and pelvis revealed a 20 × 16.5 × 13 cm irregular central abdominal mass with smooth contours (Fig. 1). It appeared to arise from the gastric antrum, and had peripheral enhancement with a central hypo-dense component suggesting necrotic change. Mass effect was demonstrated on the surrounding bowel, mesenteric vessels and the inferior vena cava in particular. The remaining CT findings were normal with no evidence to suggest recurrence of the patient's previous malignancy. Serum alpha-fetoprotein (AFP) was elevated to 6590 IU/mL.The patient consented to a laparotomy and resection. Intraoperatively, the tumour was found to arise from the gastric antrum, but was adherent to the posterior rectus sheath, first part of the duodenum, proximal Jejunum, pancreas and serosa of the transverse colon (Fig. 2). Given the patient's age and frailty, we elected not to pursue an R0 multivisceral resection, and luckily we were able to mobilize the tumour from these structures. A distal gastrectomy followed by a gastro-jejunostomy (Billroth II procedure) was performed. The patient recovered well and was discharged 1 week post-operatively.

Gastric yolk sac tumor with synchronous liver metastasis: first case report in China

“…According to reported literature, 5 cases developed systemic relapse accompanied by an increase in AFP ( 5 , 7 , 13 - 15 ). Although the reported number of YSTs is not so large to predict a proper outcome, the serum levels of AFP may be a prognostic marker for recurrence and survival of gastric YST ( 10 , 17 ). The serum AFP level in our case decreased to nearly within the normal range after surgery but has gradually increased recently which may indicate poor prognosis.…”

Unusual or Uncommon Histology of Gastric Cancer

“…Other germ cell tumor elements may present alongside embryonal carcinoma, yolk sac tumors, and hepatoid adenocarcinoma [ 58 59 ]. Only a few cases involving pure gastric yolk sac tumors have been documented [ 60 61 62 63 ].…”