Pediatric Vaginal Yolk Sac Tumor

Abstract

Review of the management of 6 young girls with vaginal yolk sac tumor over 25 years showed that the α-fetoprotein levels normalized in 5/6 within 4 cycles of primary cisplatin, bleomycin, etoposide (PEB)/carboplatin, etoposide, bleomycin (JEB)/cisplatin, vinblastine, bleomycin (PVB) chemotherapy. Radioimaging revealed residual tissue but viable tumor was found in only 1 of 2 biopsied. Resection/biopsy is necessary to avoid giving additional primary chemotherapy or to identify patients who need different treatment. If markers do not decay appropriately, PEB/JEB/PVB chemotherapy should not be continued. Taxol-containing salvage chemotherapy regimens, adjuvant modern radiotherapeutic treatment, and fertility-saving curative surgery should then be considered. Despite having mostly advanced disease, 5/6 patients were cured, 2 with chemotherapy alone.

Vaginal yolk sac tumors in infants and children: A case report and literature review

“…Furthermore, it is not clear whether the best time to operate is before or after chemotherapy. After reviewing treatment options published over the past 20 years, it was found that conservative treatment is showing a growing trend (2,11,18,19,36,37). A number of studies tended to adopt a biopsy combined with chemotherapy or chemotherapy combined with conservative surgery (38,39).…”

“…Despite their effectiveness for inhibiting tumor growth, they have some significant and long-term toxic effects, such as hearing impairment, secondary malignancy, pulmonary fibrosis and infertility in and after the whole course of treatment. The longest period of follow-up for a patient receiving chemotherapy was 25 years, and the patient had two spontaneous vaginal deliveries (11). However, it is hard to fully assess the long-term consequences of these toxic effects, as such a case is still in the minority.…”

“…The final diagnosis is based on pathological results (9,10). Over time, the treatment strategy has changed from radical surgical treatment to conservative surgery with adjuvant chemotherapy (11,12). Due to the rarity of the tumors, most of the literature regarding vaginal YSTs consists of case reports, and there is no published standardized clinical practice guideline for vaginal YSTs in children.…”