Primary mediastinal yolk sac tumor treated with platinum‐based chemotherapy and extended resection: Report of seven cases

Abstract

BackgroundPrimary mediastinal yolk sac tumor, which is also known as endodermal sinus tumor, is a rare but lethal neoplasm, and it is a kind of mediastinal non‐seminomatous germ cell tumor. The current standard treatment in mediastinal non‐seminomatous germ cell tumors is chemotherapy combined with postchemotherapy residual mass resection. We report on seven cases of primary mediastinal yolk sac tumor treated with platinum‐based chemotherapy and extended resection.MethodsWe experienced seven cases of primary mediastinal yolk sac tumor between August 2014 and August 2017. All cases had markedly raised α‐fetoprotein and normal β‐human chorion gonadotropin. Computed tomography scan revealed an anterior mediastinal tumor in all cases. Five patients underwent needle core biopsy, which showed a mediastinal yolk sac tumor. They received preoperative platinum‐based chemotherapy and then underwent extended resection, and four of them received postoperative platinum‐based chemotherapy. Two other patients did not receive preoperative biopsy, and they underwent surgical extended resection and then received postoperative platinum‐based chemotherapy.ResultsTwo patients (29%) experienced a postoperative complication, including one pneumonia and one atelectasis. There were no operative deaths. R0 resection was achieved in six patients (86%), and R2 resection was achieved in the other patient. Three patients experienced pulmonary metastases within one year, and two of them soon died. Four other patients were alive without recurrence at the time of writing.ConclusionPrimary mediastinal yolk sac tumor is rare, and the prognosis is poor. A multimodality aggressive approach including adjuvant chemotherapy followed by surgical resection is the optimal treatment and may lead to long‐term survival.

Clinical presentation and management strategies for yolk sac tumor. A case series and review of the literature

“…The initial treatment method for YST of ovary is whole uterus plus double appendectomy and postoperative chemotherapy with a single alkylating agent, but the prognosis is still poor. Combined chemotherapy significantly improves the prognosis of YST, which also makes it possible to reduce the extent of surgery [15,16]. Local extended resection becomes the main surgical method in our present case series.…”

A Rare Case of Primary Mediastinal Endodermal Sinus Tumor Presenting with Hemoptysis

“…Yolk sac tumors (also known as endodermal sinus tumors) are most commonly seen as primary testicular tumors in infants and children under the age of three [2]. Whether gonadal or extragonadal, they release AFP tumor markers, and microscopic features are unequivocal, including reticular or microcystic proliferation and the characteristic Schiller-Duval bodies (which resemble primitive glomeruli) [2,5].…”

“…Malignant EGCTs are grouped as either malignant seminomatous tumors (40%) or malignant non-seminomatous tumors (60%) [ 3 ]. ECGTs most commonly occur in the midline of the body and is thought to develop due to the failed migration of primary germ cells during embryogenesis, specifically, with 5-10% of all cases arising in the anterior mediastinum [ 4 , 5 ]. In the non-seminomatous category, yolk sac tumors have the worst prognosis.…”

Multimodal imaging changed clinical decision‐making: A rare mediastinal yolk sac tumor infiltrating the heart and follow‐up

“…Patients often present with advanced, bulky tumors that are unresectable. A comprehensive treatment with initial chemotherapy followed by surgical removal of all residual tumors is recommended 3–6 …”