Yolk sac tumor (Endodermal sinus tumor) and alpha-fetoprotein.A report of three cases

Tsuchida, Yoshiaki; Saito, Sumio; Ishida, Masanobu; Ohmi, Kazuhiro; Urano, Yoshiyori; Endo, Yasuo; Oda, Tatsuya

doi:10.1002/1097-0142(197310)32:4<917::aid-cncr2820320425>3.0.co;2-x

Cited by 103 publications

(10 citation statements)

References 19 publications

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“…A small focus of cytokeratin-positive immature cells was also found in the massive rhabdomyoblastic tumour. The serum level of AFP is a useful tumour marker in the diagnosis of hepatocellular carcinoma and yolk sac tumours in the testis and ovary [11,26,27]. Although AFP-producing carcinoma in the stomach or lung shows a certain morphological feature referred to as hepatoid differentiation [12,22], no primary tumour besides the one in the liver was found in our case.…”

Section: Discussionmentioning

confidence: 75%

Sarcomatoid hepatocellular-carcinoma showing rhabdomyoblastic differentiation in the adult cirrhotic liver

et al. 1999

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An unusual case of a massive liver tumour composed of rhabdomyosarcoma with a small focus of hepatocellular carcinoma in a 52-year-old man is presented. He had hepatitis B virus (HBV) surface antigen in his serum. Macroscopically, a large tumour with satellite nodules occupied the right lobe of the cirrhotic liver. Microscopically, the tumours were composed of small and short spindle-shaped undifferentiated cells, mixed with desmin-positive round rhabdomyoblasts and elongated striated muscle cells, strongly suggestive of rhabdomyosarcoma of the liver. Elevated levels of alpha-fetoprotein in the serum led us to examine the liver tumour closely in multiple sections, which disclosed a hepatocellular carcinoma component measuring 2 cm in diameter within the massive tumour. Immunohistochemically, the hepatocellular carcinoma cells were alpha-fetoprotein positive. There was neither a tumour capsule, nor distinct demarcation, and cytokeratin-positive clusters of undifferentiated cells were intermingled with the hepatocellular carcinoma and rhabdomyosarcoma at the border. The invading tumour outside the liver and metastatic tumours were pure rhabdomyosarcomas. It is suggested that the present case should be diagnosed as rhabdomyosarcoma transformed from hepatocellular carcinoma.

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Section: Discussionmentioning

confidence: 75%

Sarcomatoid hepatocellular-carcinoma showing rhabdomyoblastic differentiation in the adult cirrhotic liver

et al. 1999

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“…As these studies were conducted mainly by immunologists and biochemists, the histological aspects of the germ-cell neoplasms received less attention. More recently the histology of the germcell neoplasms associated with raised serum AFP has been studied and a strong correlation has been noted between presence of endodermal sinus tumour (yolk-sac tumour) elements within the tumour and raised serum AFP (Ballas, 1972; Wilkinson et al, 1973;Tsushida et al, 1973; Talerman and Haije, 1974;Itoh et al, 1974; Teilum et al, 1975; Nsrgaard-Petersen et al, 1975). AFP has been extracted from tumour tissue (Wilkinson et a/., 1973; Nsrgaard-Petersen et al, 1975;Haije et al, 1976), and has been demonstrated by immunofluorescence inside and outside the tumour cells in tissue sections (Teilum et al, 1974;Itoh et al, 1974;Shirai et al, 1976;Palmer et al, 1976), thus further confirming the association between endodermal sinus tumour and AFP synthesis.…”

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confidence: 99%

“…AFP has been extracted from tumour tissue (Wilkinson et a/., 1973;Nsrgaard-Petersen et al, 1975;Haije et al, 1976), and has been demonstrated by immunofluorescence inside and outside the tumour cells in tissue sections (Teilum et al, 1974;Itoh et al, 1974;Shirai et al, 1976;Palmer et al, 1976), thus further confirming the association between endodermal sinus tumour and AFP synthesis. The value of serial determinations of serum AFP in assessing the disease activity, monitoring the results of therapy and for early diagnosis of metastases and recurrences in patients with germ-cell neoplasms composed either partly or entirely of endodermal sinus tumour elements has been emphasized in a number of recent studies (Tsushida et al, 1973;Itoh et al, 1974;Talerman and Haije, 1974;Teilum et al, 1975;Nsrgaard-Petersen et al, 1975;Haije et al, 1976), and is now well recognized.…”

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confidence: 99%

Alpha‐1 antitrypsin (AAT) and alphafoetoprotein (AFP) in sera of patients with germ‐cell neoplasms: Value as tumour markers in patients with endodermal sinus tumour (yolk sac tumour)

Talerman¹,

Haije²,

Baggerman³

1977

Intl Journal of Cancer

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Serum alphafoetoprotein (AFP) and serum alpha-1 antitrypsin (AAT) were determined in 24 patients with germ-cell neoplasms of the gonads and extragonadal sites and in two patients with hepatocellular carcinoma. In the majority of the patients serial determinations were performed. All seven patients with testicular seminoma and four patients without evidence of active disease had normal levels of serum AAT and AFP. The remaining 13 patients with germ-cell neoplasms had tumours containing endodermal sinus tumour (yolk-sac tumour) elemetns. All these 13 patients had elevated levels of serum AFP and the levels were high or very high in most cases. Nine of these 13 patients had raised serum AAT, although the elevation above normal levels was only slight in a number of cases. When serial determinations were performed serum AAT levels frequently followed the pattern of serum AFP levels, but the AAT levels were frequently within normal limits and therefore the interpretation of the results was difficult, and much less reliable as compared with those for serum AFP. The elevation of serum AAT levels following the recurrence of the tumour was found to occur much later and was much less marked than elevation of serum AFP, which occurred early, showed a large rise and was a reliable marker of tumour recurrence in patients with germ-cell neoplasms containing endodermal sinus tumour elements. It is therefore considered that, although there is good evidence that serum AAT is produced by endodermal sinus tumour elements, serum AAT is not a useful monitor of disease activity in these patients, especially when compared with serum AFP, the value of which is well recognized. Serum AAT may be a useful tumour marker in patients with hepatocellular carcinoma, and this aspect should be investigated further.

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“…Biochemical (alpha-fetoprotein production) Masopust et al, 1968;Tsuchida et al, 1973;Norgaard-Pedersen et al, 1975), embryological (Marin-Padilla, 1968;Gaillard, 1972), and comparative anatomical (Pierce et al, 1970) evidence supports the contention that these neoplasms have a yolk sac origin. The general acceptance of this concept will enable the true incidence, age range, and clinical behaviour of testicular yolk sac tumour to be documented and the importance of alpha-fetoprotein levels in such patients to be assessed.…”

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confidence: 84%

Features of prognostic significance in testicular germ cell tumours.

Parkinson¹,

Beilby²

1977

J Clin Pathol

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SUMMARY One hundred and one testicular tumours previously diagnosed as 'teratoma' were examined and 93 of the patients were followed up. These neoplasms were assigned to one of three groups. Those composed exclusively of somatic tissues were the only tumours referred to as teratoma. The second group was exclusively extra embryonic and consisted of either yolk sac or choriocarcinoma. Neoplasms in the third group were called mixed germ cell tumours and incorporated somatic and extra embryonic tissue and occasionally seminoma. The patients with teratomas showed a very low mortality whereas pure yolk sac tumours proved highly malignant. In mixed germ cell tumours the malignant nature of the yolk sac component was maintained even when combined with somatic elements, but when seminoma was also present the survival rate was significantly improved.It would appear that yolk sac tumour tissue occurs more frequently in adult testicular neoplasms than was previously suspected and in mixed germ cell tumours it can be expected to dictate behaviour except when combined with seminoma.Within the pleomorphic group of gonadal tumours often referred to as 'teratoma' orthodox methods of histological grading are usually inapplicable. Choriocarcinomatous foci, however, are regarded as prognostically sinister. In a study of ovarian mixed germ cell tumours (solid 'teratoma') we concluded that a tumour pattern, considered to be yolk sac in origin, was an important prognostic guide (Beilby and Parkinson, 1975). Based on these findings and the knowledge that serum alpha-fetoprotein (a product of human yolk sac) (Gitlin and Perricelli, 1970) is raised in patients with testicular 'teratocarcinoma' (Norgaard-Pedersen et al., 1975), we investigated the incidence and relation to prognosis of yolk sac tumour in testicular germ cell neoplasms. Material and methodsOne hundred and one testicular tumours previously reported as 'teratoma' at the Middlesex Hospital between 1923 and 1970 were reviewed. Detailed histories were available in 93 of the 101 patients, all of whom had been treated by surgery and radiotherapy. The survivors were followed up for three to 37 years. Paraffin wax blocks from each primary neoplasm were sectioned and stained with haematoxylin and eosin. The tumours, with the exception of one which was undifferentiated, were assigned to one of the following three groups, and the clinical behaviour of these was compared: 1 teratoma, ie, those neoplasms composed exclusively of mature or immature somatic elements; 2 tumours composed exclusively of extra embryonic tissue, ie, choriocarcinoma or yolk sac tumour. The latter was identified by its characteristic range of merging patterns, including Duval-Schiller bodies, intercommunicating channels lined by flattened epithelium, clear celled reticular and microcystic formations, and acinopapillary structures lined by cuboidal and columnar epithelium (Figs.

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Yolk sac tumor (Endodermal sinus tumor) and alpha-fetoprotein.A report of three cases

Cited by 103 publications

References 19 publications

Sarcomatoid hepatocellular-carcinoma showing rhabdomyoblastic differentiation in the adult cirrhotic liver

Sarcomatoid hepatocellular-carcinoma showing rhabdomyoblastic differentiation in the adult cirrhotic liver

Alpha‐1 antitrypsin (AAT) and alphafoetoprotein (AFP) in sera of patients with germ‐cell neoplasms: Value as tumour markers in patients with endodermal sinus tumour (yolk sac tumour)

Features of prognostic significance in testicular germ cell tumours.

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