Indian Journal of Cancer
Home  ICS  Feedback Subscribe Top cited articles Login 
Users Online :2912
Small font sizeDefault font sizeIncrease font size
Navigate here
Resource links
 »  Similar in PUBMED
 »  Search Pubmed for
 »  Search in Google Scholar for
 »  Article in PDF (722 KB)
 »  Citation Manager
 »  Access Statistics
 »  Reader Comments
 »  Email Alert *
 »  Add to My List *
* Registration required (free)  

  In this article
 »  References
 »  Article Figures

 Article Access Statistics
    PDF Downloaded165    
    Comments [Add]    
    Cited by others 5    

Recommend this journal


  Table of Contents  
Year : 2014  |  Volume : 51  |  Issue : 4  |  Page : 446

Primary yolk sac tumor of the endometrium: A rare entity

Department of Gynaecologic Oncology, Kidwai Memorial Institute of Oncology, Dr. M. H. Marigowda Road, Bangalore, Karnataka, India

Date of Web Publication1-Feb-2016

Correspondence Address:
Dr. N Abhilasha
Department of Gynaecologic Oncology, Kidwai Memorial Institute of Oncology, Dr. M. H. Marigowda Road, Bangalore, Karnataka
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0019-509X.175315

Rights and Permissions

How to cite this article:
Abhilasha N, Bafna U D, Pallavi V R, Rathod P S, Krishnappa S. Primary yolk sac tumor of the endometrium: A rare entity. Indian J Cancer 2014;51:446

How to cite this URL:
Abhilasha N, Bafna U D, Pallavi V R, Rathod P S, Krishnappa S. Primary yolk sac tumor of the endometrium: A rare entity. Indian J Cancer [serial online] 2014 [cited 2020 Oct 25];51:446. Available from:


Yolk sac tumor (YST) is a malignant germ cell tumor, most commonly having a gonadal [1] origin but is also seen arising from various extragonadal sites (around 20%) like mediastinum, retroperitoneum, sacrococcygeal region, pelvis, liver, stomach, vulva, vagina, cervix. Primary yolk sac tumor of endometrium is very rare, and only 6 cases have been reported in literature so far, and we are reporting the 7th case in the world English literature.

A 31-year-old nulliparous woman came with history of menorrhagia since 1 year. Clinical examination revealed bulky uterus of 8-10 weeks size. CT scan showed a bulky uterus (9.7 × 3.9 × 5.7 cm) with thickened endometrium (16 mm) and multiple 3-5 mm mesenteric, para-aortic nodes. Endometrial biopsy showed poorly differentiated malignant neoplasm possibly clear cell carcinoma/yolk sac tumor. Total abdominal hysterectomy, bilateral salpingo oophorectomy, infracolic omentectomy with pelvic and para-aortic lymph node dissection was done. Both fallopian tubes and ovaries were normal, and no evidence of any gross or microscopic extrauterine disease in both pelvis and abdomen. Totally, 12 pelvic lymph nodes and 4 para-aortic lymph nodes were dissected, and none had any evidence of malignancy. Cut section of uterus showed a polypoidal 4 × 4 × 3 cm growth invading less than ½ thickness of myometrium. Microscopy revealed malignant yolk sac tumor [Figure 1] and [Figure 2].
Figure 1: Yolk sac tumor (H and E, ×40). Section showing the tumor invading the adjacent endometrium

Click here to view
Figure 2: Yolk sac tumor (H and E, ×40). Reticular pattern-tumor cells arranged in a loose meshwork with many empty spaces

Click here to view

Immunohistochemistry done was positive for CK, PLAP, AFP, CD117 and negative for CK7, CD10, CD 15, CD 30, SMA, MyoD1, Desmin, EMA. Pre-op raised serum a-feto protein (242.3 IU/ml) normalized (11.7 IU/ml) by 2 weeks post-op. Chemotherapy with four 3 weekly cycles of BEP (bleomycin, etoposide, cisplatin) was given, and the patient is now disease-free since 2 years.

Four theories of histogenesis have been proposed. First is the aberrant migration of primordial germ cells during embryogenesis, which remained in the basal layer of endometrium, second is metastasis from an occult ovarian tumor, third from the residual fetal tissues remaining in the uterus and fourth is the origin from somatic cells that have undergone aberrant differentiation.[2],[3],[4]

Histology is similar to gonadal YST. Histological differential diagnosis is clear cell carcinoma. Schiller duval bodies are characteristic of YST. Immunohistochemistry for AFP (alpha feto protein) helps in diagnosis. Because of its rarity, appropriate treatment has not yet been standardized. Surgery alone has been unsuccessful in preventing recurrences even in stage 1 disease. In Pileri et al.,[3] though the disease was confined to uterus, it recurred with hepatic metastasis after surgery, probably depicting the aggressive nature of YST, similar to its ovarian counterpart requiring adjuvant treatment despite early stage disease. A combination of surgery and chemotherapy seems to have a good outcome. In Rossi et al.,[5] hysterectomy with adjuvant chemotherapy with ovarian preservation was done in a stage 2 patient, and the patient is disease-free since 6 years. Chemotherapy with BEP/VAC regimen is the recommended chemotherapy for germ cell tumors of ovary and hence is used in YST endometrium and seems to be effective.[2],[3] Late stages seems to have a worse prognosis even with surgery and chemotherapy as evidenced in Clement et al.[4] But, experience is limited for recommendations and standardization of treatment protocols.

 » References Top

Teilum G. Special tumours of ovary and testis and related extragonadal lesions. In Comparative Pathology and Histological Identification. 2nd ed. Philadelphia: J.B. Lippincott; 1976. p. 33-115.  Back to cited text no. 1
Ohta M, Sakakibara K, Mizuno K, Kano T, Matsuzawa K, Tomoda Y, et al. Successful treatment of primary endodermal sinus tumor of the endometrium. Gynecol Oncol 1988;31:357-64.  Back to cited text no. 2
Pileri S, Martinelli G, Serra L, Bazzocchi F. Endodermal sinus tumor arising in the endometrium. Obstet Gynecol 1980;56:391-6.  Back to cited text no. 3
Clement PB, Young RH, Scully RE. Extraovarian pelvic yolk sac tumors. Cancer 1988;62:620-6.  Back to cited text no. 4
Rossi R, Stacchiotti D, Bernardini MG, Calvieri G, Lo Voi R. Primary yolk sac tumor of the endometrium: A case report and review of the literature. Am J Obstet Gynecol 2011;204:e3-4.  Back to cited text no. 5


  [Figure 1], [Figure 2]

This article has been cited by
1 Primary yolk sac tumor originating from the endometrium
Liang Song,Xiaoxia Wei,Danqing Wang,Kaixuan Yang,Mingrong Qie,Rutie Yin,Qingli Li
Medicine. 2019; 98(15): e15144
[Pubmed] | [DOI]
2 Endometrial tumors with yolk sac tumor-like morphologic patterns or immunophenotypes: an expanded appraisal
Oluwole Fadare,Nada Shaker,Abrar Alghamdi,Raji Ganesan,Krisztina Z. Hanley,Lien N. Hoang,Jonathan L. Hecht,Philip P. Ip,Nuha Shaker,Andres A. Roma,Vinita Parkash,Hussain Abubakr
Modern Pathology. 2019;
[Pubmed] | [DOI]
3 Primary yolk sac tumor of the endometrium: a case report and review of the literatures
Tao Lu,Liping Qi,Yanhui Ma,Guojiao Lu,Xiaolei Zhang,Peishu Liu
Archives of Gynecology and Obstetrics. 2019;
[Pubmed] | [DOI]
4 Yolk Sac Tumor in Extragonadal Pelvic Sites
Sanjita Ravishankar,Anais Malpica,Preetha Ramalingam,Elizabeth D. Euscher
The American Journal of Surgical Pathology. 2017; 41(1): 1
[Pubmed] | [DOI]
5 Intestinal differentiated mucinous adenocarcinoma of the endometrium with sporadic MSI high status: a case report
Mafalda Trippel,Sara Imboden,Andrea Papadia,Michael D. Mueller,Nando Mertineit,Kirsi Härmä,Alina Nicolae,Erik Vassella,Tilman T. Rau
Diagnostic Pathology. 2017; 12(1)
[Pubmed] | [DOI]


Print this article  Email this article


  Site Map | What's new | Copyright and Disclaimer
  Online since 1st April '07
  © 2007 - Indian Journal of Cancer | Published by Wolters Kluwer - Medknow