A Rare Case of Yolk Sac Tumour in Postmenopausal Lady

ABSTRACT

Epithelial tumours are the most common ovarian neoplasm in postmenopausal age group. Yolk sac tumour is a type of germ cell tumour which is common in younger age group. Occurrence of such tumour in postmenopausal women is extremely rare and not more than 55 cases have been reported so far in English literature. Often in such cases an association with benign or malignant epithelial tumours have been described. We report a strange case of Yolk sac tumour in a 57 year old postmenopausal lady who presented to us with chief complaints of abdominal distension and early satiety. She underwent exploratory laparotomy with presumed diagnosis of carcinoma ovary. Upon exploration she had extensive disease with peritoneal nodules and metastatic deposits over small bowel mesentery. Debulking surgery in form of total abdominal hysterectomy with bilateral oophorectomy, infracolic omentectomy and stripping of anterior peritoneum was done. Postoperative histopathological examination showed presence of high grade adeno carcinoma of left ovary with omental metastasis. On immunohistochemistry cells were immunoreactive for cytokeratin, Glypican 3, SALL 4 and negative for EMA,CK-7,CK-20,PAX8 and OCT 4.The clinical picture was consistent for Yolk Sac tumour. Postoperatively she was planned for chemotherapy with BEP. Her pulmonary function testing was suggestive of severe restrictive disease. She received one cycle of EP. One month later she developed ascites and melena and succumbed to her disease