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CASE REPORT Table of Contents   
Year : 2010  |  Volume : 53  |  Issue : 2  |  Page : 345-346
Left ovarian gonadoblastoma with yolk sac tumor in a young woman


1 Department of Pathology, Region Education and Research Hospital, Erzurum, Turkey
2 Department of Pathology, 100. Yil University, Faculty of Medicine, Van, Turkey

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Date of Web Publication12-Jun-2010
 

   Abstract 

Gonodoblastomas with ovarian germ cell tumors other than dysgerminoma coexists very rarely with yolk sac tumor (YST). Because of this rarity, we report a case of gonadoblastoma with YST. An 18-year-old female patient was admitted to our hospital with an abdomino-pelvic mass. Ultrasonographical examinations revealed a 15X14 cm heterogenous pelvic mass with calcific foci in the left adnexal area. Macroscopically, the resected mass was oval and measured 18X15X15 cm and weighed 3150 gm. Histological examination showed both gonadoblastic and YST areas. There were many gonadoblastic nests in the subcapsular areas of the tumor. The gonadoblastic nests were composed of large and small cells. The YST areas showed enteric differentiation and numerous hyaline globules. Immunohistochemical examination may help in the diagnosis of these gonadoblastoma with YST.

Keywords: Gonadoblastoma, immunohistochemistry, yolk sac tumor

How to cite this article:
Gelincik I, Ozen S, Bayram I. Left ovarian gonadoblastoma with yolk sac tumor in a young woman. Indian J Pathol Microbiol 2010;53:345-6

How to cite this URL:
Gelincik I, Ozen S, Bayram I. Left ovarian gonadoblastoma with yolk sac tumor in a young woman. Indian J Pathol Microbiol [serial online] 2010 [cited 2019 Nov 12];53:345-6. Available from: http://www.ijpmonline.org/text.asp?2010/53/2/345/64344



   Introduction Top


Gonadoblastomas are composed of germ cells and sex-cord stromal derivatives, resembling immature granulosa and  Sertoli cells More Details. These tumors are rare neoplasms of dysgenetic gonads which may undergo regression, or become overgrown by malignant germ cell tumors. Yolk sac tumor (YST) usually occurs in girls and young women, either in combination with other components in mixed germ cell tumor or alone in a pure form. [1] In 50-60% of cases, gonadoblastomas are associated with malignant germ cell tumors, mostly presenting as a pure dysgerminoma or less frequently, as immature teratoma, YST, embryonal carcinoma, or choriocarcinoma. [2],[3] Gonadoblastoma with YST origin in an ovary is considered exceedingly rare. Because of its rarity, we report a case of gonadoblastoma with YST.


   Case Report Top


An 18-year-old female patient was admitted to our hospital with an abdomino-pelvic mass. Ultrasonographical examinations revealed a 15X14 cm heterogenous pelvic mass with calcific foci in the left adnexal area. Macroscopically, the resected mass was oval, and measured 18X15X15 cm and weighed 3150 grams. The tumor's surface showed several large nodular excrescences. On cross-section, the tumor was solid and cystic and varied from dark gray to whitish-yellow [Figure 1]. Cut sections were stained with hematoxylin and eosin. Histological examination showed both gonadoblastic and YST areas. There were many gonadoblastic nests in the subcapsular areas of the tumor. The gonadoblastic nests were composed of large and small cells [Figure 2]. The large cells were similar to cells of dysgerminoma. The small cells were similar to immature granulosa, or Sertoli cells. The connective tissue stroma, surrounding gonadoblastic nests, was abundant and cellular [Figure 2]. The YST areas together with gonadoblastic nest showed enteric differentiation [Figure 3]a and the YST had numerous hyaline globules. Immunohistochemically, alpha fetoprotein (AFP) [Figure 3]b and cytokeratin [Figure 3]c were positive in the enteric-like glands of the YST areas. In this tumor, Periodic acid-Schiff (PAS) was positive in hyaline globules [Figure 3]d. Vimentin, CD 30 and CD 117 were negative in both tumor cell types. This case was evaluated as gonadoblastoma with YST with these findings


   Discussion Top


Gonadoblastomas are an unusual mixed germ cell sex cord neoplasms occurring in dysgenetic streak ovaries or abdominal testes that are generally incapable of female sex hormone production but may produce androgenic hormones. [4] It is composed of sex-cord stromal derivatives and germ cells, intimately arranged in nests of two different forms, the microfollicular and coronary patterns. These peculiar nests of uncertain origin and significance are generally surrounded by dense connective tissue, similar to the ovarian cortex. [2],[4],[5] In the present case, the connective tissue stroma surrounding gonadoblastic nests was abundant and cellular.

In general, the stromal component of gonadoblastomas is thought to be benign, although in few cases associated Sertoli cell-like tumors have been reported. [6] YST is a primitive malignant germ cell tumor characterized by a variety of distinctive microscopic patterns, some of which recapitulate phases in the development of the normal yolk sac. [7] YST of the ovary is a rare germ cell tumor that occurs primarily in adolescent girls and young women, and is considered to be the second most common form of malignant germ tumor of the ovary [8] . It is mostly seen in 10 to 29-year-old patients with median ages reported between 16-19 years. YST in postmenopausal patients is rare. [9] in addition, YST of the ovary occurs primarily in adolescent girls, and gonadoblastoma with YST origin in an ovary is considered exceedingly rare in young women. Because of its rarity, we report a case of gonadoblastoma with YST.

 
   References Top

1.Ramalingam P, Malpica A, Silva EG, Gershenson DM, Liu JL, Deavers MT. The use of cytokeratin7 and EMA in differentiating ovarian yolk sac tumors from endometrioid and clear cell carcinomas. Am J Surg Pathol 2004;28:1499-505.  Back to cited text no. 1      
2.Scully RE. Gonadoblastoma. A review of 74 cases. Cancer 1970;25:1340-56.  Back to cited text no. 2      
3.Verp MS, Simpson JL. Abnormal sexual diferentiation and neoplasia. Cancer Genet Cytogenet 1987;25:191-218.  Back to cited text no. 3      
4.Talerman A. Germ cell tumours of the ovary. In: Kurman RJ, editors. Blaustein's Pathology of the female genital tract. 5 th ed. New York: Springer-Verlag; 2002. p. 967-1033.  Back to cited text no. 4      
5.Russell P, Robboy S, Anderson MC. Gonadoblastoma. In: Robboy S, Anderson MC, Russell P, editors. Pathology of the female reproductive tract. Churchill Livingstone; 2002. p. 682-85.  Back to cited text no. 5      
6.Nomura K, Matsui T, Aizawa S. Gonadoblastoma with proliferation resembling Sertoli cell tumor. Int J Gynecol Pathol 1999;18:91-3.  Back to cited text no. 6      
7.Takashina T, Kanda Y, Hayakawa O, Kudo R, Sagae S. Yolk sac tumors of the ovary and the human yolk sac. Am J Obstet Gynecol 1987;156:223-9.  Back to cited text no. 7      
8.Oh C, Kendler A, Hernandez E. Ovarian endodermal sinus tumor in a postmenopausal woman. Gynecol Oncol 2001;82:392-4.  Back to cited text no. 8      
9.Brown JR, Green JD. Yolk sac carcinoma. South Med J 1976;69:728-31.  Back to cited text no. 9      

Top
Correspondence Address:
Ibrahim Gelincik
Bolge Egitim ve Arastirma Hastanesi, Patoloji Klinigi Cat Yolu cad. Yildizkent-Erzurum
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.64344

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    Figures

  [Figure 1], [Figure 2], [Figure 3]

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