Yolk Sac TumorMasquerading AsPericarditis: A Case Report
Introduction:Yolk sac tumor is a rare form of a germ cell tumor (GCT).This case report describes an unusual presentation of a yolk sac tumor with pericarditis, pericardial effusionand bilateral microlithiasis (MT) in a young Vietnamese male with extragonadal GCT in the anterior mediastinum.
Presentation of Case:A 23-year-old Vietnamese male with one-pack year smoking history, but no other significant past medical history presented with nonproductive cough and pleuritic chest pain for 2 weeks. Chest pain was described as sharp and localized to the right-side of his substernal area. B-symptoms were present for 1 month and included: weight loss of 10lbs, night sweats and fever.Physical exam showeddiminished breath sounds on the right side of the chest w/o accessory muscle use. CT of the chest revealed a large 14 cm round mass in the right middle lobe with possible extension to the mediastinum, moderate right pleural effusion and pericardial effusion.EKG showed a pattern consistent with pericarditis. Biopsy of the mediastinal mass was consistent with yolk sac tumor. LDH was 543, AFP 7200, and β-HCG<2.Testicular ultrasound did not find any testicular masses, but there was bilateral testicular microlithiasis. The patient was started on BEP (Bleomycin + Etoposide + Cisplatin) chemotherapy with subsequent thoracotomy and mass resection.
Conclusion:Younger patients presenting with pleural effusions and pericarditis need a detailed history and physical examination in order to diagnosea yolk sac tumor.
Young RH,& Scully RE. Testicular and paratesticular tumors and tumor‐like lesions of ovarian common epithelial and mullerian types. A report of four cases and review of the literature. Am J Clin Pathol. 1986, 86:146-52
Stang A, Trabert B, Wentzensen N, et al. Gonadal and extragonadal germ cell tumors in the United States, 1973-2007. Int J Androl. 2012, 35(4):616-25
Johnson DE, Laneri JP, Mountain CF, et al. Extragonadal germ cell tumors.Surgery. 1973, 73: 85-90
Kuzur ME, Cobleigh MA, Greco FA, et al. Endodermal sinus tumor of the mediastinum. Cancer.1982, 50(4):766-74
Nichols CR, Mediastinal germ cell tumors. Seminars in Thoracic and Cardiovascular Surgery.1992, 4(1):45-50
Talerman A.Germ cell tumors.Ann Pathol.1985, 5(3):145-57
Nakhla SG, &Sundararajan S. A Rare Case of Primary Anterior Mediastinal Yolk Sac Tumor in an Elderly Adult Male. Case Rep Oncol Med. 2016, 2016:8961486
Fizazi K, Culine S, Droz JP, et al. Primary mediastinal nonseminomatous germ cell tumors: results of modern therapy including cisplatin-based chemotherapy. Journal of Clinical Oncology. 1998, 16(2):725-732
Woodward PJ, Schwab CM,&Sesterhenn IA. From the archives of the AFIP: Extratesticular scrotal masses: Radiologic-pathologic correlation. Radiographics. 2003, 23:215-40
Lisieux EJ, Maciel F, Monnerat AC, et al. Testis tumor associated to microlithiasis. RevistaPaulista de Pediatria. 2013, 31(4): 554-558
Janzen DL,& Mathieson JR. Testicular microlithiasis and seminoma. Clin Radiol.1993, 48:219-220
Tan MH,&Eng C. Testicular microlithiasis: recent advances in understanding and management. Nat Rev Urol.2011, 8:153-63
Chamsi-Pasha M,& Bernstein A. Mediastinal yolk sac tumor mimicking pericardial effusion.Thorax. 1988, 43: 339-40
Edoute Y,& Ben-Arie Y. Primary malignant mediastinal germ cell tumor causing pericardial effusion. Harefuah.1996, 131:88-89.
Little WC,& Freeman GL. Pericardial disease. Circulation. 2006, 113:1622-1632
- There are currently no refbacks.