case presentation of extra gonadal germ cell tumor

1. Extra-Gonadal Vaginal GermExtra-Gonadal Vaginal Germ
Cell TumorCell Tumor
Dr. Mahmoud Motaz Mohammed,MScDr. Mahmoud Motaz Mohammed,MSc
South Egypt Cancer InstituteSouth Egypt Cancer Institute
Assiut UniversityAssiut University
19-6-201319-6-2013
South Egypt Cancer
Institute
Assiut University

2. WELCOME

3. AcknowledgementAcknowledgement
Prof: Lobna ShalabyProf: Lobna Shalaby
Assistant Prof: Amany M AliAssistant Prof: Amany M Ali
Assistant Prof: Heba A SayedAssistant Prof: Heba A Sayed
Dr. Khaled F riyadDr. Khaled F riyad

4. History of Present Illness:History of Present Illness:
Female patient, 12 years old, presented to usFemale patient, 12 years old, presented to us
on 5/2013 .on 5/2013 .
The condition started on 7/2012 withThe condition started on 7/2012 with
progressive vaginal bleeding, of sidous onset,progressive vaginal bleeding, of sidous onset,
progressive course. First it was minimal inprogressive course. First it was minimal in
the form of few drops so patient saughtthe form of few drops so patient saught
medical advice and diagnosed as hormonalmedical advice and diagnosed as hormonal
disturbance and received hormonal therapydisturbance and received hormonal therapy
with no response.with no response.

5. Continued...Continued...
On 4/2013, the bleeding increased inOn 4/2013, the bleeding increased in
frequency and amount so patient saughtfrequency and amount so patient saught
medical advice and abdominal imaging wasmedical advice and abdominal imaging was
done and revealed vaginal mass so patientdone and revealed vaginal mass so patient
referred to AUH where surgical removal of thereferred to AUH where surgical removal of the
mass then the patient referred to us .mass then the patient referred to us .
The condition wasn't associated with otherThe condition wasn't associated with other
orifical bleeding, body swellings or masses ,orifical bleeding, body swellings or masses ,
history of trauma or child abusehistory of trauma or child abuse

7. ExaminationExamination
Examination:Examination:
- Sexual maturity:Sexual maturity:
- Breast bud: Tanner stage 3-4- Breast bud: Tanner stage 3-4
- Pubic hair: Tanner stage 3-4- Pubic hair: Tanner stage 3-4
-Infra-umbilical midline scare healed by-Infra-umbilical midline scare healed by
primary intentionprimary intention

8. WorkupWorkup
Pre-operativePre-operative
 Imaging workup:Imaging workup:
-Plevic U/S :-Plevic U/S : huge soft tissue mass behind thehuge soft tissue mass behind the
uterusuterus
-MRI of the abdomen and pelvis:-MRI of the abdomen and pelvis: Large upperLarge upper
vaginal soft tissue lesion seen extending into thevaginal soft tissue lesion seen extending into the
posterior vaginal fornix and causing distention of theposterior vaginal fornix and causing distention of the
vagina. It measures 6*6.5*7 cm in its maximumvagina. It measures 6*6.5*7 cm in its maximum
dimensions. Not clearly separable from the cervix.dimensions. Not clearly separable from the cervix.
The uterine body shows normal signal intensity withThe uterine body shows normal signal intensity with
normal endometrial cavity which is seen empty.normal endometrial cavity which is seen empty.

9. WorkupWorkup
Post-operativePost-operative
 Laboratory workup:Laboratory workup:
-- Alpha feto protein:Alpha feto protein: 2.8 ng/ml2.8 ng/ml
-- B- HCGB- HCG: less than 2 ng/ml: less than 2 ng/ml
 Imaging workup:Imaging workup:
--MRI abdomen and pelvis:MRI abdomen and pelvis: No residual or recurrent soft tissueNo residual or recurrent soft tissue
pelvic massespelvic masses
--CT chest :CT chest : freefree
 Pathology reportPathology report
- Suggestive extra-gonadal vaginal yolk sac tumor. The cells give- Suggestive extra-gonadal vaginal yolk sac tumor. The cells give
positive staining of (AFP)positive staining of (AFP)

10. ManagementManagement
Final Diagnosis:Final Diagnosis: Extra gonadal yolk sacExtra gonadal yolk sac
tumor stage 1 (vaginal mass completely resectedtumor stage 1 (vaginal mass completely resected
with no regional lymphadenopathy with tumorwith no regional lymphadenopathy with tumor
markers unknown at presentation but returned tomarkers unknown at presentation but returned to
normal after surgical removal the massnormal after surgical removal the mass