Parampalli Srinivas Srilatha, Shivamurthy Archana, Rao Lakshmi, Gurumoorthy Bhat Rajeshwari
Dept . of Pathology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India.
Dept. of Pathology, Melaka Manipal Medical College , Manipal Academy of Higher Education, Manipal, Karnataka, India.
Iran J Pathol. 2018 Spring;13(2):289-293. Epub 2018 Jul 17.
Hepatoid variant of yolk sac tumor of ovary is an unusual tumor with an aggressive behavior. It is usually observed in young females, presents with abdominal complaints and is associated with raised α-fetoprotein (AFP) levels. It should be differentiated from other hepatoid tumors involving the ovary. A complete patient evaluation with gross, microscopy, and immunohistochemistry can identify the site of origin to administer appropriate treatment. The current study reported the case of a 30-year-old married parous female presenting with abdominal distention and pain of two months duration. She had regular menstrual cycles. Based on lab investigations her serum AFP level was markedly raised to 34,244 ng/mL (normal range: 0-9 ng/mL). Computerized tomography (CT) scan showed large lobulated heterogeneous mass in both ovaries and omental, gall bladder, and lung metastasis. A CT guided biopsy of the ovarian mass was done. On histopathology, a differential diagnosis of hepatoid variant of yolk sac tumor, hepatoid carcinoma of ovary and hepatoid tumor arising from gall bladder metastasizing to the ovary were observed. Patient underwent surgery. Per operatively gross ascites with bilateral ovarian mass, extensive omental, pelvic, and gall bladder deposits were observed. Bilateral salpingo-oophorectomy with omental deposit biopsy was conducted. Histopathology along with immunohistochemistry confirmed a diagnosis of hepatoid variant of yolk sac tumor in both ovaries with widespread intra-abdominal metastasis.
卵巢卵黄囊瘤的肝样变型是一种具有侵袭性的罕见肿瘤。它通常见于年轻女性，表现为腹部不适，且与甲胎蛋白（AFP）水平升高有关。应将其与其他累及卵巢的肝样肿瘤相鉴别。通过大体检查、显微镜检查和免疫组织化学对患者进行全面评估，可确定肿瘤起源部位，从而进行适当治疗。本研究报告了一例30岁已婚已育女性，出现腹胀和腹痛两个月。她月经周期规律。根据实验室检查，其血清AFP水平显著升高至34244 ng/mL（正常范围：0 - 9 ng/mL）。计算机断层扫描（CT）显示双侧卵巢、大网膜、胆囊及肺部有巨大分叶状不均匀肿块伴转移。对卵巢肿块进行了CT引导下活检。组织病理学检查发现，需对卵黄囊瘤的肝样变型、卵巢肝样癌以及源自胆囊转移至卵巢的肝样肿瘤进行鉴别诊断。患者接受了手术。术中可见大量腹水，双侧卵巢有肿块，大网膜、盆腔及胆囊有广泛转移灶。进行了双侧输卵管卵巢切除术及大网膜转移灶活检。组织病理学检查及免疫组织化学检查确诊双侧卵巢为卵黄囊瘤的肝样变型，伴广泛腹腔内转移。
