J Pathol Transl Med.  2022 May;56(3):152-156. 10.4132/jptm.2021.12.09.

A sinonasal yolk sac tumor in an adult

• Shin J
• Kim JH
• Jung KC
• Cho KJ

• KMID: 2529806
• DOI: http://doi.org/10.4132/jptm.2021.12.09

Abstract

Yolk sac tumors (YSTs), which are also called endodermal sinus tumors, are malignant tumors of germ cell origin. These tumors usually occur in the gonads, but 20% of cases have been reported at extragonadal sites. The head and neck is a rarely affected region that accounts for just 1% of all malignant tumors of germ cell origin. In addition, YSTs arise mostly in childhood. We present a rare pathologically pure case of primary adult YST in the sinonasal area. A 45-year-old male patient presented with a rapidly growing mass in the nasal cavity, which caused nasal obstruction and bloody post-nasal drip. The histopathologic features indicated pure YST, and immunohistochemical analysis revealed positive reactivity for Sal-like protein 4 and alpha-fetoprotein. Herein, we discuss the clinical, radiologic, and histologic features of this YST and review other cases of sinonasal YST in adults.

Keyword

Yolk sac tumor; Endodermal sinus tumor; Paranasal sinus; Nasal cavity; Adult

Figure

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  Fig. 1 Coronal (A) and transverse (B) magnetic resonance imaging shows a mass in the right nasal cavity and bilateral frontal sinus.

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  Fig. 2 Histopathologic findings of a sinonasal yolk sac tumor. (A) Reticular and microcystic growth patterns are observed with loose myxoid stroma. (B) A polyvesicular vitelline pattern is occasionally observed. (C) Schiller-Duval bodies are noted focally. (D) Intra- and extra-cytoplasmic hyaline globules are observed.

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  Fig. 3 On immunohistochemical staining, the tumor cells show diffuse strong nuclear positivity for Sal-like protein 4 (A) and diffuse strong cytoplasmic positivity for α-fetoprotein (B).

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  Fig. 4 Immunohistochemical staining revealed that the tumor cells were negative for p40 (A) and diffusely positive for integrase interactor 1 (B) and Brahma-related gene-1 (C).

Reference

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