VAGINAL YOLK SAC TUMOR IN AN INFANT-MANAGEMENT DILEMMA.

Dr Shailesh Patel; Dr Mayur Manchaiah; Dr Mukesh Chaudhary; Dr Ajay Kumar; Dr Harish Neelamraju Lakshmi

Volume : VIII, Issue : IV, April - 2019

VAGINAL YOLK SAC TUMOR IN AN INFANT-MANAGEMENT DILEMMA.

Dr Shailesh Patel, Dr Mayur Manchaiah, Dr Mukesh Chaudhary, Dr Ajay Kumar, Dr Harish Neelamraju Lakshmi

Abstract :

Malignant Germ Cell Tumors are extremely rare in pediatric age group. Yolk sac tumor of vagina is a highly malignant, rare form of GCT and is seen exclusively in children less than 3 years. There are no treatment guidelines for this malignancy as the literature is limited to few case reports. Treatment options are primary chemotherapy, induction chemotherapy with conservative surgery or radical surgery. A 12 month old female infant was referred to our center for intermittent vaginal bleeding. The clinical examination revealed a grape like material per vaginally. She had elevated serum AFP levels (7781ng/ml), and MRI pelvis suggested mass lesion involving uterus and upper vagina. Histopathological examination suggestive of yolk sac tumor, confirmed by IHC (PLAP– strong positive, AFP, AE1, B–HCG positive). Patient was treated with chemotherapy (JEB). There was complete clinical and radiological response and decreased serum AFP levels. After DFS of 4 months patient developed recurrent lesion and had raised serum AFP levels. As parents didn�t consent for surgery she was started on second line chemotherapy (VeIP). The size of recurrent lesion and serum AFP levels decreased but patient developed lung metastasis.