A Case of Pimary Yolk Sac Tumor of the Liver

Shunji Narumi, Yukimasa Momota, Michihiro Sugai, Mutsuo Sasaki, Hiroyuki Ohnuma*, Keiji Matsuda*, Yasuo Itoh*

Second Department of Surgery, Hirosaki University School of Medicine
*Department of Surgery, Mutsu Municipal Hospital

A primary yolk sac tumor of the liver, which is very rare with only 3 previous reports worldwide, occurring in a 27-year-old woman is described. She complained of right flank pain that rediated to the right shoulder. Ultrasonography revealed a liver tumor and serum alpha-fetoprotein (AFP) and lactate dehydrogenase (LDH) levels were highly elevated. As an aspiration biopsy indicated a possible diagnosis of hepatocellular carcinoma, right hepatectomy was performed. The definite diagnosis of primary yolk sac tumor was established by postoperative pathological examination. Four months later, she complained of severe cough and an abdominal mass. Pleural effusion and a metastatic great omental tumor were uncovered by chest X-ray and computed tomography. An anticancer regimen (PVB chemotherapy) containing CDDP, VLB, and MMC was given twice in two months and had a marked effect, leading to diminution of the pleural effusion and a decrease in the size of the abdominal tumor and in the levels of AFP and type l-dominant LDH. However, the abdominal tumor and ascites increased again, with extreme increases in AFP and LDH, 7 months after the last PVB treatment. She died of hepatic failure 16 months after the surgery. Ultrasonography and angiography seemed to be useful for the diagnosis of this rare disease. The serum level of AFP and type 1 dominant LDH well reflected the clinical course. PVB chemotherapy was very effective in palliation of this disease.

Key words
yolk sac tumor, α-fetoprotein

Reprint requests
Shunji Narumi Second Department of Surgery, Hirosaki University School of Medicine, 5 Zaifu-cho, HIrosaki, 036 JAPAN

Accepted
October 11, 1989

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