Retroperitoneal yolk sac tumor with spinal cord compression and intracardiac extension

A patient with an unusual, retroperitoneal yolk sac tumor with intracardiac extension is presented. A 2-year-old boy had an emergency laminectomy with resection of the epidural portion of the tumor. Chemotherapy with cisplatin, VP-16, and bleomycin was then given to reduce the tumor burden. alpha-Fetoprotein levels returned to normal in 8 weeks and a second operation was performed to remove a residual mass in the inferior vena cava. The mass consisted only of fibrosis with no signs of viable tumor. Additional cases of epidural extension of yolk sac tumor are also presented. While the epidural extension was removed surgically, the use of chemotherapy made an open heart surgical procedure unnecessary and was successful in producing a complete response in a patient with an advanced yolk sac tumor.