A Rare Pathology in Gynecologic Oncology - Endodermal Sinus Tumor

Endodermal sinus tumor of the ovary is a primitive malignant germ cell tumor. They constitute 2-5% of all ovarian malignancies. It is rare and very aggressive, frequently occurring in adolescents and young adult women, rare in postmenopausal women. For this reason, the conservative surgery with fertility preservation/sparing is required as a first step, followed by adjuvant chemotherapy considering the sensitivity of this tumor for chemotherapy. In the last 5 years, we have diagnosed 2 patients with endodermal sinus tumor. A-21-years old woman, respectively a-31-years old woman presented in our hospital with abdominal distension, pelvic pain and ascites. The ultrasound examination revealed a unilateral uterine mix echogenic mass and a big quantity of ascites liquid. Serum human gonadotropin hormone level was under 1mIU/ml, serum level of the AFP was elevated. After clinical and imagistic examination (ultrasound, CT/IRM) we decided surgery for imagistic suspect ovarian tumor and ascites for histopathological confirmation in order to diagnosis and staging of disease. In the first case, the conservative surgery was practiced and it consisted in right salpingo-oophorectomy, inframezocolic omentectomy and bilateral pelvic lymphadenectomy (external iliac and obturator lymph nodes), serial peritoneal biopsies. At the second patient, because she didn't want to preserve fertility, the surgery consisted in total abdominal hysterectomy with bilateral salpingo-oophorectomy, omentectomy and bilateral pelvic lymphadenectomy (external iliac and obturator lymph nodes), serial peritoneal biopsies. In both cases, the histopathological diagnosis was endodermal sinus tumor without peritoneal, pelvic lymph nodes and omental metastasis. We planned an adjuvant chemotherapy with etoposide and cisplatin. The postoperative course was without complications and the alphafetoprotein levels decreased and it has remained low until now. The follow-up of the case evolution is made with serum level of AFP, clinical and imagistic examination. Endodermal sinus tumors are rare and aggressive; they metastasize early and invade intraabdominal structures. The treatment should be prompt for limiting expansion and increasing survival rates. The standard management of yolk sac tumors is based on radical surgery or conservative surgical treatment, considering the patient's desire for procreation associated with adjuvant chemotherapy and a careful follow-up (AFP levels, clinical and imagistic examination). The prognosis depends on the stage of the disease, the surgery (optimal or not) and the evolution of the serum level of AFP.