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1 23
Journal of Gastrointestinal Surgery
ISSN 1091-255X
J Gastrointest Surg
DOI 10.1007/s11605-016-3123-1
Giant Primary Yo...
1 23
Your article is protected by copyright and all
rights are held exclusively by The Society for
Surgery of the Alimenta...
GI IMAGE
Giant Primary Yolk Sac Tumor of the Liver
Aleksandr A. Reznichenko1
& Lindsey R. Klingbeil1
& Shimul A. Shah1
Rec...
embryogenesis in mature liver. The clinical behavior of the
YST of the liver also is unclear.1
After diagnosis, the gold
s...
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10.1007_s11605-016-3123-1 YST

  1. 1. 1 23 Journal of Gastrointestinal Surgery ISSN 1091-255X J Gastrointest Surg DOI 10.1007/s11605-016-3123-1 Giant Primary Yolk Sac Tumor of the Liver Aleksandr A. Reznichenko, Lindsey R. Klingbeil & Shimul A. Shah
  2. 2. 1 23 Your article is protected by copyright and all rights are held exclusively by The Society for Surgery of the Alimentary Tract. This e-offprint is for personal use only and shall not be self- archived in electronic repositories. If you wish to self-archive your article, please use the accepted manuscript version for posting on your own website. You may further deposit the accepted manuscript version in any repository, provided it is only made publicly available 12 months after official publication or later and provided acknowledgement is given to the original source of publication and a link is inserted to the published article on Springer's website. The link must be accompanied by the following text: "The final publication is available at link.springer.com”.
  3. 3. GI IMAGE Giant Primary Yolk Sac Tumor of the Liver Aleksandr A. Reznichenko1 & Lindsey R. Klingbeil1 & Shimul A. Shah1 Received: 19 February 2016 /Accepted: 28 February 2016 # 2016 The Society for Surgery of the Alimentary Tract Keywords Yolk sac tumor . Hepatocellular carcinoma . Liver resection Case Presentation A 39-year-old female with prior history of obesity and C- section developed right upper quadrant abdominal pain. She did not have fever, nausea and vomiting, or weight loss. Her pain was worse with deep breath but was not affected by food. She stopped taking birth control pills 14 years ago. Her BMI was 36.75. On physical exam, she had a large palpable mass in right upper quadrant. Her labs were prominent for Alpha- fetoprotein (AFP) 34.321 and Human chorionic gonadotropin (hCG) 22. A CT of the abdomen and pelvis with contrast showed a giant 25 cm solid heterogeneous mass in the right lobe of the liver (Fig. 1), and additional smaller masses in segments 4a and 5 measuring 4 and 3.5 cm, respectively (Fig. 2). All of the liver masses demonstrated peripheral and septal enhancement on the arterial and portal venous phases, which was highly suspicious for malignancy. Patient underwent right extended hepatectomy. There was a giant tumor in the right hepatic lobe with significant neovas- cularization of the adjoining areas, including inferior vena cava and diaphragm. Large specimen was removed (Fig. 3). Final pathology showed malignant neoplasm with marked necrosis, consistent with yolk sac tumor (YST), all margins of resection were negative for tumor, and there were no lympho- vascular invasion. Patient made uneventful recovery and was discharged to home on day 7. Three weeks after the procedure, her AFP was 851, and hCG was <1. She was referred to a medical oncologist. Primary YST tumors of the liver are rare. Only few cases of liver yolk sac tumor in adults were reported. The histogenesis of primary YST of the liver is unclear. It has been suggested that YSTs might originate from a germ cell that escaped its migration course from the yolk sac to the genital ridge during embryogenesis. Alternatively, the embryonic cell theory fa- vors the persistence of pluripotential embryonic cells that es- caped the influence of the differentiation process during Fig. 1 CT abdomen with contrast, axial view, arterial phase. Large heterogeneous mass (yellow arrow) in the right hepatic lobe * Aleksandr A. Reznichenko reznicaa@ucmail.uc.edu 1 Division of Transplant Surgery, Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, Suite 1555, Cincinnati, OH 45267-0519, USA J Gastrointest Surg DOI 10.1007/s11605-016-3123-1 Author's personal copy
  4. 4. embryogenesis in mature liver. The clinical behavior of the YST of the liver also is unclear.1 After diagnosis, the gold standard treatment is surgery, usually followed by adjuvant chemotherapy, with a reported mortality rate greater than 50 %. Although the morphologic features of hepatic YST have been described in the literature, this rare neoplasm fre- quently poses significant diagnostic problems. The serum AFP is uniformly elevated in HCC, hepatoblastoma, and YST, which is making preoperative differential diagnosis on the basis of serum markers quite difficult. Reported imaging findings of YST range from solid to predominantly cystic mass with heterogeneous appearances and prominent en- hancement on contrast or post contrast CT phases, like a large nodule of HCC. The female gender, age less than 30 years, very high levels of serum AFP, and the presence of a predom- inantly cystic mass within a non-cirrhotic liver were consid- ered suggestive of YST.2 In this case, both hepatocellular carcinoma and YST were considered preoperatively in the differential diagnosis. However, based on the patient age, CT findings, size of the major tumor, and presence of multifocal liver masses, HCC was primarily considered. Our case is noticeable because of the giant (25 cm) size of the primary liver YST. To our knowledge, this is the first report of multifocal YST in the liver. References 1. Toumi N, Chaumette-Plankaert MT, Cherqui D, de Revel T, Duvillard P, Theodore C. Germ cell tumors. Case 3. Primary yolk sac tumor of the liver. J Clin Oncol. 2004 May 1; 22(9):1756–8. 2. Lenci I, Tariciotti L, Baiocchi L, Manzia TM, Toti L, Craboledda P, Callea F, Angelico M, Tisone G. Primary yolk sac tumor of the liver: incidental finding in a patient transplanted for hepatocellular carci- noma. Transpl Int. 2008 Jun; 21(6):598–601. Fig. 3 Resected specimen. Giant mass (red arrow) occupying most of the right hepatic lobe. Smaller mass (yellow arrow) in segment 5 Fig. 2 CT abdomen with contrast, coronal view, venous phase. Large heterogeneous mass (yellow arrow) in the right hepatic lobe. Two additional smaller lesions (red arrow) in segments 4a and 5 J Gastrointest Surg Author's personal copy

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