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  Table of Contents 
CASE REPORT
Year : 2017  |  Volume : 33  |  Issue : 2  |  Page : 167-168
 

Primary intrarenal yolk sac tumor


1 Department of Uro-oncology, Apollo Hospital, Chennai, Tamil Nadu, India
2 Department of Pathology, Apollo Hospital, Chennai, Tamil Nadu, India

Date of Submission03-May-2016
Date of Acceptance14-Nov-2016
Date of Web Publication30-Mar-2017

Correspondence Address:
P Dholakia Kunal
Department of Uro-oncology, Apollo Hospital, Chennai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-1591.203410

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   Abstract 


Extragonadal germ cell tumors (EGGCTs) usually are not coexistent with a gonadal tumor, hence in a way, are primary and are rare. The origin of primary EGGCT is still a matter of debate. Herewith, we report a patient with primary intrarenal yolk sac tumor in a 43-year-old man. The purpose of this report is to add a rare tumor to the differential diagnosis of renal neoplasms.



How to cite this article:
Ragavan N, Kunal P D, Annapurneshwari S. Primary intrarenal yolk sac tumor. Indian J Urol 2017;33:167-8

How to cite this URL:
Ragavan N, Kunal P D, Annapurneshwari S. Primary intrarenal yolk sac tumor. Indian J Urol [serial online] 2017 [cited 2019 Aug 25];33:167-8. Available from: http://www.indianjurol.com/text.asp?2017/33/2/167/203410





   Introduction Top


Yolk sac tumor (endodermal sinus tumor) (YST) is a malignant germ cell tumor that usually arises in the gonads. Rare occurrence of extragonadal germ cell tumors is known to occur in the mediastinum, retroperitoneum, sacrococcygeal region, and pineal gland.[1] We report an isolated intrarenal YST in an adult who presented with a renal mass.


   Case Report Top


A 43-year-old male presented with left upper abdominal pain, mildly tender palpable mass, normal genitals, and unremarkable previous surgical issues. Imaging revealed bilateral renal calculi along with grossly enlarged, calculi laden, hydronephrotic left kidney, intrarenal mass lesion of renal pelvis, and perinephric stranding. Multiple enlarged necrotic retroperitoneal nodes were noted [Figure 1].
Figure 1: Contrast enhanced computed tomography scan showing heterogeneous mass in the left renal pelvis (thick white arrow) with multiple calculi with gross hydronephrosis with thinned out parenchyma with paraaortic lymphadenopathy (thin white arrow)

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With the clinical suspicion of xanthogranulomatous pyelonephritis with squamous metaplasia/carcinoma, open left radical nephrectomy, and excision of palpable retroperitoneal nodes was performed.

Histopathological examination revealed high-grade malignant germ cell tumor with features favoring for YST (Schiller-Duval body, microcytic, and solid pattern along with hyaline globules stained dark pink on D-PAS stain) with positive metastatic nodes. Immunohistochemistry confirmed YST (alpha-fetoprotein [AFP], cytokeratin, placental-like alkaline phosphatase, CD30, glypican 3 positivity and negative for c-kit and beta-human chorionic gonadotropin [HCG]) [Figure 2]. Subsequent scrotal ultrasonography did not show echogenicity/scars. Serum AFP levels of 2640 ng/mL with normal beta-HCG and lactate dehydrogenase levels. The patient has been advised adjuvant chemotherapy.
Figure 2: Histopathological images, (a) low power view of the entire tumor depicting microcytic and solid pattern, (b) high power view showing Schiller-Duval bodies (thick arrow) and hyaline globules stained dark pink on D-PAS stain (thin arrow); immunohistochemistry images, (c) alpha-fetoprotein positive, (d) placental alkaline phosphatase positive and (e) glypican 3 positive

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   Discussion Top


Extragonal YST is rare and intrarenal tumor has been reported in pediatric age group.[2],[3],[4],[5] To the best of our knowledge, this is the first reported case of an intrarenal YST in adults. The purpose of this report is to add a rare tumor to the differential diagnosis of renal neoplasms.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Garnick MB, Canellos GP, Richie JP. Treatment and surgical staging of testicular and primary extragonadal germ cell cancer. JAMA 1983;250:1733-41.  Back to cited text no. 1
    
2.
Kumar Y, Bhatia A, Kumar V, Vaiphei K. Intrarenal pure yolk sac tumor: An extremely rare entity. Int J Surg Pathol 2007;15:204-6.  Back to cited text no. 2
    
3.
Radhika S, Bakshi A, Rajwanshi A, Nijhawan R, Das A, Kakkar N, et al. Cytopathology of uncommon malignant renal neoplasms in the pediatric age group. Diagn Cytopathol 2005;32:281-6.  Back to cited text no. 3
    
4.
Liu YC, Wang JS, Chen CJ, Sung PK, Tseng HH. Intrarenal mixed germ cell tumor. J Urol 2000;164:2020-1.  Back to cited text no. 4
    
5.
Lin S, Li X, Sun C, Feng S, Peng Z, Huang S, et al. CT findings of intrarenal yolk sac tumor with tumor thrombus extending into the inferior vena cava: A case report. Korean J Radiol 2014;15:641-5.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2]



 

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