Ovarian Yolk Sac Tumor Presenting as an Acute Urinary Infection: Case Report

Introduction: Yolk sac tumor(YST) or endodermal primitive tumor represents the commonest non-germinomatous among all malignant ovarian germ cell tumors(MOGCTs) and accounts for almost 3,5% of all childhood cancers.It usually arises in gonads,testicles or ovaries,and it should be considered in patients with a history of intermittent abdominal pain and fever,that have already reached out for medical assessment multiple times without significant findings.It is highly malignant growing rapidly with very short duration of symptoms.It tends to metastasize through the hematogenous route in >50% of pediatric patients.The treatment consists of surgery followed by chemotherapy.

Objective: A highly malignant tumor presenting with mild “innocent” symptoms.

Methods: We present a 14-year-old adolescent girl who was brought to our emergency department due to abdominal pain starting 24hours prior to her admission and dysuria.Discomfort of the lower abdomen had begun a few weeks earlier.During her clinical evaluation we found temperature of 37.3oC,BP:111/63mmHg,SO2:100% and pain while palpating the epigastrium with normal bowel sounds auscultation.A laboratory examination revealed increased CRP:9,97mg/dl(0-0,7mg/dl),anaemia(Hb:10,5g/dl) and abnormal urine examination with white blood cells(wbc:+2) and protein(pro:+1).

Results: An abdominal ultrasound was performed were a mass in the right ovary was revealed,a complicated cystic mass with abnormal wall and parenchyma and diameter of almost 11cm.Ascites and right pleural infusion were also observed.The levels of a-fetoprotein(aFP) and Ca-125 were 15.517ng/ml and 151,7U/ml respectively,while b-human chorionic gonadotropin(b-HCG) was normal,confirming the diagnosis of a yolk sac tumor of the right ovary.The girl was transferred to a Pediatric Oncology department where she underwent surgery 6days later and afterwards chemotherapy for the following 4months.Since then, she has been disease-free in all her follow-ups.

Conclusion: Although malignancies are rare in childhood,there should always be in our minds when dealing with persistent symptoms with unclear diagnosis.As they tend to present with mild routine symptoms,a high suspicion must grow in unresolved cases,which keep returning for medical evaluation.