Abstract:

Yolk sac tumor is a highly malignant yet curable germ cell tumor. We report a case of advanced-stage (FIGO stage Ⅲ) pure ovarian yolk sac tumor characterized by extreme serum alpha-fetoprotein (AFP) elevation (>60 500 ng/mL) and rare direct myometrial invasion. The patient underwent cytoreductive surgery followed by postoperative bleomycin, etoposide, and cisplatin (BEP) chemotherapy. A rapid decline in AFP was achieved post-treatment; however, early objective evidence of bleomycin pulmonary toxicity, manifested as a decline in pulmonary function. Through dynamic assessment of tumor response and toxic effects, and with intensive pulmonary function monitoring, the patient completed the planned BEP regimen. Serum AFP level subsequently normalized (14.47 ng/mL), imaging demonstrated a significant reduction in peritoneal lesions and complete resolution of the splenic metastasis, indicating a favorable prognosis. This case demonstrates that standardized multimodal therapy can achieve significant efficacy even in the presence of an extremely high tumor burden. Furthermore, for young women presenting with a pelvic mass, abnormal AFP elevation, and abnormal uterine morphology, the possibility of local invasion by a yolk sac tumor should be considered.

Key words: Neoplasms, germ cell and embryonal, Endodermal sinus tumor, Alpha-fetoproteins, Bleomycin, Diagnosis, Therapy