腹腔鏡下生検により診断し、早期に化学療法を開始できた卵黄嚢腫瘍の一例

抄録

  Yolk sac tumors are found in approximately 1% of all ovarian malignancies. Many cases of yolk sac tumors develop at a young age. For the treatment of yolk sac tumors, early initiation of postoperative chemotherapy is effective. Generally, for good effects from postoperative chemotherapy for yolk sac tumors, surgery is performed to preserve the patient's fertility. We present a case of peritoneal dissemination, which was diagnosed as a yolk sac tumor using laparoscopic biopsy. The tumor developed postadnexectomy for a mature cystic teratoma and we were able to start early postoperative chemotherapy. A 16-year-old girl was hospitalized due to a sensation of abdominal fullness. Magnetic resonance imaging revealed a giant abdominal tumor that was suspected of being an immature teratoma. We performed left uterine adnexectomy and omentectomy using laparotomy, based on an intraoperative rapid diagnosis of an immature teratoma. The final pathological diagnosis was a mature cystic teratoma, so the patient did not receive any postoperative treatment. Seven months after surgery, she experienced lower abdominal pain. Computed tomography revealed peritoneal dissemination, and the serum alpha-fetoprotein level was 1938 ng/ml. We performed a tissue biopsy using laparoscopic surgery, and we made a diagnosis of a yolk sac tumor. We promptly administered BEP chemotherapy (bleomycin, etoposide, and cisplatin) after laparoscopic surgery, and treatment has been successful. This case shows that laparoscopic surgery could be a minimally invasive diagnostic method for patients who should start receiving chemotherapy soon after surgery.