Traumatic rupture of a yolk sac tumor: A case report

Introduction

Yolk sac tumors are rare neoplasms with a risk of rupture due to their rapid growth and vascularity. There is only one reported case of a ruptured yolk sac tumor in the literature.

Case presentation

A nine-year-old girl presented to an outside hospital with worsening bilateral lower quadrant abdominal pain following a handlebar injury. The patient was tachycardic and tachypneic with a hemoglobin of 7.4 g per deciliter, lactic acid of 7.7 mmol/L, and white blood cell count of 45,000 per μL. A Computed Tomography (CT) scan revealed a large, hypodense 19.1 × 11.4 cm abdominal mass and free fluid concerning for a hematoma with possible peritoneal carcinomatosis. The patient was transfused with one unit of packed red blood cells (PBRCs) given her tachycardia. After transfer from the outside hospital, the patient continued to be tachycardic (143 beats per minute) and tachypneic (36 breaths per minute). A repeat CT was performed, revealing a 6 × 5.5 cm right subhepatic mass and a 16 × 12 cm pelvic mass. In the OR (operating room), a large, multi-cystic hemorrhagic tumor measuring 16.8 cm was discovered in the left pelvis. A second mass was found in the subhepatic space that was a large tumor nodule. The patient underwent left oophorectomy and salpingectomy for tumor resection. An omentectomy was performed due to omental carcinomatosis, with tumor nodules reaching up to 9.5 cm in length. A smaller tumor nodule was resected from the left round ligament. During the operation, the patient received a transfusion of five units of PBRCs, four units of fresh frozen plasma, one unit of platelets, and 2.5 units of crystalloids. Labs taken at the time of surgery revealed an alpha fetal protein (AFP) level of 17,523 ng/mL. The patient was staged as a stage IIIC mixed germ cell tumor with 99% yolk sac and 1% mature teratoma cells. Post-operatively, the patient was treated with BEP chemotherapy, achieving normalization of AFP levels by the end of the fourth cycle.

Conclusion

The aggressive growth pattern of yolk sac tumors places patients at risk of tumor rupture, potentially leading to an acute abdomen. These patients require prompt surgical intervention followed by chemotherapy.