장간막에 발생한 원발성 난황낭종

초록

Yolk sac tumors (YST) may arise in many extragonadal locations in both males and females. The most common extragonadal sites are the sacrococcyx, mediastinum, vagina, brain, and retroperitoneum. YST arising in mesentery is very rare. We have recently encountered one YST that arose in the small bowel mesentery. YST primary at this site have been described only three cases previously. A 28-year old woman, para 1-0-0-1, visited our hospital with a symptom of lower abdominal pain of a month's duration. She underwent cystectomy of right ovary due to simple cyst 7 years ago. Otherwise her past medical and gynecologic history was unremarkable The patient underwent abdominal exploration, which disclosed a large mass involving the mesentery of the terminal ileum, a tumor mass in the liver and multiple tumor nodules in the omentum. No mass in the retroperitoneum, ovaries and uterus was observed. The pathologic specimen consists of a 85cm long segment of small intestine, cecum, ascending colon, uterus and both adnexae. At the distal part of the terminal ileum, there is a large, well circumscribed, oval shaped, whitish-gray solid tumor mass in the mesentery, measuring 9.2x8.0x6.5cm. The mass is tightly adhered to the serosa of ileum, but not invaded the ileal wall. The uterus and both adnexae are umremarkable.The cut surface of the tumor was whitish-yellow to tan, solid appearance with multifocal hemorrhage, necrosis and focal cystic change. Microscopic examination disclosed a cellular neoplasm composed of interlacing and anastomosing trabeculae and papillary formation of pleomorphic epithelioid cells. Honeycomb, reticular, solid and microcystic patterns were present with occasional Schiller-Duval bodies. Extracellular acidophilic hyaline droplets were present. The tumor cells were immunoreactive for α-fetoprotein and α1-antitrypsin.