Yolk Sac Tumor = Endometrial Sinus Tumor

Yolk Sac Tumor = Endometrial Sinus Tumor

DDx

	Benign	Malignant	Population	Associated Symptom	Tumor Markers
Epithelial	Serous/mucinous “Cystadenoma” or
”Borderline tumor”	Serous (High* vs Low grade) cystadenocarcinoma, Clear Cell, Endometrioid, Mucinous	90-80%, Older age,	‣ Hx (CC/Endometrioid),
‣ (Epithelial)
Sex-cord Stroma	Fibroma, theacoma	Granulosa cell tumor (Estrogen), Sertoli/Lewig (Testosterone)	10-15%, Age 10-30 yo,	GCT: ‣, early puberty,
S/L: ‣	GCT estrogen, ‣
Germ Cell	Dermoid cyst (mature teratoma)	Immature teratoma, Dysgerminoma	5-10%		‣ , ‣ , HCG (tumor, not beta)
Metastatic	X	Krukenberg (GI most common, Lung, Breast, lymphoma)			‣ , ‣ (colon), CA15

*Classic Ovarian Cancer: High Grade Serous Ovarian Ca

Hand-written Note

Investigation

Imaging

ORAD Score (<4) if suspicious → CT CAP

CT CAP Negative ⇒ Staging Surgery (excision biopsy)
- USO → Fronzen Sections
  - if Malignant: follow “Debulking Surgery”
CT CAP Positive ⇒ Debulking Surgery
- Pelvic & Peri-aortic Lymph Node Biopsy
- Omental Biopsy
- Pelvic washing (before removal)

Treatment

Debulking Surgery

Primary Cyto-reductive Surgery
- Surgery (removal ALL disease we can) → Adjudgment Chemo
  - NED (no macroscopic disease)
  - Optimal (no > 1 cm)
  - Sub-optimal
- *Intra-mesenchymal disease = Not resectable
Neoadjuvent chemotherapy
- Chemo → Interval cyto-reductive surgery (+HIPEC) → Repeat Chemo

Chemotherapy

High Grade Serous: Stage 1A would get Chemo (6-8 cycles grouped in 2)

Platinum-Based Chemo (Carboplatin or Cisplatin(Platinol®) )
- Nausea Vomiting Fatigue GI symptos
- Bone Marrow Suppression
- Febril Neutropenia