hepatoid yolk sac tumor

Hepatoid differentiation, usually scattered, small clusters of polygonal cells with abundant eosinophilic cytoplasm and prominent nucleoli, is common in yolk sac tumors, occurring in 20% to 22% of cases and is infrequently seen in other ovarian tumors.

Rarely, there is a predominant or pure hepatoid pattern; in males prominent hepatoid differentiation is almost always seen in metastatic lesions resected after chemotherapy, particularly in the context of late recurrence, rather than in the primary.

For pure or predominantly hepatoid ovarian yolk sac tumors, the differential includes the rare hepatoid carcinoma. The occurrence of the latter in older patients and its common admixture with an adenocarcinomatous component of surface epithelial type (usually serous), sometimes evident only in metastases, are helpful findings.

Distinction of hepatoid yolk sac tumor from metastatic hepatocellular carcinoma to the ovary is usually facilitated by knowledge of tumor in the liver, a history of long-standing liver disease and presence in the ovarian tumor of minor foci of yolk sac neoplasia.

Synopsis

 sheets of polygonal cells with abundant eosinophilic cytoplasm
 hyaline globules
 bile canaculi
 sheets of medium-sized, round to polygonal neoplastic cells

• moderate amounts of eosinophilic cytoplasm
• round to oval nuclei with prominent nucleoli

 homogeneous cellular proliferation
 moderate cellular atypia
 scattered mitotic activity
 foci of more conventional areas of yolk sac tumor

• reticular pattern
• scattered intra- and extracellular hyaline globules
• occasional Schiller-Duval bodies

Immunochemistry

 alpha-fetoprotein +

See also

 yolk sac tumor

References

 Devouassoux-Shisheboran M, Schammel DP, Tavassoli FA. Ovarian hepatoid yolk sac tumours: morphological, immunohistochemical and ultrastructural features. Histopathology 1999;34:462–469. PMID: 10231422

 Moran CA, Suster S. Hepatoid yolk sac tumors of the mediastinum: a clinicopathologic and immunohistochemical study of four cases. Am J Surg Pathol. 1997 Oct;21(10):1210-4. PMID: 9331294

 Ishikura H, Scully RE. Hepatoid carcinoma of the ovary. A newly described tumor. Cancer 1987; 60: 2775–2784.

 Hepatoid yolk sac tumor of the ovary (endodermal sinus tumor with hepatoid differentiation): a light microscopic, ultrastructural and immunohistochemical study of seven cases. Prat J, Bhan AK, Dickersin GR, Robboy SJ, Scully RE. Cancer. 1982 Dec 1;50(11):2355-68. PMID: 7139531

 Nakashima N, Fukatsu T, Nagasaka T, et al. The frequency and histology of hepatic tissue in germ cell tumors. Am J Surg Pathol 1987;11:682–692.

 Prat J, Bhan AK, Dickersin GR, et al. Hepatoid yolk sac tumor of the ovary (endodermal sinus tumor with hepatoid differentiation): a light microscopic, ultrastructural and immunohistochemical study of seven cases. Cancer 1982;50:2355–2368.