Tariq Mufti, M Saeed Khan, Muzher U Dua, Farah Waqar.
Malignant Sacrococcygeal Yolk Sac (Endodermal Sinus) Tumor.
J Ayub Med Coll Abottabad Jan ;14(2):28-30.

We report a 2½ years old female child who presented with Malignant Sacrococcygeal Yolk sac (Endodermal Sinus) tumor as presacral mass with ulceration of overlying skin. Her ultrasonography (USG) abdomen revealed a huge presecral mass with irregular margins extending in to the pelvis, pushing the rectum antero-laterally. CT scanning of abdomen confirmed USG finding with out enlargement of retroperitoneal lymph nodes and no involvement of the liver. Serum AFP was abnormally elevated. The tumor was excised along with Coccyx in-toto through posterior approach dividing the sacrum and 3-Drugs (VAC) Chemotherapy started post-operatively i.e. 2-weeks after surgery. Here we discuss our experience with this extremely rare malignant extra-gonadal germ-cell tumor and review of literature.

Case Report: The parents of this young baby gave history of appearance of painless swelling over sacral region with gradual increase in size of 5-6 months duration. The child was taken to the nearest doctor. A biopsy piece was taken for laboratory diagnosis. The histopathology report (AFIP) revealed Malignant Yolk sac (endodermal sinus) tumor. The patient was referred to Ayub Teaching Hospital Complex (ATHC), Abbottabad for necessary treatment. Where she got admitted in Surgical-A unit. Her USG abdomen revealed a huge (solid) presacral mass with irregular margins extending into the pelvis pushing the rectum antero-laterally. CT scanning of abdomen also confirmed these findings. Retro-Peritoneal lymph nodes were not enlarged, no metastases in liver were reported in C.T scan. Her x-ray chest was clear. Her AFP was raised. Patient was staged as stage-II according to St. Jude Children research hospital staging system and operated i.e removing the tumor in one piece along with coccyx after dividing the sacrum through posterior approach. No serious complications occurred during surgery and her post- operative recovery was excellent.

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