{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T22:33:34Z","timestamp":1781908414262,"version":"3.54.5"},"reference-count":21,"publisher":"Walter de Gruyter GmbH","issue":"1","license":[{"start":{"date-parts":[[2020,1,1]],"date-time":"2020-01-01T00:00:00Z","timestamp":1577836800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,2,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Germ cell tumors (GCTs) localized extragonadally are rare, with only 14 reported cases of a yolk sac tumor in the endometrium. Here we report a case of mixed endometrium GCTs in a 65-year-old postmenopausal woman with abnormal vaginal bleeding. An ultrasound examination showed an oval-shaped mass in the patient\u2019s uterine cavity. Biochemical examination revealed elevated serum \u03b1-fetoprotein (AFP) at 359 ng\/mL, whereas the tumor markers CA-125, CA-199, and CEA were all within normal range. Total hysterectomy and bilateral salpingo-oophorectomy were performed;. a histological examination revealed that the malignant components contained a yolk sac tumor, embryonal carcinoma, and focal immature teratoma. Immunohistochemical staining showed that AFPs were diffusively distributed in both the yolk sac tumor and embryonal carcinoma. The stem cell marker OCT3\/4 was positive in the embryonal carcinoma component and that the pan-cytokeratin AE1\/AE3 staining was positive in glandular areas. GFAPs (Glial Fibrillary Acidic Proteins) were positive in neuroectodermal tubules; the Ki-67 protein was positive in 90% of the tumor cells, whereas CD117 and placental alkaline phosphatase (PLAP) were negative. The cumulative evidence indicated mixed GCTs of endometrium as the final histopathological diagnosis. The patient received three courses of adjunct chemotherapy that provided good therapeutic efficacy as evidenced by the decreased serum AFP level. Our report on this rare case of mixed GCTs of the endometrium, supported by associated histological patterns and immunophenotypes and successful adjunct chemotherapy after surgery, could provide insight on future treatment of this rare but lethal disease.<\/jats:p>","DOI":"10.1515\/med-2020-0010","type":"journal-article","created":{"date-parts":[[2020,2,7]],"date-time":"2020-02-07T09:01:06Z","timestamp":1581066066000},"page":"65-70","source":"Crossref","is-referenced-by-count":10,"title":["Mixed germ cell tumor of the endometrium: a case report and literature review"],"prefix":"10.1515","volume":"15","author":[{"given":"Heping","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Pathology, Anhui Province Maternal and Child Health Hospital , Hefei 230001 , People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fangyun","family":"Liu","sequence":"additional","affiliation":[{"name":"FenLan Medical Lab , Hangzhou 310052 , People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianguo","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Pathology, Shaoxing People\u2019s Hospital & Shaoxing Hospital of Zhejiang University , Shaoxing , People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debin","family":"Xue","sequence":"additional","affiliation":[{"name":"FenLan Medical Lab , Hangzhou 310052 , People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhengxin","family":"Xie","sequence":"additional","affiliation":[{"name":"FenLan Medical Lab , Hangzhou 310052 , People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunwei","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Pathology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital , Fuzhou 350014 , People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2020,2,4]]},"reference":[{"key":"2022042711563128533_j_med-2020-0010_ref_001_w2aab3b7c81b1b6b1ab2b1b1Aa","doi-asserted-by":"crossref","unstructured":"Kurman RJ, Ellenson LH, Ronnett BM: Blaustein\u2019s pathology of the female genital. (6th edition). Springer Science+business Media, LLC, 2011; 848.","DOI":"10.1007\/978-1-4419-0489-8"},{"key":"2022042711563128533_j_med-2020-0010_ref_002_w2aab3b7c81b1b6b1ab2b1b2Aa","doi-asserted-by":"crossref","unstructured":"Ait Benali H, Lalya I, Allaoui M, Benmansour A, Elkhanoussi B, Benjelloun S, Benjaafar N and Elyaacoubi M: Extragonadal mixed germ cell tumor of the right arm: description of the first case in the literature. World J of Surg Oncol 2012; 10: 69.","DOI":"10.1186\/1477-7819-10-69"},{"key":"2022042711563128533_j_med-2020-0010_ref_003_w2aab3b7c81b1b6b1ab2b1b3Aa","doi-asserted-by":"crossref","unstructured":"Dede M, Pabuccu R, Yagci G, Yenen MC, Goktolga U and Gunhan O: Extragonadal yolk sac tumor in pelvic localization. A case report and literature review. Gynecol Oncol 2004; 92(3): 989-991.","DOI":"10.1016\/j.ygyno.2003.12.026"},{"key":"2022042711563128533_j_med-2020-0010_ref_004_w2aab3b7c81b1b6b1ab2b1b4Aa","unstructured":"Kurman RJ, Carcangiu ML, Herrington S, Yong RH: WHO classification of tumours of female reproductive organs (4th edition).IARC Press: lyon, 2014; 62."},{"key":"2022042711563128533_j_med-2020-0010_ref_005_w2aab3b7c81b1b6b1ab2b1b5Aa","unstructured":"Pileri S, Martinelli G, Serra L and Bazzocchi F: Endodermal sinus tumor arising in the endometrium. Obstet Gynecol 1980; 56(3): 391-396."},{"key":"2022042711563128533_j_med-2020-0010_ref_006_w2aab3b7c81b1b6b1ab2b1b6Aa","doi-asserted-by":"crossref","unstructured":"Clement PB, Young RH and Scully RE: Extraovarian pelvic yolk sac tumors. Cancer 1988; 62(3): 620-626.","DOI":"10.1002\/1097-0142(19880801)62:3<620::AID-CNCR2820620330>3.0.CO;2-P"},{"key":"2022042711563128533_j_med-2020-0010_ref_007_w2aab3b7c81b1b6b1ab2b1b7Aa","doi-asserted-by":"crossref","unstructured":"Ohta M, Sakakibara K, Mizuno K, Kano T, Matsuzawa K, Tomoda Y, Nakashima N and Ogawa T: Successful treatment of primary endodermal sinus tumor of the endometrium. Gynecol Oncol 1988; 31(2): 357-364.","DOI":"10.1016\/S0090-8258(88)80015-5"},{"key":"2022042711563128533_j_med-2020-0010_ref_008_w2aab3b7c81b1b6b1ab2b1b8Aa","doi-asserted-by":"crossref","unstructured":"Joseph MG, Fellows FG and Hearn SA: Primary endodermal sinus tumor of the endometrium. A clinicopathologic, immunocytochemical, and ultrastructural study. Cancer 1990; 65(2): 297-302.","DOI":"10.1002\/1097-0142(19900115)65:2<297::AID-CNCR2820650219>3.0.CO;2-E"},{"key":"2022042711563128533_j_med-2020-0010_ref_009_w2aab3b7c81b1b6b1ab2b1b9Aa","doi-asserted-by":"crossref","unstructured":"Spatz A, Bouron D, Pautier P, Castaigne D and Duvillard P: Primary yolk sac tumor of the endometrium: a case report and review of the literature. Gynecol Oncol 1998; 70(2): 285-288.","DOI":"10.1006\/gyno.1998.5036"},{"key":"2022042711563128533_j_med-2020-0010_ref_010_w2aab3b7c81b1b6b1ab2b1c10Aa","doi-asserted-by":"crossref","unstructured":"Patsner B: Primary endodermal sinus tumor of the endometrium presenting as \u201crecurrent\u201d endometrial adenocarcinoma. Gynecol Oncol 2001; 80(1): 93-95.","DOI":"10.1006\/gyno.2000.6011"},{"key":"2022042711563128533_j_med-2020-0010_ref_011_w2aab3b7c81b1b6b1ab2b1c11Aa","doi-asserted-by":"crossref","unstructured":"Oguri H, Sumitomo R, Maeda N, Fukaya T and Moriki T: Primary yolk sac tumor concomitant with carcinosarcoma originating from the endometrium: case report. Gynecol Oncol 2006; 103(1): 368-371.","DOI":"10.1016\/j.ygyno.2006.04.024"},{"key":"2022042711563128533_j_med-2020-0010_ref_012_w2aab3b7c81b1b6b1ab2b1c12Aa","doi-asserted-by":"crossref","unstructured":"Rossi R, Stacchiotti D, Bernardini MG, Calvieri G and Lo Voi R: Primary yolk sac tumor of the endometrium: a case report and review of the literature. Am J Obstet Gynecol 2011; 204(4): e3-e4.","DOI":"10.1016\/j.ajog.2010.12.014"},{"key":"2022042711563128533_j_med-2020-0010_ref_013_w2aab3b7c81b1b6b1ab2b1c13Aa","doi-asserted-by":"crossref","unstructured":"Wang C, Li G, Xi L, Gu M and Ma D: Primary yolk sac tumor of the endometrium. Int J Gynaecol Obstet 2011; 114(3): 291-293.","DOI":"10.1016\/j.ijgo.2011.03.020"},{"key":"2022042711563128533_j_med-2020-0010_ref_014_w2aab3b7c81b1b6b1ab2b1c14Aa","doi-asserted-by":"crossref","unstructured":"Ji ML, Lu Y, Guo LN, Feng FZ, Wan XR and Xiang Y: Endometrial carcinoma with yolk sac tumor-like differentiation and elevated serum \u03b2-hCG: a case report and literature review. Onco Targets Ther 2013; 24: 1515-1522.","DOI":"10.2147\/OTT.S51983"},{"key":"2022042711563128533_j_med-2020-0010_ref_015_w2aab3b7c81b1b6b1ab2b1c15Aa","doi-asserted-by":"crossref","unstructured":"Abhilasha N, Bafna UD, Pallavi VR, Rathod PS and Krishnappa S: Primary yolk sac tumor of the endometrium: a rare entity. Indian J Cancer 2014; 51(4): 446.","DOI":"10.4103\/0019-509X.175315"},{"key":"2022042711563128533_j_med-2020-0010_ref_016_w2aab3b7c81b1b6b1ab2b1c16Aa","unstructured":"Ozler A, Dogan S, Mamedbeyli G, Rahatli S, Haberal AN, Dursun P and Ayhan A: Primary yolk sac tumor of endometrium: report of two cases and review of literature. J Exp Ther Oncol 2015; 11(1): 5-9."},{"key":"2022042711563128533_j_med-2020-0010_ref_017_w2aab3b7c81b1b6b1ab2b1c17Aa","unstructured":"Hu Y, Zeng F, Xue M and Xiao S: A case report for primary yolk sac tumor of endometrium. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2016; 41(12): 1362-1365."},{"key":"2022042711563128533_j_med-2020-0010_ref_018_w2aab3b7c81b1b6b1ab2b1c18Aa","doi-asserted-by":"crossref","unstructured":"Flanagan CW, Parker JR, Mannel RS, Min KWand Kida M: primary endodermal sinus tumor of the vulva: a case report and review of the literature. Gynecol Oncol 1997; 66(3): 515-518.","DOI":"10.1006\/gyno.1997.4759"},{"key":"2022042711563128533_j_med-2020-0010_ref_019_w2aab3b7c81b1b6b1ab2b1c19Aa","doi-asserted-by":"crossref","unstructured":"Liu SG, Lei B, Li XN, Chen XD, Wang S, Zheng L, Zhu HL, Lin PX and Shen H: Mixed extragonadal germ cell tumor arising from the prostate: a rare combination. Asian J Androl 2014; 16(4): 645-646.","DOI":"10.4103\/1008-682X.122871"},{"key":"2022042711563128533_j_med-2020-0010_ref_020_w2aab3b7c81b1b6b1ab2b1c20Aa","doi-asserted-by":"crossref","unstructured":"Glenn OA and Barkovich AJ: Intracranial germ cell tumors: a comprehensive review of proposed embryologic derivation. Pediatr Neurosurg 1996; 24(5): 242.","DOI":"10.1159\/000121046"},{"key":"2022042711563128533_j_med-2020-0010_ref_021_w2aab3b7c81b1b6b1ab2b1c21Aa","doi-asserted-by":"crossref","unstructured":"Mayordomo JI, Paz-Ares L, Rivera F, L\u00f3pez-Brea M, L\u00f3pez Mart\u00edn E, Mendiola C, D\u00edaz-Puente MT, Lianes P, Garcia-Prats MD and Cort\u00e9s-Funes H: Ovarian and extragonadal malignant germ-cell tumors in females: a single-institution experience with 43 patients. Ann Oncol 1994; 5(3): 225-231.","DOI":"10.1093\/oxfordjournals.annonc.a058797"}],"container-title":["Open Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.degruyter.com\/view\/journals\/med\/15\/1\/article-p65.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.degruyter.com\/document\/doi\/10.1515\/med-2020-0010\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.degruyter.com\/document\/doi\/10.1515\/med-2020-0010\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,4,27]],"date-time":"2022-04-27T16:15:08Z","timestamp":1651076108000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.degruyter.com\/document\/doi\/10.1515\/med-2020-0010\/html"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,1,1]]},"references-count":21,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2020,9,30]]},"published-print":{"date-parts":[[2020,9,30]]}},"alternative-id":["10.1515\/med-2020-0010"],"URL":"https:\/\/doi.org\/10.1515\/med-2020-0010","relation":{},"ISSN":["2391-5463"],"issn-type":[{"value":"2391-5463","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,1,1]]}}}