Yolk sac carcinoma: an immunohistochemical and clinicopathologic review

The records of 14 children with yolk sac carcinoma were reviewed to determine if the production of specific proteins by the tumor could be used to predict the biologic potential of the neoplasm. Several marker proteins were identified by immunohistochemical staining of tissue specimens. The presence or absence of these proteins (periodic acid, Schiff-positive and diastase-resistant globules, alpha-1-antitrypsin, alpha-fetoprotein, beta-subunit of human chorionic gonadotropin and albumin) was of no prognostic significance when survivals free of disease were compared. Six patients underwent retroperitoneal node dissection as part of initial staging (group A), 1 (17 per cent) of whom had retroperitoneal lymphatic metastasis. Eight patients were not subjected to lymphadenectomy initially (group B). Retroperitoneal node dissection did not produce an increase in survival free of disease. Our findings suggest that retroperitoneal node dissection should not be used routinely in all children with yolk sac tumors. Adjunctive chemotherapy has proved extremely effective in salvaging patients in whom metastatic disease develops.