Endodermal sinus tumor

WikiDoc Resources for Endodermal sinus tumor
Articles
Most recent articles on Endodermal sinus tumor Most cited articles on Endodermal sinus tumor Review articles on Endodermal sinus tumor Articles on Endodermal sinus tumor in N Eng J Med, Lancet, BMJ
Media
Powerpoint slides on Endodermal sinus tumor Images of Endodermal sinus tumor Photos of Endodermal sinus tumor Podcasts & MP3s on Endodermal sinus tumor Videos on Endodermal sinus tumor
Evidence Based Medicine
Cochrane Collaboration on Endodermal sinus tumor Bandolier on Endodermal sinus tumor TRIP on Endodermal sinus tumor
Clinical Trials
Ongoing Trials on Endodermal sinus tumor at Clinical Trials.gov Trial results on Endodermal sinus tumor Clinical Trials on Endodermal sinus tumor at Google
Guidelines / Policies / Govt
US National Guidelines Clearinghouse on Endodermal sinus tumor NICE Guidance on Endodermal sinus tumor NHS PRODIGY Guidance FDA on Endodermal sinus tumor CDC on Endodermal sinus tumor
Books
Books on Endodermal sinus tumor
News
Endodermal sinus tumor in the news Be alerted to news on Endodermal sinus tumor News trends on Endodermal sinus tumor
Commentary
Blogs on Endodermal sinus tumor
Definitions
Definitions of Endodermal sinus tumor
Patient Resources / Community
Patient resources on Endodermal sinus tumor Discussion groups on Endodermal sinus tumor Patient Handouts on Endodermal sinus tumor Directions to Hospitals Treating Endodermal sinus tumor Risk calculators and risk factors for Endodermal sinus tumor
Healthcare Provider Resources
Symptoms of Endodermal sinus tumor Causes & Risk Factors for Endodermal sinus tumor Diagnostic studies for Endodermal sinus tumor Treatment of Endodermal sinus tumor
Continuing Medical Education (CME)
CME Programs on Endodermal sinus tumor
International
Endodermal sinus tumor en Espanol Endodermal sinus tumor en Francais
Business
Endodermal sinus tumor in the Marketplace Patents on Endodermal sinus tumor
Experimental / Informatics
List of terms related to Endodermal sinus tumor

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Monalisa Dmello, M.B,B.S., M.D. [2]; Shivali Marketkar, M.B.B.S. [3]; Ammu Susheela, M.D. [4]

For patient information, click here Synonyms and keywords: Endodermal sinus tumor(EST)

Overview

Endodermal sinus tumor was first discovered by Dr. Gunner Telium, a Danish pathologist, in 1971 following publication of a distinctive variety of germ cell tumor. The hypermethylation of the RUNX3 gene promoter and overexpression of GATA-4, a transcription factor has been associated with the development of endodermal sinus tumor. On gross pathology, solid gray-white with a gelatinous, myxoid, or mucoid appearance, necrosis, cystic changes, and hemorrhage are characteristic findings of endodermal sinus tumor. On microscopic histopathological analysis, Schiller-Duval bodies is a characteristic finding of endodermal sinus tumor. Endodermal sinus tumor must be differentiated from other diseases that cause ovarian mass, such as Stein-Leventhal syndrome ovary teratoma, tubal pregnancy, ovary adenocarcinoma, and tubo-ovarian abscess. Endodermal sinus tumor have a bimodal distribution more commonly observed among young and adult population. The symptoms of endodermal sinus tumor include the following:abdominal distention, acute/sub acute abdominal pain. The mainstay of therapy for endodermal sinus tumor is chemotherapy.

Historical Perspective

• Endodermal sinus tumor was first discovered by Dr. Gunner Telium, a Danish pathologist, in 1971 following publication of a distinctive variety of germ cell tumor.

Classification

• Endodermal sinus tumor may be classified according to histology into 10 groups:

• Reticular
• Endodermal sinus-like
• Microcystic
• Papillary
• Solid
• Glandular
• Alveolar
• Polyvesicular vitelline
• Enteric
• Hepatoid

Pathophysiology

• The hypermethylation of the RUNX3 gene promoter and overexpression of GATA-4, a transcription factor has been associated with the development of endodermal sinus tumor.
• On gross pathology, solid gray-white with a gelatinous, myxoid, or mucoid appearance, necrosis, cystic changes, and hemorrhage are characteristic findings of endodermal sinus tumor.
• On microscopic histopathological analysis, Schiller-Duval bodies is a characteristic finding of endodermal sinus tumor.

Causes

• There are no established causes for endodermal sinus tumor.

Differentiating From Endodermal sinus tumor Other Diseases

Endodermal sinus tumor must be differentiated from other diseases that cause ovarian mass, such as:

• Stein-Leventhal syndrome

• Ovary teratoma

• Tubal pregnancy

• Ovary adenocarcinoma

• Tubo-ovarian abscess

Epidemiology and Demographics

Age

• Endodermal sinus tumor have a bimodal distribution more commonly observed among young and adult population.

Gender

• Endodermal sinus tumor affects men and women equally.

Natural History, Complications and Prognosis

• If left untreated, endodermal sinus tumor may progress to develop death.
• Prognosis is generally dependant on the response to treatment.
• Ovarian germ cell tumor (endodermal sinus tumor) is surgically staged using the FIGO cancer staging system:

Stage	Finding
I	Growth limited to the ovaries
Ia	Growth limited to one ovary; no ascites present containing malignant cells. No tumor on the external surface; capsule intact
Ib	Growth limited to both ovaries; no ascites present containing malignant cells. No tumor on the external surfaces; capsules intact
Icb	Tumor either stage Ia or Ib, but with tumor on surface of one or both ovaries, or with capsule ruptured, or with ascites present containing malignant cells, or with positive peritoneal washings
II	Growth involving one or both ovaries with pelvic extension
IIa	Extension and/or metastases to the uterus and/or tubes
IIb	Extension to other pelvic tissues
IIcb	Tumor either stage IIa or IIb, but with tumor on surface of one or both ovaries, or with capsule(s) ruptured, or with ascites present containing malignant cells, or with positive peritoneal washings
III	Tumor involving one or both ovaries with histologically confirmed peritoneal implants outside the pelvis and/or positive regional lymph nodes. Superficial liver metastases equals stage III. Tumor is limited to the true pelvis, but with histologically proven malignant extension to small bowel or omentum
IIIa	Tumor grossly limited to the true pelvis, with negative nodes, but with histologically confirmed microscopic seeding of abdominal peritoneal surfaces, or histologic proven extension to small bowel or mesentery
IIIb	Tumor of one or both ovaries with histologically confirmed implants, peritoneal metastasis of abdominal peritoneal surfaces, none exceeding 2 cm in diameter; nodes are negative
IIIc	Peritoneal metastasis beyond the pelvis >2 cm in diameter and/or positive regional lymph nodes
IV	Growth involving one or both ovaries with distant metastases. If pleural effusion is present, there must be positive cytology to allot a case to stage IV. Parenchymal liver metastasis equals stage IV

Diagnosis

Symptoms

The symptoms of endodermal sinus tumor include the following:

• Abdominal distention
• Acute/sub acute abdominal pain

Physical Examination

Ovarian Germ Cell Tumor Physical Examination

Abdomen

• Abdominal distention
• Abdominal tenderness

Pelvic exam

• Adnexal mass

Laboratory Findings

• An elevated concentration of serum alpha feto-protein is diagnostic of endodermal sinus tumor.

Imaging Findings

• On MRI, endodermal sinus tumor is characterized by areas of haemorrhage.

Other Diagnostic Studies

• Endodermal sinus tumor may also be diagnosed using biopsy and measurement of GATA-4, a transcription factor.

Treatment

Medical Therapy

• The mainstay of therapy for endodermal sinus tumor is chemotherapy.

Stage I endodermal sinus tumor

• Unilateral salpingo-oophorectomy with adjuvant chemotherapy

Stage II endodermal sinus tumor

• Unilateral salpingo-oophorectomy with adjuvant chemotherapy

Stage III endodermal sinus tumor

• Total abdominal hysterectomy and bilateral salpingo-oophorectomy with adjuvant chemotherapy, with or without neoadjuvant chemotherapy
• Unilateral salpingo-oophorectomy with adjuvant chemotherapy, with or without neoadjuvant chemotherapy

Stage IV endodermal sinus tumor

• Total abdominal hysterectomy and bilateral salpingo-oophorectomy with adjuvant chemotherapy with or without neoadjuvant chemotherapy
• Unilateral salpingo-oophorectomy with adjuvant chemotherapy with or without neoadjuvant chemotherapy

Surgery

Surgery is the mode of treatment for endodermal sinus tumor when chemotherapy is not effective:

Stage I endodermal sinus tumor

• Unilateral salpingo-oophorectomy with adjuvant chemotherapy
• Unilateral salpingo-oophorectomy followed by observation

Stage II endodermal sinus tumor

• Unilateral salpingo-oophorectomy with adjuvant chemotherapy
• Second-look laparotomy

Stage III endodermal sinus tumor

• Total abdominal hysterectomy and bilateral salpingo-oophorectomy with adjuvant chemotherapy, with or without neoadjuvant chemotherapy
• Unilateral salpingo-oophorectomy with adjuvant chemotherapy, with or without neoadjuvant chemotherapy
• Second-look laparotomy

Stage IV endodermal sinus tumor

• Total abdominal hysterectomy and bilateral salpingo-oophorectomy with adjuvant chemotherapy with or without neoadjuvant chemotherapy
• Unilateral salpingo-oophorectomy with adjuvant chemotherapy with or without neoadjuvant chemotherapy

Video

{{#ev:youtube|KGKRaTciMK4}}