CYTODIAGNOSIS OF VAGINAL ENDODERMAL SINUS TUMOR - A CASE-REPORT

BACKGROUND: Endodermal sinus tumor (EST) of anginal origin is extremel y rare, and few previously published reports have described the cytolo gy of this tumor. CASE: A high serum alpha-fetoprotein (AFP) level and magnetic resonance imaging findings in a 10-year-old female suggested EST of the lower genital tract. Laparotomy revealed EST occupying the pelvic cavity. The patient died on the 17th postoperative day due to complications from disseminated intravascular coagulation. Autopsy was performed immediately after death. The tumor originated in the poster ior vaginal wall directly below the ectocervical area. Both ovaries we re involved, and the tumor proliferated to occupy the cavity of the pe lvis minor. A vaginal smear, obtained on two occasions, revealed sever e necrosis with fe tu cells, and a diagnosis could not be made. An imp rint smear of the tumor obtained during surgery showed relatively char acteristic cytologic findings of EST. Immunocytochemical and immunohis tochemical studies revealed staining positive for AFP. CONCLUSION: Vag inal EST usually occurs in patients under 3 years of age. This 10-year -old patient was the oldest among the reported cases. Vaginal EST is c linically similar to sarcoma botryoides and clear cell carcinoma, and a differential diagnosis is necessary. Immunocytostaining for AFP is e ssential for a definitive cytologic diagnosis of EST.