Pitfalls in the diagnosis of yolk sac tumor: Lessons from a clinical trial

Adeline Yang; Alison Patterson; Tara Pavlock; Kenneth S Chen; Jeffrey Gagan; Mark E Hatley; A Lindsay Frazier; James F Amatruda; Theodore W Laetsch; Dinesh Rakheja

doi:10.1002/pbc.29451

Pitfalls in the diagnosis of yolk sac tumor: Lessons from a clinical trial

Pediatr Blood Cancer. 2022 Feb;69(2):e29451. doi: 10.1002/pbc.29451. Epub 2021 Dec 5.

Authors

Adeline Yang^{1

2}, Alison Patterson³, Tara Pavlock^{1

3}, Kenneth S Chen^{1

3}, Jeffrey Gagan⁴, Mark E Hatley⁵, A Lindsay Frazier⁶, James F Amatruda⁷, Theodore W Laetsch^{1

3

8}, Dinesh Rakheja^{2

4}

Affiliations

¹ Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas.
² Children's Medical Center, Dallas, Texas.
³ Pauline Allen Gill Center for Cancer and Blood Disorders, Children's Medical Center, Dallas, Texas.
⁴ Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas.
⁵ Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.
⁶ Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, Massachusetts.
⁷ Division of Hematology-Oncology, Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California.
⁸ Division of Oncology and Center for Childhood Cancer Research, Children's Hospital of Philadelphia and Department of Pediatrics and Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania.

Abstract

Though outcomes for patients with recurrent/refractory malignant germ cell tumors (mGCTs) are poor, therapies targeting mTOR and EGFR inhibition have shown promise in vitro. We hypothesized that the combination of sirolimus and erlotinib will show activity in patients with recurrent/refractory mGCTs. Patients were enrolled in a prospective phase II clinical trial; central review of existing pathology specimens was performed. Of the five patients evaluated, two had their diagnoses revised to pancreatic acinar cell carcinoma and alpha-fetoprotein (AFP)-secreting gastric adenocarcinoma, respectively. Although mGCTs are common AFP-secreting neoplasms, recurrence or refractoriness to standard regimens should prompt histologic reevaluation for other diagnoses.

Keywords: alpha-fetoprotein-secreting gastric adenocarcinoma; malignant germ cell tumor; pancreatic acinar cell carcinoma; refractory; relapse; yolk sac tumor.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Clinical Trials, Phase II as Topic
Endodermal Sinus Tumor* / diagnosis
Endodermal Sinus Tumor* / drug therapy
Humans
Neoplasm Recurrence, Local
Neoplasms, Germ Cell and Embryonal*
Prospective Studies
alpha-Fetoproteins

Substances

alpha-Fetoproteins

Abstract

Publication types

MeSH terms

Substances

Grants and funding