Long-term outcome of the vaginoscopic approach for infantile vaginal yolk sac tumors: A case report

Introduction: Infantile vaginal yolk sac tumor (YST) is a rare and aggressive form of pediatric cancer that often presents with bloody discharge. Despite advances in chemotherapy, managing post-chemotherapy AFP level rebounds remains a challenge. This case report describes a 7-month-old girl with vaginal YST whose AFP levels rose following 3 cycles of PEB chemotherapy.

Case presentation: Despite aggressive PEB chemotherapy, the patient's AFP levels increased, indicating ongoing disease activity. MRI scans failed to reveal any visible lesions, suggesting a potential oversight in disease assessment. However, a vaginoscopy uncovered a 1.5-cm residual lesion in the vaginal area, highlighting the importance of this procedure in identifying occult disease. The lesion was successfully resected, and histopathological examination confirmed clear margins. Postoperatively, there was a marked decrease in serum AFP levels, and no tumor recurrence was observed over a 60-month follow-up period. The patient's ovarian function and uterine development were preserved.

Clinical discussion: This case underscores the value of a multimodal approach in managing vaginal YSTs, particularly when standard imaging fails to detect residual disease. The vaginoscopic approach not only identified a residual lesion missed by MRI but also allowed for minimally invasive treatment, reducing the need for additional chemotherapy and its associated side effects.

Conclusion: The vaginoscopic approach provides a significant alternative for treating vaginal YSTs, especially in cases where AFP levels rise post-chemotherapy. This method emphasizes fertility preservation and minimizes the impact on reproductive health, offering a promising direction for future treatment strategies in pediatric oncology.