The University of Toledo Translation Journal of Medical Sciences 
Internal Medicine Abstract, Department of Medicine Research Symposium UTJMS 2023 May 05; 11(1):e1-e1 

Primary Esophageal Extra-Gonadal Yolk 
Sac Tumor Metastasized to the Liver 
Ziad Abuhelwa, MD1*, Azizullah Beran, MD1, Saif-Eddin Malhas, MD1, Wasef 
Sayeh1, Omar Sajdeya1, Caleb Spencer1, Ragheb Assaly, MD2

1Division of Internal Medicine, Department of Medicine, The University of Toledo, 
Toledo, OH 43614 
2Division of Pulmonology and Critical Care, Department of Medicine, The 
University of Toledo, Toledo, OH 43614 

*Corresponding author: ziad.abuhelwa@utoledo.edu

Published: 05 May 2023 

Introduction:  Extra-gonadal germ cell tumors (EGCTs) usually arise from midline structures such as 
the retroperitoneum, mediastinum, and sacrococcygeal region. EGCTs originating from the 
gastrointestinal system such as the stomach and esophagus are rarely reported. No reported case of 
primary esophageal yolk sac tumor (YST) has been published yet in the literature. 

Case Presentation:  A 62-year-old male presented with difficulty swallowing and feeling of food stuck 
in the middle of his chest for two months. There were associated right upper-quadrant abdominal pain, 
early satiety, and weight loss (25 pounds) in the last three months. Abdominal CT demonstrated 
abnormal thickening in the distal esophagus and metastatic disease in the liver adjacent to the distal 
esophagus. Biopsy of the liver lesions showed poorly differentiated carcinoma with features consistent 
with YST (positive isochromosome 12p FISH). EGD  showed partially obstructing tumor in the lower 
third of the esophagus. Biopsy of the esophageal mass also showed findings consistent with the YST. 
PET scan showed increased activity in the lower esophagus but did not identify testicular activity. Blood 
tests showed AFP of 12,752, HCG of 11, and LDH of 1039. Brain MRI and testicular ultrasound 
findings were unremarkable. Eventually, he was diagnosed with stage IIIc M1b (liver metastasis) 
primary esophageal YSK. The patient was started on a chemotherapy regimen with etoposide, 
ifosfamide, and cisplatin. 

Discussion:  Primary gastrointestinal germ cell tumors have been very rarely reported in the literature. 
To the best of our knowledge, our case is the first extra-gonadal yolk sac tumor that originated from the 
esophagus and metastasized to the liver. 

https://dx.doi.org/10.46570/utjms.vol11-2023-637 

https://dx.doi.org/10.46570/utjms.vol11-2023-637
mailto:ziad.abuhelwa@utoledo.edu