Asian Research Journal of Gynaecology and Obstetrics

Endometrial carcinoma with yolk sac differentiation is a rare malignancy for which definitive treatment and surveillance guidance remains limited. This case report describes a previously healthy 33-year-old para 1 woman who presented with a two-month history of heavy menstrual bleeding. Hysteroscopic assessment and endometrial sampling demonstrated endometrial adenocarcinoma. Preoperative contrast-enhanced computed tomography and positron emission tomography-computed tomography revealed an intrauterine mass with extensive intra-abdominal disease involving both ovaries, the peritoneum, omentum, and liver. The patient underwent laparotomy, total abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic lymph node dissection, omentectomy, appendicectomy, and resection of peritoneal and subdiaphragmatic disease, achieving complete macroscopic cytoreduction. Histopathological examination confirmed endometrioid adenocarcinoma with yolk sac differentiation supported by immunohistochemistry. The postoperative serum alpha-fetoprotein level was markedly elevated at 5943.91 ng/mL on postoperative day 26. She received six three-weekly cycles of intravenous carboplatin at an area under the curve of 5 and paclitaxel at 175 mg/m². Serum alpha-fetoprotein normalised after the second chemotherapy cycle. Following completion of treatment, positron emission tomography-computed tomography showed complete resolution of the disease, corresponding with the normalised tumour marker level. This case demonstrates the diagnostic value of histopathology, immunohistochemistry, and serum alpha-fetoprotein, together with the potential role of complete cytoreductive surgery and platinum-taxane chemotherapy in this uncommon presentation.