Primary yolk sac tumour of liver with unusual clinical presentation mimicking acute appendicitis

Primary hepatic yolk sac tumour (YST) is an extremely rare tumour of the liver. The exact etiology of primary hepatic YST is still unclear. This tumour is very aggressive with ability to spread into distant sites, where it can lead to the first clinical presentation. The authors present a case of a 20-year-old woman with fever and pain in the epigastrium, which later on moved to the right hypogastrium clinically resembling acute appendicitis. Ultrasound revealed tumorous mass in the liver and hypoechogenous tumorous mass in the area of right adnexes and terminal ileum. Tumorous mass in the liver was confirmed on the CT scan. Markedly raised levels of serum α-fetoprotein concentration were detected. Laparoscopic appendectomy was performed and there was bioptically verified a diagnosis of YST. Afterwards, patient underwent right hemihepatectomy, right hemicolectomy and right adnexectomy. There was found no evidence of the gonadal, mediastinal, retroperitoneal and central nervous system origin of the YST. Histological findings from the liver proved primary yolk sac tumour of the liver with the metastatic spread into the appendix, caecum and regional lymph nodes.