Medical Journal of The Islamic Republic of Iran (MJIRI)

 Malignant germ-cell tumors (MGCT) are rare tumors of childhood accounting for less than 3% of pediatric malignancies. Endodermal sinus tumor (EST) forms the most common histologic subtype of MGCT. The vagina is an extremely rare site for GCTs. An 8-month-old female was admitted with a short history of vaginal bleeding, and a mass protruding from the vagina. She was pale and a mass was palpable anteriorly on rectal examination. Computed tomography (CT) showed a tumor mass posterior to the bladder. A biopsy revealed a vaginal EST. The serum alpha-fetoprotein (AFP) was elevated. Vaginohysterectomy was done. The patient was subsequently referred to the oncologist for further management. EST is the most common GCT in children. In females, it is usually encountered in the ovary. EST of the vagina is a rare, highly malignant GCT that exclusively involves children less than 3 years of age. The diagnosis is based on histology and raised AFP. Vaginal EST is both locally aggressive and capable of metastasis. The serum AFP level is a useful marker for diagnosis and monitoring the recurrence of vaginal EST in infants.