Vaginal Bleeding in an Infant due to Extragonadal Germ Cell Tumor: A Case Report with Review of Literature

Abstract Background: The occurrence of germ cell tumors (GCTs) in the vagina is uncommon in children, with yolk sac tumors being the most commonly identified histological subtype in young female infants. Clinical Description: A 7-month-old baby girl was presented with gradually progressive painless vaginal bleeding for 2 weeks. The infant was otherwise thriving well with no evidence of any local or systemic abnormality or constitutional symptoms. Management and Outcome: The child’s initial laboratory investigations were normal except for mild anemia. Further tests revealed elevated alpha-fetoprotein levels. Magnetic resonance imaging showed a mass in the vagina, which on cystovaginoscopic biopsy showed vaginal GCT. The patient was treated as per carboplatin (JM8), etoposide, and bleomycin (JEB) protocol. After the completion of the first cycle of chemotherapy, the infant responded well and was symptom-free. Conclusion: Vaginal bleeding in an otherwise healthy infant should raise suspicion of malignancy with GCT being a rare occurrence in this location. The present case highlights the success of the JEB protocol which is well tolerated by an infant.