A 25-year-old woman has a 10 cm complex ovarian mass. Serum AFP = 890 ng/mL, LDH elevated, beta-hCG normal. Which histological type does this tumor pattern MOST suggest, and what is the characteristic gross finding?

• A Yolk sac tumor (endodermal sinus tumor) — highly elevated AFP; characteristic Schiller-Duval bodies ✓
• B Choriocarcinoma — elevated beta-hCG; hemorrhagic, friable tumor
• C Immature teratoma — elevated AFP due to liver elements; hair/teeth on gross examination
• D Dysgerminoma — elevated LDH with 'cobblestone' gross pattern and fibrous septa

Explanation

Yolk sac tumors (endodermal sinus tumors) characteristically secrete AFP at very high levels (often >1000 ng/mL) in young women and children. The pathognomonic histological feature is the Schiller-Duval body — a papillary structure with a central vessel and surrounding tumor cells resembling primitive glomeruli (also called glomeruloid bodies). Choriocarcinoma secretes beta-hCG predominantly. Dysgerminoma elevates LDH (and sometimes hCG from syncytiotrophoblastic elements). Immature teratoma can mildly elevate AFP but not to extreme levels.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

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Written and medically reviewed by the StethoPrep medical team.