A 28-year-old woman has an elevated serum AFP (2400 IU/mL) and normal beta-hCG. CA-125 is mildly elevated at 65 U/mL. Pelvic ultrasound shows a 9 cm complex predominantly solid right ovarian mass. The most likely diagnosis and appropriate surgical approach are:
- A Mixed germ cell tumor; bilateral oophorectomy with total hysterectomy
- B Granulosa cell tumor; fertility-sparing surgery appropriate for stage I disease
- C Yolk sac tumor (endodermal sinus tumor); fertility-sparing surgery with unilateral salpingo-oophorectomy ✓
- D Immature teratoma; always requires bilateral oophorectomy to prevent recurrence
Explanation
Markedly elevated AFP with normal beta-hCG is the hallmark of yolk sac tumor (endodermal sinus tumor), the most common pure germ cell malignancy in females. It is highly aggressive but chemosensitive (BEP regimen: bleomycin, etoposide, cisplatin). Since it typically affects young women and is usually unilateral, fertility-sparing surgery (unilateral salpingo-oophorectomy) is appropriate even in advanced stages, because the contralateral ovary and uterus are generally not involved and chemotherapy can address metastatic disease. Granulosa cell tumors produce inhibin/estradiol, not AFP.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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Written and medically reviewed by the StethoPrep medical team.