A 22-year-old woman has a right ovarian mass. Tumor markers show AFP 850 ng/mL, LDH elevated, beta-hCG normal. The most likely diagnosis is:

• A Choriocarcinoma
• B Embryonal carcinoma
• C Immature teratoma Grade 3
• D Yolk sac tumor (endodermal sinus tumor) ✓

Explanation

Yolk sac tumors (endodermal sinus tumors) are the second most common malignant germ cell tumor and are defined by markedly elevated AFP — often in the thousands — with normal or minimally elevated beta-hCG. They arise from primitive yolk sac cells. Choriocarcinoma produces extremely high beta-hCG. Embryonal carcinoma produces both AFP and hCG. Immature teratomas do not secrete AFP unless a yolk sac component is present.

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

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Written and medically reviewed by the StethoPrep medical team.