A young woman with a 12 cm ovarian mass has serum AFP of 1800 ng/mL, β-hCG normal, LDH elevated. Histology shows a tumour with Schiller-Duval bodies. Which specific chemotherapy regimen is considered standard first-line treatment for this tumour following fertility-sparing surgery?

• A BEP (bleomycin, etoposide, cisplatin) — 3 cycles ✓
• B TC (paclitaxel + carboplatin) — 6 cycles
• C VAC (vincristine, actinomycin-D, cyclophosphamide) — 6 cycles
• D CHOP (cyclophosphamide, doxorubicin, vincristine, prednisolone) — 6 cycles

Explanation

Schiller-Duval bodies (glomeruloid structures) are pathognomonic of yolk sac tumour (endodermal sinus tumour), a malignant germ cell tumour that secretes AFP. BEP (bleomycin, etoposide, cisplatin) for 3 cycles is the standard first-line adjuvant/treatment chemotherapy for malignant ovarian germ cell tumours including yolk sac tumour, achieving cure rates of 85–90% even in advanced disease. TC is used for epithelial ovarian cancer; VAC is an older, less effective regimen; CHOP is for lymphomas.

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

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Written and medically reviewed by the StethoPrep medical team.