A 22-year-old woman has a 7 cm right ovarian mass with elevated serum AFP (1200 ng/mL) and normal beta-hCG. Histology shows a solid tumor with Schiller-Duval bodies. What is the most appropriate chemotherapy regimen for this tumor?

• A CHOP (Cyclophosphamide, Doxorubicin, Vincristine, Prednisolone)
• B Carboplatin-Paclitaxel doublet
• C BEP (Bleomycin, Etoposide, Cisplatin) ✓
• D PVB (Cisplatin, Vinblastine, Bleomycin) — the original testicular regimen

Explanation

Schiller-Duval bodies and elevated AFP are pathognomonic of a yolk sac tumor (endodermal sinus tumor), a germ cell tumor. The standard chemotherapy for germ cell tumors of the ovary is BEP (Bleomycin-Etoposide-Cisplatin), which achieves high cure rates even in advanced stages while preserving fertility in most cases. CHOP is for lymphoma. Carboplatin-paclitaxel is for epithelial ovarian cancer. PVB has been replaced by BEP due to better tolerability.

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

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Written and medically reviewed by the StethoPrep medical team.