A 14-year-old girl has a large pelvic mass, serum AFP 1800 ng/mL, and β-hCG within normal limits. CT shows a right ovarian mass with no metastases. Which ovarian germ cell tumor is most likely and what is the primary treatment?
- A Yolk sac tumor; BEP chemotherapy after fertility-sparing surgery ✓
- B Dysgerminoma; whole-abdomen radiotherapy
- C Embryonal carcinoma; total abdominal hysterectomy with bilateral salpingo-oophorectomy
- D Immature teratoma; surveillance alone after surgery
Correct answer: A. Yolk sac tumor; BEP chemotherapy after fertility-sparing surgery
Explanation
Markedly elevated AFP with a malignant-appearing ovarian mass in an adolescent points to yolk sac tumor (endodermal sinus tumor), which characteristically secretes AFP. Dysgerminoma is the most common malignant germ cell tumor overall but is LDH-positive with normal AFP. Standard management of yolk sac tumor is fertility-sparing unilateral salpingo-oophorectomy followed by BEP (bleomycin, etoposide, cisplatin) chemotherapy — the regimen achieves excellent cure rates even in advanced stage. Radiotherapy is not used for yolk sac tumor.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.