Alpha-fetoprotein (AFP) is elevated in hepatocellular carcinoma. However, which of the following conditions produces the highest serum AFP levels, often exceeding 10,000 ng/mL?
- A Hepatocellular carcinoma (HCC)
- B Mixed germ cell tumor with teratoma component
- C Yolk sac tumor (endodermal sinus tumor) ✓
- D Hepatoblastoma in adults
Explanation
Yolk sac tumor (endodermal sinus tumor) produces markedly elevated AFP because yolk sac cells are normally responsible for AFP synthesis during fetal development, and the tumor recapitulates this function. Levels often exceed 10,000 ng/mL and can reach millions of ng/mL, far exceeding typical HCC levels (which are elevated but usually in a lower range). The Schiller-Duval body is the pathognomonic histological structure of yolk sac tumor, representing a glomeruloid structure. HCC elevates AFP, but the highest AFP levels are associated with yolk sac tumors; hepatoblastoma in adults is exceedingly rare and produces much lower levels.
Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.