A 62-year-old man with a testicular non-seminomatous germ cell tumor has markedly elevated AFP and beta-hCG. After orchiectomy and chemotherapy, AFP remains elevated while beta-hCG normalizes. The persistently elevated AFP most likely indicates:
- A Residual yolk sac tumor elements ✓
- B Persistent choriocarcinoma
- C Sertoli cell activation
- D Secondary liver metastasis producing AFP physiologically
Correct answer: A. Residual yolk sac tumor elements
Explanation
AFP is produced by yolk sac tumor (endodermal sinus tumor) and embryonal carcinoma components, while beta-hCG is produced by syncytiotrophoblastic cells of choriocarcinoma. Normalization of beta-hCG but persistence of AFP points to residual or metastatic yolk sac tumor elements. Sertoli cells do not produce AFP; liver normally produces only minimal AFP in adults.
Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.