Germ-cell tumours: Case

Framing the case

This fifteen-year-old girl has the classic presentation of an ovarian germ cell tumour with the markedly raised alpha-fetoprotein that points to the yolk sac histology. The abdominal pain and the large pelvic mass, the negative pregnancy test, and the alpha-fetoprotein at six thousand nanograms per millilitre with the normal beta-human chorionic gonadotropin, together make the malignant nongerminomatous ovarian germ cell tumour the working diagnosis, and the first decision is to confirm and to stage the tumour and to plan the surgery and the chemotherapy. The framework that organises the case is the histology, the yolk sac tumour that secretes the alpha-fetoprotein, and the stage, which together drive the risk-adapted therapy. ^[3][10]

Immediate assessment and the diagnostic pathway

The assessment begins with the airway, the breathing and the circulation, because the adolescent with the large abdominal mass may have the torsion or the rupture that produces the acute surgical abdomen, and the haemodynamic stability is confirmed first. The serum alpha-fetoprotein, the beta-human chorionic gonadotropin and the lactate dehydrogenase are sent, and the markedly raised alpha-fetoprotein with the normal beta-human chorionic gonadotropin makes the yolk sac tumour the leading diagnosis. The pelvic ultrasound and the magnetic resonance imaging define the complex solid and cystic mass, and the computed tomography of the chest stages the metastatic disease. The girl is over one year of age, so the alpha-fetoprotein is not confounded by the physiological neonatal elevation, and the raised value is genuinely significant. ^[3][10]