## Tumor Markers in Ovarian Germ Cell Tumors **Key Point:** AFP is the most sensitive and specific marker for yolk sac tumor (endodermal sinus tumor) and dysgerminoma, making it the primary tumor marker for surveillance and monitoring. ### Marker-Tumor Correlation | Germ Cell Tumor | AFP | hCG | Other Markers | | --- | --- | --- | --- | | **Dysgerminoma** | Negative | Negative (unless syncytiotrophoblastic cells) | Minimal elevation | | **Yolk Sac Tumor (EST)** | **Markedly elevated** | Negative | Elevated in ~90% | | **Immature Teratoma** | Often elevated | Negative | Variable | | **Choriocarcinoma** | Negative | **Markedly elevated** | Elevated in ~100% | | **Mixed GCT** | Variable | Variable | Depends on components | **High-Yield:** AFP is produced by yolk sac tumor cells and is elevated in 50–90% of yolk sac tumors and 10–30% of dysgerminomas. It is the single most useful marker for these tumors. **Clinical Pearl:** In a young woman with an ovarian mass and elevated AFP, yolk sac tumor is the primary concern. Serial AFP monitoring during chemotherapy helps assess treatment response and detect recurrence earlier than imaging. **Mnemonic:** **YEAST** — **Y**olk sac tumor → **A**lpha-**F**etoprotein; **E**ndodermal sinus tumor → **A**FP; **S**ensitive marker; **T**racking tool for therapy. ### Why AFP Is Superior - Produced directly by yolk sac tumor cells (endodermal differentiation) - Rises before clinical or radiologic evidence of recurrence - Normalized after successful chemotherapy - Persistent or rising AFP indicates treatment failure or recurrence 
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