A need for cautious interpretation of elevated serum germ cell tumor markers in children. Review and own experiences.
Protocols for pediatric germ cell tumors (GCT) allow for chemotherapy (CHT) initiation without histological diagnosis, based on typical clinical and radiological picture and increased alphafetoprotein (AFP) or beta-human chorionic gonadotropin serum levels. Such strategy may result in misdiagnoses in rare cases. We present two patients with abdominal tumors and high serum AFP levels, diagnosed as GCT. In both, no tumor shrinkage and increasing AFP was observed after first cycles of multidrug CHT for pediatric GCT. Histological examination of biopsied tumor tissues revealed metastatic cholangiocarcinoma in patient 1 and pancreatoblastoma in patient 2, which implicated immediate change of therapy. Presented cases support the necessity to consider the tumor biopsy when patients diagnosed with GCT based on typical clinical presentation and elevated AFP do not respond to CHT with AFP decrease and tumor size reduction.
Department of Pediatrics, Hematology & Oncology, Medical University of Gdansk, Poland.
Elzbieta
E
Drozynska
Department of Pediatrics, Hematology & Oncology, Medical University of Gdansk, Poland.
Ewa
E
Bien
Department of Pediatrics, Hematology & Oncology, Medical University of Gdansk, Poland.
Katarzyna
K
Polczynska
Department of Pediatrics, Hematology & Oncology, Medical University of Gdansk, Poland.
Joanna
J
Stefanowicz
Department of Pediatrics, Oncology, Hematology & Diabetology, Medical University of Lodz, Poland.
Beata
B
Zalewska-Szewczyk
Department of Pathology & Neuropathology, Medical University of Gdansk, Poland.
Ewa
E
Izycka-Swieszewska
Department of Pediatrics, Hematology & Oncology, Medical University of Gdansk, Poland.
Anna
A
Ploszynska
Department of Pediatrics, Hematology & Oncology, Medical University of Gdansk, Poland.
Malgorzata
M
Krawczyk
The English Division Pediatric Oncology Scientific Circle, Medical University of Gdansk, Poland.
Gabrielle
G
Karpinsky
D000293:Adolescent; D014408:Biomarkers, Tumor / Q000097:blood*; D002675:Child, Preschool; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D008297:Male; D009373:Neoplasms, Germ Cell and Embryonal / Q000097:blood* / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D047368:Tumor Burden; D000509:alpha-Fetoproteins / Q000032:analysis
D014408:Biomarkers, Tumor; D018997:Chorionic Gonadotropin, beta Subunit, Human; D000509:alpha-Fetoproteins
AFP; differential diagnosis; germ cell tumors; intrahepatic cholangiocarcinoma; pancreatoblastoma; serum tumor markers; β-hCG