Abstract
A 7-year-old girl with an immature teratoma of the right ovary combined with a mature teratoma of the left ovary, whose serum alpha-fetoprotein (AFP) was negative, underwent salpingo-oophorectomy for the right tumor and enucleation of the left. Four months later her serum AFP was positive, without apparent clinical symptoms and signs. Nine months after initial operation, a large retroperitoneal tumor developed with elevated serum AFP of 1,600 ng/ml. A subtotal resection of the recurrent tumor was performed, followed by VACA (VCR, AMD, CPM, ADM) chemotherapy, with decrease and disapearance of serum AFP. A microscopic reexamination of the primary and recurrent tumors revealed almost the same findings composed of moderate quantities of immature neural tissue, moderately differentiated endodermal tissue, and small foci of immature endodermal components, combined with localized coagulation necrosis. Tumor cells show the atypicality and mitotic activity corresponding to Grade 2 (Thurlbeck & Scully) immature teratoma. Components of yolk sac tumor or embryonal carcinoma could not be found. AFP was identified by an immunoperqxidase method, which was strongly positive in the cytoplasma of the cells of the immature and moderately differentiated endodermal components, and faintly positive in the immature neural tissue. Despite of the same appearance of the AFP localization and intensity in both specimens, it is unclear why serum AFP was negative in the primary tumor, whereas the serum AFP level was high in the recurrent tumor. Now, 2 years and 10 months after reoperation, she is in a state of disease free.
