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B 3-monthly AFP, clinical examination, US DISCUSSION
There are a number of factors which contribute to germ cell tumor (GCT) recurrence after resection including tumor histology, incomplete resection/tumor rupture, and failure to remove the coccyx.
Serum AFP is a well-established marker of malignancy, and its interpretation during the first few months of life when it is known to be physiologically elevated, in a patient who has undergone GCT resection can be confusing. Another poorly understood, but well documented phenomenon is the potential for a resected benign (mature or immature) GCT to have a malignant recurrence. A recently published meta-analysis of 22 studies identified a total of 999 patients with mature histology following SCT resection, from which there were 102 recurrences (10.2%). Of these, 57 (56%) proved to be malignant recurrences, and almost all were yolk sac tumors. The association of immature teratomas with malignant recurrence is even higher. This presumes the existence of a nest of malignant cells in a resected teratoma that is missed at initial pathologic review, or residual yolk sac tumor or residual benign teratoma that undergoes malignant transformation.
Following GCT resection in any newborn or infant, serum AFP and clinical (digital rectal) examination should be 3 monthly, until 3 years of age. Regular primary site imaging (usually ultrasound, but occasionally MRI or CT scan) is also recommended.
Recommended followup schedule following infant germ cell tumor resection
B 3-monthly AFP, clinical examination, US DISCUSSION
There are a number of factors which contribute to germ cell tumor (GCT) recurrence after resection including tumor histology, incomplete resection/tumor rupture, and failure to remove the coccyx.
Serum AFP is a well-established marker of malignancy, and its interpretation during the first few months of life when it is known to be physiologically elevated, in a patient who has undergone GCT resection can be confusing. Another poorly understood, but well documented phenomenon is the potential for a resected benign (mature or immature) GCT to have a malignant recurrence. A recently published meta-analysis of 22 studies identified a total of 999 patients with mature histology following SCT resection, from which there were 102 recurrences (10.2%). Of these, 57 (56%) proved to be malignant recurrences, and almost all were yolk sac tumors. The association of immature teratomas with malignant recurrence is even higher. This presumes the existence of a nest of malignant cells in a resected teratoma that is missed at initial pathologic review, or residual yolk sac tumor or residual benign teratoma that undergoes malignant transformation.
Following GCT resection in any newborn or infant, serum AFP and clinical (digital rectal) examination should be 3 monthly, until 3 years of age. Regular primary site imaging (usually ultrasound, but occasionally MRI or CT scan) is also recommended.
Recommended followup schedule following infant germ cell tumor resection
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