Which combination of markers is commonly elevated in both pregnancy and testicular germ cell tumors?

Which combination of markers is commonly elevated in both pregnancy and testicular germ cell tumors?

• A. Both AFP and hCG
• B. AFP only
• C. hCG only
• D. Neither

Answer: (A)

Markers AFP and hCG are tied to tissues that are active in pregnancy and can also be produced by germ cell tumor components. AFP comes from fetal liver and yolk sac, so it rises during pregnancy and can be produced by testicular yolk sac tumors or embryonal carcinoma. hCG is produced by placental trophoblasts, so it rises in early pregnancy and can be produced by tumor elements like choriocarcinoma (and sometimes by seminoma with syncytiotrophoblastic cells). When a testicular germ cell tumor contains both yolk sac (AFP-producing) and choriocarcinoma (hCG-producing) components, both markers can be elevated. Therefore, the combination of elevation of both AFP and hCG best matches what’s seen in pregnancy and in such germ cell tumors.

Markers AFP and hCG are tied to tissues that are active in pregnancy and can also be produced by germ cell tumor components. AFP comes from fetal liver and yolk sac, so it rises during pregnancy and can be produced by testicular yolk sac tumors or embryonal carcinoma. hCG is produced by placental trophoblasts, so it rises in early pregnancy and can be produced by tumor elements like choriocarcinoma (and sometimes by seminoma with syncytiotrophoblastic cells). When a testicular germ cell tumor contains both yolk sac (AFP-producing) and choriocarcinoma (hCG-producing) components, both markers can be elevated. Therefore, the combination of elevation of both AFP and hCG best matches what’s seen in pregnancy and in such germ cell tumors.