[A case of nonseminomatous germ cell tumor: usefulness of alphafetoprotein subfraction]

Alfa-fetoprotein (AFP) is an indispensable examination in the management of non-seminomatous germ cell tumor. However, many liver diseases also frequently show the elevation of AFP. Therefore, it is essential to discriminate between yolk sac-derived component and liver-derived one. A 32-year-old male who had suffered from chronic hepatitis, visited our clinic in December, 1991. He complained of left scrotal atrophy and dull pain. Surgical specimen was histologically diagnosed as embryonal carcinoma with syncytiotrophoblastic giant cell. The levels of tumor markers, such as AFP, beta-human chorionic gonadotropin (beta-HCG), were estimated. Both of them were elevated, and radiographical studies demonstrated metastatic lesions of bilateral lung field and retroperitoneal lymph nodes (RPLN). After three courses of cisplatin based chemotherapy, lung and RPLN metastases diminished and serum beta-HCG had normalized. However, the serum AFP persisted to show an abnormally high concentration. The subfraction profile with lens culinaris hemagglutinin (LCA) was estimated. The one after the first course was compared with the one after third course. The latter one showed complete diminution of peak 2. This implied the diminishment of yolk sac element.