[size=20px]A 12-year old girl presents with dysmenorrhea. Menarche started one year ago, but she has been bleeding heavily and irregularly for the last 6 months. Despite taking oral contraceptives her bleeding has not been controlled. A CT shows a large pelvic mass. Which of the following tumor markers would likely be elevated in this patient’s serum?

 

A Alpha-fetoprotein (AFP)

 

B Beta-subunit Human Chorionic Gonadotropin (β HCG)

 

C Inhibin A and B

 

D CA 125

 

E CA 19-9​[/size]

[center]

[/center]

B hcg

B

D

A

correct answer

C Inhibin A and B

 

This tumor is likely a granulosa tumor (GCT), a sex cord-stromal tumor that can cause a higher than normal estrogen production in women. Inhibin is a peptide hormone produced by ovarian granulosa cells that has a regulatory effect on follicular stimulating hormone (FSH) secretion.

 

There are two distinct types: juvenile (JGCT) and adult (AGCT). Juvenile GCT is a subtype of ovarian sex cord stromal tumor which has a favorable prognosis if diagnosed at an early stage. Due to the estrogen production, JGCT causes isosexual precocious puberty, which is found in this patient. Stage I patients have a five year survival of 95-100%. Recurrences are uncommon and likely occur within the first year.

 

AFP and β HCG are typically secreted by germ cell tumors, and would not manifest the symptoms seen in this patient. CA 125 is seen in epithelial tumors of the ovary, the most common tumors seen in the adult population. CA19-9 elevation is commonly associated with hepatopancreaticobiliary tumors.

 

​