RECURRENT IMMATURE TERATOMA - LACK OF CORRELATION BETWEEN SERUM LEVELAND IMMUNOHISTOCHEMICAL DETECTION OF SERUM ALPHA-FETOPROTEIN

We present the clinicopathologic and immunohistochemical features of a pure immature ovarian teratoma that had arisen in a 15-year-old girl. At original diagnosis immature extra ovarian implants were noted (gra de 3) accompanied by moderately elevated serum alpha-fetoprotein (AFP) levels, AFP was immunohistochemically demonstrable in immature endode rmal elements. The immature neural tissue present was negative for AFP , and no other tumor elements were recognisable. Serum AFP fell post-o peratively to within normal limits. Despite five courses of chemothera py and asymptomatic status, the patient re-presented 15 months after o riginal diagnosis with a massive abdominal and pelvic tumor recurrence with predominantly mature glial tissue, but some persistent immature foci, There was no associated increase in serum AFP at this time. AFP was, however, persistently detectable immunohistochemically in immatur e endodermal components only. Immature neural elements were no longer identified. Disappearance of immature neural tissue in the tumor recur rence may have been related to chemotherapy. This case demonstrates th e lack of correlative ability of serum AFP levels with both clinical b ehaviour and immunohistochemical demonstration of AFP expression in th e tumor recurrence.