There is a controversy concerning the value of second look surgery and lymph node sampling for patients with germ cell tumors of the ovary. A patient is presented with endodermal sinus tumor in a mixed germ cell tumor of the ovary. The elevated serum alpha-fetoprotein (AFP) became normal. At second look surgery microscopic lymph node metastases were present. The disease progressed, AFP became elevated, and the patient did not survive. Second look surgery with lymph node sampling is necessary for such patients for endodermal sinus tumor may not produce AFP, inadequate tumor volume may not elevate the AFP, and malignant elements not producing tumor markers may be identified only by histologic evaluation. With microscopic persistence of disease further therapy could possibly result in cure.
Adult Female