A 27-year-old male presents with a testicular mass, which is resected and diagnosed as being a yolk sac tumor. Which one of the listed substances is most likely to be increased in this patient’s serum as a result of being secreted from the cells of this tumor?
**Core Concept**
Yolk sac tumors, also known as endodermal sinus tumors, are a type of germ cell tumor that primarily affects the testes in young males. These tumors are known to produce various substances due to their immaturity and neoplastic nature.
**Why the Correct Answer is Right**
The correct answer is related to the production of a specific substance by yolk sac tumor cells. These cells are known to produce alpha-fetoprotein (AFP), a major plasma protein produced by the yolk sac and the liver during fetal development. In children and adults, elevated serum levels of AFP are often associated with yolk sac tumors, hepatocellular carcinomas, and certain other germ cell tumors. This substance serves as a tumor marker, helping to diagnose and monitor the disease.
**Why Each Wrong Option is Incorrect**
**Option A:** Human chorionic gonadotropin (hCG) is a hormone produced by the placenta during pregnancy and is also secreted by some types of germ cell tumors, such as choriocarcinoma. However, it is not typically associated with yolk sac tumors.
**Option B:** Lactate dehydrogenase (LDH) is an enzyme that is often elevated in various types of cancer, including testicular cancer. However, it is not specific to yolk sac tumors and can be elevated in other conditions as well.
**Option C:** Prostate-specific antigen (PSA) is a protein produced by the prostate gland and is often used as a marker for prostate cancer. It is not related to yolk sac tumors.
**Option D:** Calcitonin is a hormone produced by the thyroid gland and is associated with medullary thyroid carcinoma. It is not related to yolk sac tumors.
**Clinical Pearl / High-Yield Fact**
It is essential for clinicians to remember that yolk sac tumors are often associated with high levels of AFP, which can be used as a tumor marker for diagnosis and monitoring. This knowledge helps in differentiating yolk sac tumors from other types of testicular cancer and in monitoring the effectiveness of treatment.
**Correct Answer:** D.