Match each patient's clinical presentation and biomarker profile with the most likely ovar… — USMLE Step 2 CK

Match each patient's clinical presentation and biomarker profile with the most likely ovarian neoplasm diagnosis.

A $17$ -year-old female presents with a rapidly growing pelvic mass. Laboratory evaluation reveals a markedly elevated serum alpha-fetoprotein (AFP) and normal $\beta$ -hCG.Endodermal sinus (yolk sac) tumor
A $22$ -year-old female presents with pelvic pain and a solid adnexal mass. Labs show an elevated serum lactate dehydrogenase (LDH) and normal AFP.Dysgerminoma
A $65$ -year-old female presents with postmenopausal bleeding. Endometrial biopsy shows simple hyperplasia. Pelvic ultrasound reveals a solid unilateral ovarian mass.Granulosa cell tumor
A $62$ -year-old female presents with progressive abdominal distension and early satiety. Imaging shows a complex adnexal mass with ascites. Serum CA-125 is significantly elevated.Serous cystadenocarcinoma

Answer

The correct matches align the age demographic, clinical signs of hormone production, and specific tumor markers (AFP, LDH, CA-125) with their respective ovarian neoplasms.

Each clinical presentation strongly correlates with a specific gynecologic neoplasm's classic demographic, tumor marker profile, and associated clinical findings. Germ cell tumors present in younger patients with specific markers (AFP, LDH), sex cord-stromal tumors present with hormonal manifestations, and epithelial tumors present with advanced-stage abdominal symptoms in older patients.

Step-by-Step Solution

Analyze the presentation of the

17

-year-old with elevated AFP.

The elevation of AFP strongly indicates an endodermal sinus (yolk sac) tumor.

Yolk sac tumors are malignant germ cell tumors that characteristically secrete alpha-fetoprotein.

Evaluate the

22

-year-old with a solid mass and elevated LDH.

Elevated lactate dehydrogenase points to a dysgerminoma.

Dysgerminomas are the most common malignant germ cell tumors and typically produce LDH rather than AFP.

Assess the

65

-year-old with postmenopausal bleeding and endometrial hyperplasia.

The concurrent endometrial hyperplasia suggests an estrogen-secreting granulosa cell tumor.

Granulosa cell tumors are sex cord-stromal tumors that produce excessive estrogen, leading to endometrial proliferation.

Examine the presentation of the

62

-year-old with ascites and elevated CA-125.

These findings are classic for serous cystadenocarcinoma.

Malignant epithelial ovarian tumors, particularly serous carcinomas, typically occur in older women and present with elevated CA-125 and ascites.

Key Concept

Clinical and biochemical profiling of ovarian neoplasms

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