Keiko Ohmi

Yolk sac tumor (endodermal sinus tumor) and alpha-fetoprotein. A report of three cases.

Three instances of malignant teratomas with positive reaction for alpha‐fetoprotein (AFP) are presented. Sequential evaluations in them revealed that the production rate of AFP closely paralleled the amount of the viable malignant tumor tissue which fluctuated in the course of the diseases. Two of these tumors originated in the testis and a third in the presacral region. The microscopic sections of these malignant teratomas were carefully reviewed and it was concluded that they are properly classified as yolk sac tumor or endodermal sinus tumor. The occurrence of AFP in these tumors is best explained by the yolk sac notion, because it is known that large amounts of AFP are synthesized not only by the fetal liver, but also by the yolk sac at early embryogenesis. This phenomenon will conversely lend an additional support to the morphologic contention that these tumors are of yolk sac origin and deserves further investigation.

Evaluation of alpha-fetoprotein in early infancy*

Serum AFP concentrations of normal subjects were statistically analyzed in order to obtain the normal ranges in early infancy. The 95% prediction band would seem to offer a convenient means of evaluating serum AFP in the age range 0-300 days of life. Some illustrative cases, whose AFP values were formerly considered to be abnormally high but later proved to be within normal range, are presented.

A study on alpha-fetoprotein and endodermal sinus tumor

Abstract The phenomenon of alpha-fetoprotein production by testicular, ovarian, or sacrococcygeal teratocarcinomas is frequently observed but has not been well explained. This paper includes clinicopathologic studies of 19 cases of teratocarcinoma with positive AFP reactions. Sixteen of the 19 showed typical histologic features of endodermal sinus tumor (yolk sac tumor) of Teilum and one other was compatible with this diagnosis. 6,7 The occurrence of AFP in these tumors is best explained by the concept of endodermal sinus tumor; because it is known that large amounts of AFP are synthesized not only by the fetal liver but also by the yolk sac during early embryonic life, and because the diagnosis of endodermal sinus tumor itself implies that the tumor is of yolk sac origin morphologically. 13 More direct evidence of AFP synthesis was demonstrated by immunofluorescent technique in one of our cases. Immunofluorescence was seen only in that cell layer long defined as of yolk sac origin morphologically. Alpha-fetoprotein studies are valuable in following such patients, unless they are 1 mo of age or younger.

Serum lactate dehydrogenase isoenzyme-1 in children with Yolk sac tumor

Although in recent years the evidence of an increase in serum lactate dehydrogenase isoenzyme‐1 (LDH‐1) in patients with germ cell tumor (GCT) has attracted attention, there have only been a few reports concerning yolk sac tumor (YST), which is a frequent type of GCT in childhood. Serum LDH isoenzymes were determined in eight children with YST, and an increase in LDH‐1 was found in seven of them, excluding one in an early stage. On the basis of the findings of serial serum LDH‐1 levels during treatment and of LDH isoenzyme pattern in tumor tissues, it is presumed that the increased serum LDH‐1 is derived from tumor tissues. LDH‐1 seems to be useful as a tumor marker, not specific for YST but associated with the whole spectrum of GCT, for monitoring of YST.

Rhabdomyosarcoma-induced hypercalcemia in a nude mouse

Hypercalcemia in nude mice with a rhabdomyosarcoma transplanted from a hypercalcemic patient is reported. The tumor had been transplanted to nude mice from a 15‐year‐old girl with hypercalcemia which appeared as the rhabdomyosarcoma developed and metastasized to the peritoneal and pleural cavities. The tumor was successfully transplanted to nude mice, which presented an elevated serum calcium level. No remarkable elevation of serum parathyroid hormone or 1α,25‐dihydroxyvitamin D was found in the mouse with rhabdomyosarcoma. Injection of indomethacin restored the elevated serum calcium level to the normal range. The prostaglandin E2 level was approximately 15 times higher in the tumor‐bearing mouse serum than in the control mouse serum. These data indicate that hypercalcemia in this patient can be ascribed to prostaglandin E2 produced by the rhabdomyosarcoma. Cancer 50:94–96, 1982.

Serum lactate dehydrogenase isoenzyme pattern in neuroblastoma.

Total serum LDH activity and isoenzyme distribution were studied in children with neuroblastoma at the time of hospital admission. The total LDH was determined in 26 cases, and 20 (77%) of them showed elevation of its activity. On the other hand, in 9 of these 26 cases, the isoenzyme distribution was determined along with the total LDH. All 9 cases, 4 of them with normal total LDH activity, showed an abnormal isoenzyme pattern with a percentage increase in the intermediate fractions (malignant pattern). The results suggest the usefulness of the determination of serum LDH isoenzymes as a screening procedure in children with malignant tumors including neuroblastoma.

Clinico-pathological Aspects of Endodermal Sinus Tumor in Childhood with Reference to PAS-positive Hyaline Globules observed in Tissue Culture

During the years 1952 through June, 1977, 64 children with tumor of germ cell origin were seen at the Department of Pediatric Surgery, the University of Tokyo Hospital. There were 39 mature, 7 immature and 18 frankly malignant teratomas. Sixteen cases had histological features of endodermal sinus tumor in pure or mixed form, and all of the last eight patients showed elevated serum AFP concentrations ranging from 92,000 ng/ml to 952 ng/ml. Serum AFP concentration declined almost to zero ng/ml with a half life of about 4 days when surgical removal was complete, whereas AFP decreased only to 100–200 ng/ml with radiation therapy and chemotherapy alone. Serum concentrations of prealbumin, albumin, alpha‐1‐antitrypsin and transferrin were almost within normal ranges.

Analysis of Serum Alpha-fetoprotein Dynamics in Early Infancy

In early infancy, the serum alpha‐fetoprotein (AFP) level remains quite high and the clinical interpretation of hyper‐alphafetoproteinemia in this age should be made in comparison with its normal ranges. We presented some illustrative cases of early infancy, whose AFP values were formerly considered abnormally high, but later found within normal ranges. Our normal ranges were obtained by statistical calculations of serum AFP values studied in normal subjects: namely infants with inguinal hernia and neonates at birth (the cord blood was used).