Question

In which of the following conditions is an elevated HCG level NOT seen?

• A. Choriocarcinoma
• B. Polyembryoma
• C. Endodermal Sinus Tumor
• D. Embryonal Carcinoma

Hint:

Yolk sac (endodermal sinus) tumor secretes AFP, not HCG; trophoblastic tissue is what makes HCG.

Answer 1

The Correct Option is C

Step 1: Recall which germ cell tumor elements secrete which markers.
Germ cell tumors are graded by which primitive tissue they mimic, and each type tends to secrete a specific tumor marker into the blood.

Step 2: Check choriocarcinoma.
Choriocarcinoma mimics placental trophoblastic tissue, made of cytotrophoblast and syncytiotrophoblast. The syncytiotrophoblast cells make human chorionic gonadotropin (HCG), the same hormone raised in a normal pregnancy. So HCG is always high in choriocarcinoma.

Step 3: Check polyembryoma.
A polyembryoma contains embryoid bodies that resemble early embryos, with elements of both yolk sac and trophoblastic tissue. Because it carries trophoblastic tissue, it can also raise HCG, and its yolk sac component raises AFP as well.

Step 4: Check embryonal carcinoma.
Embryonal carcinoma is made of primitive, undifferentiated cells. It can secrete AFP, HCG, or both, because scattered syncytiotrophoblast-like giant cells are often present within it.

Step 5: Check endodermal sinus tumor.
The endodermal sinus tumor, also called the yolk sac tumor, is the malignant counterpart of the fetal yolk sac. It classically secretes alpha-fetoprotein (AFP), not HCG, since it lacks trophoblastic differentiation.

Step 6: Final answer.
Of the four, only the endodermal sinus tumor does not raise HCG; it raises AFP instead.
\[ \boxed{\text{Endodermal Sinus Tumor}} \]