Neoplasia: interpreting tumour markers: practice question

A Pathology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pathology · Neoplasia: interpreting tumour markers

Sample item

A 30-year-old man has an orchidectomy for a testicular mass. Histology appears to show pure seminoma, but preoperative serum alpha-fetoprotein is 1200 ng/mL. How should this be interpreted?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. A non-seminomatous germ cell component such as yolk sac tumour is present and he is managed as non-seminoma

Pure seminoma does not produce AFP, although mild beta-hCG elevation can occur from syncytiotrophoblastic giant cells. A markedly raised AFP means there is a yolk sac or other non-seminomatous element, sampled or not, and the tumour is treated as a non-seminomatous germ cell tumour, which carries a different prognosis and treatment.

Option by option

  • A. It is a pure seminoma, because seminomas typically secrete large amounts of AFP

    Pure seminomas do not secrete AFP, so this finding cannot be explained by seminoma alone.

  • B. It indicates a Leydig cell tumour of the testis

    Leydig cell tumours secrete androgens or oestrogens, with Reinke crystals, and do not raise AFP.

  • C. A non-seminomatous germ cell component such as yolk sac tumour is present and he is managed as non-seminoma (correct)

    AFP elevation indicates a non-seminomatous element and changes management.

  • D. It is lab error, because AFP is irrelevant in testicular tumours

    AFP and beta-hCG are central to testicular germ cell tumour diagnosis, staging and follow-up.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is C, A non-seminomatous germ cell component such as yolk sac tumour is present and he is managed as non-seminoma. Pure seminoma does not produce AFP, although mild beta-hCG elevation can occur from syncytiotrophoblastic giant cells.

Why is "It is a pure seminoma, because seminomas typically secrete large amou…" not the answer?

Pure seminomas do not secrete AFP, so this finding cannot be explained by seminoma alone.

Why is "It indicates a Leydig cell tumour of the testis" not the answer?

Leydig cell tumours secrete androgens or oestrogens, with Reinke crystals, and do not raise AFP.

Why is "It is lab error, because AFP is irrelevant in testicular tumours" not the answer?

AFP and beta-hCG are central to testicular germ cell tumour diagnosis, staging and follow-up.

What concept does this question test?

It tests Neoplasia: interpreting tumour markers in Pathology. A markedly raised AFP means there is a yolk sac or other non-seminomatous element, sampled or not, and the tumour is treated as a non-seminomatous germ cell tumour, which carries a different prognosis and treatment.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neoplasia: interpreting tumour markers?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.