Question
A 1-year and 9-month-old girl was found to have an abdominal mass on November 18, 2014, and underwent surgery to remove a retroperitoneal mixed germ cell tumor 10 days later. The tumor measured approximately 10cm x 8cm x 7.6cm. The pathological report indicated that the tumor was a malignant mixed germ cell tumor, with microscopic observation of squamous epithelial tissue, nerve glial tissue, and endodermal sinus tumor structures, accounting for 40%. Immunohistochemical staining results showed AFP (+), EMA (+), CK (-), PLAP (partly +). Two weeks after surgery, the girl received JEB chemotherapy regimen, including bleomycin (6.5mg), VP16 (0.035g), and carboplatin (90mg) combined treatment. The preoperative AFP level was 7000, which decreased to 400 before chemotherapy.
Answer
The tumor staging requires a comprehensive examination including cranial MRI enhancement, chest CT, postoperative enhanced CT, bone marrow biopsy, and whole-body bone scan to determine the presence of distant metastasis. Typically, chemotherapy will continue until the alpha-fetoprotein level returns to normal, followed by four more treatment cycles. The 5-year survival rate is approximately 70%. Shanghai Children’s Medical Center’s pediatric surgery department is a national clinical key specialty, and its hematology department is one of the largest pediatric hematology, leukemia, malignant solid tumors, and hematopoietic stem cell transplantation treatment centers in China, with a national children’s oncology key laboratory that can provide more accurate diagnosis and evaluation. However, the hospital does not accept children who have already received chemotherapy at other hospitals.