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Abstract
Primary alpha-fetoprotein secreting ovarian tumors have been detected in pregnancy by markedly elevated midtrimester MSAFP accompanied by sonographically visualized adnexal masses. We present a recurrent mixed germ cell tumor manifesting only as a moderately elevated MSAFP screen. A 23-year-old para 1–0–0–1 at 17 weeks had a MSAFP screen of 3.88 multiples of the median (MOM). Since age 13 she had been treated for primary and recurrent mixed germ cell tumor of the ovary, after which her serum AFP had been negative. Ultrasound confirmed gestational age and normal fetal anatomy. Amniocentesis revealed a normal 46, XY karyotype, AFAFP, and negative acetylcholinesterase. Monthly MSAFP levels rose throughout pregnancy without the expected plateau and fall after 30 weeks. Definitive surgery at delivery confirmed recurrent AFP-secreting tumor. The trend over pregnancy of an unexplained elevated MSAFP level may signify recurrent mixed germ cell tumor