Hepatoma in a young adult: to biopsy or not to biopsy?

The management of metastatic hepatic germ cell tumour in a young woman: case report and literature review

Germ cell tumours (GCTs) have an excellent prognosis but rarely arise from the liver. Our case describes a young woman referred for urgent radiotherapy for a bone metastasis. There was also a large lesion in the liver and marked elevation of the serum α-fetoprotein (AFP) level. Liver biopsy indicated a germ cell tumour. Reduced intensity chemotherapy was commenced using the combination of etoposide, cisplatin and paclitaxel. After four cycles the AFP values had fallen, the liver function tests had normalised and the previous bone lesions had healed. The predominant lesion in the liver had also regressed. Hepatocellular carcinoma (HCC) is the main differential diagnosis. Hepatic germ cell tumours predominantly occur in young, healthy women whereas hepatocellular carcinoma occurs in cirrhotic male livers. These two malignancies are very different and accurate diagnosis is essential. Diagnosing this rare condition early allows the delivery of effective therapy and a better outcome.