Required section · Section 4 of 6

Guided case: correct the AFP before staging

Pre-orchiectomy AFP is 38 ng/mL (local reference interval <8.1 ng/mL), a discordantly low-for-context result beside a 9 cm nodal mass. Under local reflex policy, serial dilution shows qualitative proportional recovery, supporting suspected antigen excess; no corrected preoperative concentration is assigned because this case has no method-specific validated magnitude.

For post-orchiectomy germ-cell tumor staging, use the valid pre-treatment day-10 marker set: AFP 1,050 ng/mL, hCG 210 mIU/mL, and LDH 1.1 × ULN. AFP is in the 1,000–10,000 ng/mL band, so the highest marker band assigns S2. The invalid preoperative AFP is not used for staging.

A day-10 post-orchiectomy marker set can support staging, but one later same-method value is needed to assess clearance.

Timing diagram: preoperative AFP 38 ng/mL is invalid under suspected antigen excess; serial dilution has qualitative proportional recovery; day 10 post-orchiectomy AFP 1,050 ng/mL, hCG 210 mIU/mL, and LDH 1.1 times ULN assign S2; a later same-method value is needed to assess clearance. — Figure 1Timing diagram distinguishes invalid preoperative AFP 38 ng/mL under suspected antigen excess, qualitative dilution recovery, the valid day-10 marker set, and the later same-method value needed for clearance assessment.

Case results. Local reference intervals and dilution rules must be verified for the in-use method.
Time	AFP ng/mL	hCG mIU/mL	LDH U/mL	Interpretation
Pre-orchiectomy	38	—	—	Discordant AFP; invalid under suspected antigen excess
Serial dilution	Qualitative proportional recovery	—	—	Supports local interference evaluation; no corrected AFP magnitude
Day 10 post-orchiectomy	1,050	210	1.1 × ULN	AFP 1,000–10,000 band sets S2

Knowledge checks

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Knowledge check 1

Using the valid day-10 post-orchiectomy set—AFP 1,050 ng/mL, hCG 210 mIU/mL, and LDH 1.1 × ULN—which marker sets the S category?

Choose one option.

AFP, placing the case in the S2 AFP band

hCG because it is numerically high

LDH because it is above its reference interval

Knowledge check 2

What can the single valid day-10 post-orchiectomy marker set establish?

Choose one option.

It supports staging, but a later same-method value is needed to assess clearance.

Proof that residual disease is absent

A result that should be called normal immediately

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