Diagnosing Germ Cell Tumors

Doctors at Hassenfeld Children’s Hospital at NYU Langone diagnose several types of germ cell tumors in children. These tumors arise in the body’s reproductive cells and can affect the ovaries and testes, as well as other parts of the body. A small percentage of germ cell tumors occur outside the ovaries and testes, some of them in the brain.

Germ cell tumors may be noncancerous or cancerous. Malignant germ cell tumors constitute about 3 percent of all childhood cancers.

Symptoms vary based on the type, size, and location of the germ cell tumor and may include back pain, coughing, difficulty breathing, nausea, pain with bowel movements, unusual vaginal bleeding, or a lack of menstruation in postpubescent girls. You or your child may also notice a lump or mass in the scrotum, the sac that holds the testicles; the abdomen; the base of the spine; or the ovaries. These can occur with or without pain.

Because these symptoms can indicate many different conditions, your child’s doctor performs tests to diagnose germ cell tumors.

Diagnostic Tests

The doctor performs a physical exam to check for lumps and takes a medical history to identify symptoms and determine when they began. If he or she suspects an ovarian or testicular germ cell tumor, the physical exam includes a pelvic exam in girls and a testicular exam in boys.

Blood Tests

Our specialists take a sample of your child’s blood to check the numbers of white blood cells, which fight infection; red blood cells, which carry oxygen throughout the body; and platelets, which help blood clot. This can help the doctor determine the state of your child’s health.

The doctor may also order a serum tumor marker test to look for levels of alpha-fetoprotein in the blood. This protein, which is produced in the liver, appears in a baby’s blood before birth and dissipates to very low levels in adulthood. Elevated levels of alpha-fetoprotein can be a sign of certain ovarian and testicular germ cell tumors.

Your child’s doctor may also check the levels of human chorionic gonadotropin, a hormone produced while a baby is in the womb. It supports the development of eggs or sperm and may be associated with ovarian or testicular tumors.

These tests may also be performed after treatment for germ cell tumors to determine how effective it is. Levels tend to drop when the treatments work.


A doctor may take an X-ray, which uses electromagnetic radiation to form an image of the abdomen or the chest, where germ cell tumors tend to grow.


If a tumor is suspected in the abdomen, ovaries, or testicles, the doctor may recommend an ultrasound, which uses sound waves to create images of the body. In this test, which is performed in the doctor’s office, a warm gel is spread on the abdomen or testes, and a wand called a transducer is used to send images to a computer.

Sometimes, a tumor is detected by ultrasound when an unborn child is in the womb.

CT Scans

A CT scan may be used to locate tumors. This imaging test uses X-rays and a computer to create three-dimensional, cross-sectional images of the body. Before the scan, your child may receive a contrast agent that highlights internal organs during the test.

If your child is young, sedation may be used. If you accompany your child to the CT scan, you must wear a lead apron to avoid radiation exposure. Pregnant women are advised not to be in the room while the machine is operating. The test takes 30 to 45 minutes.


A doctor may recommend performing a biopsy to determine the type of germ cell tumor in the body. This is done by removing tissue or fluid from the tumor for examination under a microscope.

The type of biopsy performed depends on the location and size of the tumor. With fine-needle aspiration, tissue is removed with a thin needle. With a surgical biopsy, the doctor removes the entire tumor.

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