Forensic Psychiatry and Behavioral Analysis
Q: Forensic psychiatry involves the assessment of a defendant's mental state at the time of a crime (insanity defense).
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Alpha-fetoprotein (AFP) is the tumor marker least likely to be elevated in a pure seminoma. In fact, an elevated AFP definitively rules out the diagnosis of a pure seminoma. By definition, if AFP is elevated, the tumor contains non-seminomatous elements (such as yolk sac tumor) and is classified as a mixed germ cell tumor or a non-seminomatous germ cell tumor (NSGCT). Pure seminomas may have a mild to moderate elevation of human chorionic gonadotropin (hCG) in about 15-20% of cases, and lactate dehydrogenase (LDH) is a non-specific marker that can be elevated due to high tumor burden. Prostate-specific antigen (PSA) is specific to prostate tissue and is not associated with testicular tumors. Therefore, the AFP level is a critical differentiator in the initial evaluation of a testicular mass.
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