AFP and Respiratory insufficiency: Reasons for biopsy in those 8 cases were higher age at diagnosis (n = 2), high serum alpha fetoprotein (n = 2), atypical presentation on imaging (n = 2), atypical presentation with respiratory insufficiency due to a pulmonary tumor mass (n = 1) and elevated serum uric acid and lactate dehydrogenase (n = 1).