SALL4 and neoplasm: In summary, considering the patient’s perimenopausal age, initial symptom of persistent irregular vaginal bleeding, significantly elevated AFP, bilateral ovarian lesions without hepatic involvement, and the tumor’s immunohistochemical profile (CK7+, HepPar-1+, Glypican-3+, SALL4–), the clinical and pathological findings support a diagnosis of HCO.