Testicular yolk sac tumors in children: a review of 61 patients over 19years.

Yi Wei,Shengde Wu,Peng Lu,Junhong Liu,Xing Liu,Tao Lin,Xuliang Li,Yi Hua,Guanghui Wei,Dawei He

doi:10.1186/1477-7819-12-400

Abstract

BackgroundTo describe 19 years of clinical experience managing pediatric patients with testicular yolk sac tumors at the Chongqing Medical University Affiliated Children’s Hospital.MethodsThis study involved a retrospective review of the records of 61 pediatric patients who presented with testicular yolk sac tumor at our institution between 1995 and 2014.ResultsAll patients presented with a painless scrotal mass. Serum alpha-fetoprotein (AFP) levels were elevated (n = 15). Ultrasonography identified the yolk sac tumors as solid masses. Color Doppler flow imaging showed rich blood flow inside and around the masses in 84.8% cases. X-ray of the scrotum showed no intrascrotal calcification (n = 38). Inguinal orchiectomy was performed in 60 patients, one case was treated with testis-sparing surgery. In 11 cases, radical dissection of the inguinal lymph nodes was performed. Histological analysis showed pathologies typical of yolk sac tumor including microcapsule and reticular structures, gland tube-gland bubble structures, an embryo sinus structure, and papillary structures. All patients received postoperative chemotherapy. Serum AFP levels returned to normal 1 to 2 months after surgery. No patients treated with surgery in our hospital relapsed.ConclusionTesticular yolk sac tumor presents as a painless scrotal mass, increased serum AFP levels, and a solid mass on ultrasound. Chest radiography and abdominal ultrasound should be used to accurately stage the tumor. We advocate for inguinal orchiectomy for Stage I disease and postoperative chemotherapy to prevent recurrence in the ipsilateral or contralateral testis.

Highlights

To describe 19 years of clinical experience managing pediatric patients with testicular yolk sac tumors at the Chongqing Medical University Affiliated Children’s Hospital
Demographic and clinical characteristics of the patients All patients presented with a painless scrotal mass; 26 occurred on the left side, 35 occurred on the right side
Six cases were misdiagnosed as hydrocele, four cases as inguinal hernia, two cases as testicular inflammation, and one case as adenoma. These cases were misdiagnosed for presenting with a painless scrotal mass, all were cleared with transillumination test, ultrasonography, and the frozen biopsy: (1) transillumination test result was positive for the six hydrocele and negative for the yolk sac tumors; (2) the four inguinal hernia were shown as intestinal canalshaped structures on ultrasonography; (3) the two testicular inflammations were described as diffusely enlarged with rich blood flow, no space-occupying lesion were found inside on ultrasound; (4) ultrasound showed tumor tissue with adenoid structure beside normal testis and clear septum between tumor and testis, while no specific structure change in this case of adenoid carcinoma of PR PR PR PR PR Figure 1 The age distribution of the 61 pediatric patients suffering from testicular yolk sac tumors

Summary

Introduction

To describe 19 years of clinical experience managing pediatric patients with testicular yolk sac tumors at the Chongqing Medical University Affiliated Children’s Hospital. Testicular tumors are uncommon in children, comprising approximately 1% to 2% of all pediatric malignancies [1,2,3,4]. The incidence of testicular tumors in children is increasing, and associated morbidity has doubled during the last 40 years [4,5]. The prognosis of testicular yolk sac tumors is dependent on early detection and treatment. Pediatric patients with testicular yolk sac tumors usually present with an asymptomatic scrotal mass early (Stage I) in the disease process. An elevated serum AFP level is closely associated with yolk sac tumors in more than 90% of patients [7]

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Results

Conclusion