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Testicular yolk sac tumors in children
Insights
Pediatric yolk sac tumors have a good prognosis. Radical inguinal orchiectomy is effective for stage I disease, while chemotherapy is used for recurrence or metastasis.
Area of Science:
- Pediatric Oncology
- Urologic Oncology
- Tumor Markers
Background:
- Testicular tumors are rare in children, accounting for 1% of pediatric malignancies.
- Yolk sac tumor is the most common type of malignant testicular tumor in children.
- Treatment for pediatric yolk sac tumors remains controversial due to rarity.
Purpose of the Study:
- To evaluate the optimal management and treatment outcomes for pediatric testicular yolk sac tumors.
- To assess the effectiveness of radical inguinal orchiectomy and chemotherapy.
Main Methods:
- Retrospective review of 15 children diagnosed with testicular yolk sac tumor between 1981 and 1996.
- Patients underwent radical inguinal orchiectomy.
- Serum alpha-fetoprotein (AFP) levels were monitored.
Main Results:
- 14 out of 15 patients (93.3%) survived without disease.
- Radical inguinal orchiectomy was the primary treatment for all patients.
- Two patients with recurrence were successfully treated with cisplatin-based chemotherapy, with normalized AFP levels.
Conclusions:
- Pediatric testicular yolk sac tumors generally have a favorable prognosis.
- Serum AFP is a valuable tool for diagnosis and treatment monitoring.
- Stage I disease may be adequately treated with orchiectomy alone if AFP normalizes; chemotherapy is indicated for recurrence or metastasis.
Background:
Testicular tumors in children are uncommon, comprising about 1% of pediatric malignancies. Yolk sac tumor is the most common malignant testicular tumor in children. Because yolk sac tumor in children is rarely seen, its treatment has been controversial. We reviewed the records of 15 children with testicular yolk sac tumor treated at our hospital in order to evaluate optimal management and treatment outcome.
Methods:
From February, 1981, to August, 1996, 15 children with testicular yolk sac tumor were treated. Mean patient age at diagnosis was 15.8 months (range, 7-22 months). Fourteen patients presented with stage I disease and one presented with stage III disease. Mean follow-up was 88 months (range, 2-156 months).
Results:
All 15 patients received radical inguinal orchiectomy as initial treatment. Serum alpha-fetoprotein (AFP) concentrations were measured in 14 stage I patients preoperatively and were elevated in all of them. During follow-up, the one stage III patient died of the disease. Of the remaining 14 patients, two (14.3%) had recurrence with elevated AFP at three months and 10 months postorchiectomy, respectively. These patients were managed with cisplatin-based combination chemotherapy. To date, they are both alive with no further recurrence, and AFP concentrations returned to normal after chemotherapy. Overall, of the 15 patients with testicular yolk sac tumor, 14 (93.3%) survived without disease.
Conclusions:
Our results suggest that testicular yolk sac tumor in children is a tumor with a favorable prognosis. Serum AFP concentration is extremely useful in diagnosis and monitoring of treatment response. Radical inguinal orchiectomy alone seems adequate for patients with stage I disease if serum AFP concentrations return to normal postoperatively. Cisplatin-based combination chemotherapy should be administered in patients with tumor recurrence or metastasis.