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Clinical experience with yolk sac tumors and teratoma in children
A Terai1, M Kawakita, O Yoshida
1Department of Urology, Faculty of Medicine, Kyoto University, Japan.
Insights
Pediatric testicular germ cell tumors, including yolk sac tumors and teratomas, show promising survival rates. Early-stage cancers often respond well to surgery, with advanced cases benefiting from chemotherapy and resection.
Area of Science:
- Pediatric Urology
- Oncology
- Surgical Oncology
Background:
- Testicular germ cell tumors (TGCTs) are rare in children.
- Management strategies have evolved over time.
- Understanding outcomes is crucial for pediatric cancer care.
Purpose of the Study:
- To review the treatment and outcomes of pediatric TGCTs.
- To analyze the efficacy of different management approaches.
- To report long-term survival data for pediatric TGCT patients.
Main Methods:
- Retrospective review of 12 pediatric TGCT cases treated between 1971-1993.
- Analysis of tumor types (yolk sac tumor, teratoma), stages, and treatment modalities.
- Evaluation of surgical interventions (orchiectomy, lymph node dissection) and chemotherapy.
Main Results:
- Six of seven yolk sac tumor patients (85.7%) survived, with stage I tumors responding well to surgery.
- Two stage I yolk sac tumors developed lung metastases, one successfully treated with chemotherapy and surgery.
- One stage III yolk sac tumor patient achieved remission after chemotherapy and resection.
- All five mature teratoma patients, treated with orchiectomy or enucleation, are alive.
Conclusions:
- Pediatric testicular germ cell tumors, particularly yolk sac tumors and teratomas, have favorable prognoses.
- Surgical management, including orchiectomy and lymph node dissection, is effective for early-stage disease.
- Multimodal therapy combining chemotherapy and surgery can salvage patients with advanced or metastatic TGCTs.
Abstract:
Between 1971 and 1993, 12 children with testicular germ cell tumors were treated at the Department of Urology, Faculty of Medicine, Kyoto University. Seven patients had yolk sac tumors and 5 had mature teratoma. Of the 7 patients with yolk sac tumors 6 had stage I and 1 had stage III tumors. Initial management of the stage I tumors consisted of high orchiectomy in 5 patients and high orchiectomy plus retroperitoneal lymph node dissection in 1 patient. Of these 6 patients, 4 were cured by surgery alone but lung metastases developed in the other 2 patients. One of them was salvaged with thoracotomy and chemotherapy but the other died of tumor. The patient with stage III tumor had bulky tumor spread to lung and retroperitoneum, but seems to have been cured by chemotherapy followed by resection of the residual mass although follow-up is still inadequate (14 months). Six of the 7 patients (85.7%) are alive 13 months to 21 years after diagnosis. Five patients with mature teratoma were treated by high orchiectomy or, more recently, enucleation and all are alive 4 months to 22 years after surgery.