From the Guidelines
The most common type of testicular tumor in infants is yolk sac tumor, also known as endodermal sinus tumor. This tumor typically presents as a painless testicular mass in children under 2 years of age, with the peak incidence occurring between 6 months and 2 years. Yolk sac tumors account for approximately 80% of all testicular tumors in this age group 1. These tumors produce alpha-fetoprotein (AFP), which serves as an important tumor marker for diagnosis and monitoring treatment response. Management typically involves radical inguinal orchiectomy (surgical removal of the affected testicle), followed by close surveillance with regular physical examinations, AFP measurements, and imaging studies. Unlike in adults, infants with yolk sac tumors generally have an excellent prognosis with survival rates exceeding 90% when properly treated 1. The tumor's embryonic origin from primitive germ cells explains its predominance in the infant population, as these cells are more active during early development. Key points to consider in the management of testicular tumors in infants include:
- Early diagnosis and treatment are crucial for optimal outcomes
- Radical inguinal orchiectomy is the primary treatment for most patients
- Close surveillance is necessary to monitor for recurrence and metastasis
- AFP measurements and imaging studies are essential for monitoring treatment response and detecting potential complications.
From the Research
Testicular Tumors in Infants
- The most common type of testicular tumor in infants is the yolk sac tumor, which is a malignant nonseminomatous germ-cell tumor 2, 3, 4, 5.
- Yolk sac tumors account for 70%-80% of all testicular tumors in children and are characterized by elevated levels of α-fetoprotein (AFP) 4, 5.
- The age range for yolk sac tumors in infants and children is typically between 5 to 71 months, with a mean age of 20.7 months 5.
- Treatment for yolk sac tumors usually involves radical inguinal orchiectomy, and in some cases, chemotherapy and/or radiotherapy may be necessary 2, 3, 6, 5.
Characteristics and Prognosis
- Yolk sac tumors can be misdiagnosed as orchitis due to their similar presentation on ultrasonography, highlighting the importance of measuring AFP levels for accurate diagnosis 4.
- The prognosis for infants and children with yolk sac tumors is generally good, with a high survival rate due to effective chemotherapy and the inherent characteristics of the tumor in this age group 2, 3, 5.
- Factors associated with a poor outcome in patients with stage I yolk sac tumors include tumor size >4.5 cm, invasion of rete testis and/or epididymis, and necrosis 5.