The Diagnosis And Treatment Of Testicular Yolk Sac Tumors (Report Of 53 Cases)

Objective:To improve the level of diagnosis and treatment of testicular yolk sac tumor by clinicians and improve the prognosis.Methods:The clinical data and follow-up data of 53 cases of testicular yolk sac tumor admitted to the first affiliated hospital of Guangxi Medical university from 2012 to 2018 were retrospectively analyzed.Results Among the 53 patients,44 children and 9 adults with a median age of 20 months were treated with scrotal masses.Among them,52 patients had no obvious pain and 1 patient had dull pain in scrotal area.All the 53 patients felt heavy scrotal drop and underwent light transmission test(-);Four patients were misdiagnosed as inguinal hernia at the first diagnosis,and one case had inflammation of testis and epididymis.Among 47 cases of preoperative serum AFP examination,46 cases were increased,40 cases of ultrasonography showed solid hypoechoic mass in the testis of the affected side,and CDFI showed rich blood flow in the mass,7 cases of scrotal CT showed clear edge cystic solid mass in the testis of the affected side,and the enhanced scan showed uneven enhancement.MRI in 2 cases showed testicular enlargement.51 patients were treated with radical orchiectomy,2 with testis sparing surgery,8 withretroperitoneal lymph node dissection,and 1 with pelvic lymph node dissection.47 cases were pathologically diagnosed as simple yolk sac tumor.Six cases were mixed testicular tumors including yolk sac tumor,and all of them were adults.Postoperative chemotherapy was performed in 31 patients(including PEB,JEB,CISCA,TIP),and 22 patients did not receive postoperative chemotherapy.In most cases,the AFP values in the 1-3 months follow-up were significantly lower than those before the operation,and the serum AFP values could be maintained within the normal range after long-term review.2 patients relapsed and 1 died.Conclusion Testicular yolk sac tumors mostly occurs in children less than 2years old,often due to painless gradually increased testicular mass to see a doctor,combined with serum AFP and scrotal ultrasound can be a preliminary diagnosis,diagnosis depends on histopathological examination;Radical orchiectomy is the first choice for treatment,and postoperative treatment should be based on the clinical and pathological stages of the disease.Early diagnosis,early treatment and long-term follow-up are the keys to improve the prognosis of this disease.