Yu Shun-Li, Luo Bin-Jie, Zhai Tian-Yuan, Zhou Nai-Chun, Jin Zhi-Bo, Jia Zhan-Kui, Yang Jin-Jian, Gu Chao-Hui
Department of Urology / Urology Institute of Henan Province, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China.
Zhonghua Nan Ke Xue. 2019 Feb;25(2):144-149.
To compare the clinical characteristics of simple testicular yolk sac tumor (YST) in children with those in adults so as to improve the diagnosis and treatment of the malignance.
This study included 75 cases of simple testicular YST pathologically confirmed between May 2008 and July 2018, which were divided into groups A (aged <18 years, n = 64) and B (aged ≥18 years, n = 11). We analyzed the clinical data on all the cases and compared the clinical manifestations, laboratory results, pathological findings, clinical stages, treatment methods and prognostic outcomes between the two groups of patients.
The patients of group A ranged in age from 6 months to 5 years (［1.38 ± 0.89］ yr), with the tumor diameter of 0.9－6.0 (2.48 ± 1.12) cm, while those of group B from 25 to 49 years (median 34 years), with the tumor diameter of 3.5－6.3 (5.16 ± 1.32) cm, most presenting with a painless scrotal mass, 4 (6.2%) in group A and 5 (45.5%) in group B with testis pain. There were statistically significant differences between the two groups in the tumor diameter and initial manifestations (P < 0.05). All the patients were treated by radical high-level spermatectomy and orchiectomy and, in addition, 1 in group A and 3 in group B by retroperitoneal lymph node dissection (RPLND), 24 in the former and 5 in the latter group followed by chemotherapy. Elevated levels of serum alpha-fetoprotein (AFP) were observed in all the cases. Sixty-five of the patients were followed up for 10－78 (52.00 ± 23.78) months, during which 2 cases of simple metastasis, 3 cases of simple relapse, 3 cases of relapse with metastasis and 5 cases of death were found in group A, and 5 cases of simple metastasis, 1 case of simple relapse, 1 case of relapse with metastasis and 4 cases of death in group B.
There are significant differences in the clinical manifestation, biological behavior, treatment and prognosis of testicular YST between children and adults. In children, most of the testicular YST cases are at clinical stage I and preferably treated by radical high-level spermatectomy and orchiectomy with favorable prognosis. In adults, however, the tumor is highly malignant, with high incidences of recurrence and metastasis and poor prognosis, for the treatment of which the first choice is radical high-level spermatectomy and orchiectomy combined with RPLND and chemotherapy.
比较儿童与成人单纯性睾丸卵黄囊瘤（YST）的临床特征，以提高该恶性肿瘤的诊治水平。
本研究纳入2008年5月至2018年7月间病理确诊的75例单纯性睾丸YST患者，分为A组（年龄<18岁，n = 64）和B组（年龄≥18岁，n = 11）。分析所有病例的临床资料，比较两组患者的临床表现、实验室检查结果、病理表现、临床分期、治疗方法及预后。
A组患者年龄6个月至5岁（［1.38±0.89］岁），肿瘤直径0.9－6.0（2.48±1.12）cm；B组患者年龄25至49岁（中位年龄34岁），肿瘤直径3.5－6.3（5.16±1.32）cm，多数表现为无痛性阴囊肿块，A组4例（6.2%）、B组5例（45.5%）伴有睾丸疼痛。两组患者在肿瘤直径及首发表现方面差异有统计学意义（P<0.05）。所有患者均行根治性高位精索切除术及睾丸切除术，此外，A组1例、B组3例行腹膜后淋巴结清扫术（RPLND），A组有24例、B组有5例术后接受化疗。所有病例血清甲胎蛋白（AFP）水平均升高。65例患者随访10－78（52.00±23.78）个月，其中A组发现2例单纯转移、3例单纯复发、3例复发伴转移及5例死亡，B组发现5例单纯转移、1例单纯复发、1例复发伴转移及4例死亡。
儿童与成人睾丸YST在临床表现、生物学行为、治疗及预后方面存在显著差异。儿童睾丸YST多数处于临床I期，首选根治性高位精索切除术及睾丸切除术，预后良好。而在成人中，肿瘤恶性程度高，复发和转移发生率高，预后差，则首选根治性高位精索切除术及睾丸切除术联合RPLND及化疗。
