Infantile embryonal carcinoma of testis.

Between 1968 and 1979 we treated 19 patients with infantile embryonal carcinoma of the testis. All 10 patients treated with orchiectomy plus chemotherapy (methotrexate, actinomycin D and cyclophosphamide) are well with no evidence of disease, whereas 2 of 4 who underwent orchiectomy alone and 2 of 5 treated with orchiectomy plus lymphadenectomy are dead. Infantile tumors with yolk sac elements have an apparent increase in hematogenous spread and, despite negative lymph nodes in the majority, a significant number have subsequent disseminated metastases. This suggests that infantile embryonal carcinoma is different from the adult type and implies that in clinical stage A disease retroperitoneal lymphadenectomy is unnecessary. The alpha-fetoprotein correlates with the presence of yolk sac tissue in biopsy and the radioimmunoassay level assists in monitoring the treatment.