Two Cases of Retroperitoneal Lymph Node Dissection for the Treatment of Yolk Sac Tumor of Testis / 대한비뇨기과학회지

Germ cell tumors in children are rare but the predominent pathologic type is the yolk sac carcinoma. And there are no specific guidelines for the treatment of the young child with a testis tumor of the yolk sac or endodermal sinus type. Initial treatment of radical orchiectomy is not in question. However, because of its presumed less virulent character, especially in children less 2 years old, confusion remains As to adjunctive treatment for yolk sac carcinoma. Although chemotherapy is so effective its toxicity cannot be minimized. Therefore, adjunctive chemotherapy should be reserved for those patients who have lymphatic spread. Young children with yolk sac tumors are not immune to metastatic disease and, regardless of age, should be treated with retroperitoneal Iymphadenectomy for staging and appropriate treatment regimens. Herein we report two cases of yolk sac carcinomas in children treated with adjunctive chemotherapy and nerve sparing retroperitoneal lymphadenectomy.

Large Mononuclear Cells in Seminoma: An Immunohistochemical Analysis of 21 Cases

Twenty-one cases of seminoma (including testicular seminoma, ovarian dysgerminoma and extragonadal germinoma) were reviewed for the cell types responsible for the production of alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG). Histologically the cases included seventeen classical seminomas and 4 anaplastic seminomas. The latter had some mononuclear and multinuclear giant cells. All 4 patients with anaplastic seminoma had elevated levels of serum AFP, and each of these cases contained AFP producing tumor cells identified by immunoperoxidase staining. All seminomas of patients with elevated serum levels of HCG were of the classical type but HCG producing tumor cells could not be identified by immunoperoxidase staining. Immunoreactivity to anti-AFP was found in some large mononuclear cells and anaplastic cells. To explain these results, we propose that the large mononuclear cell is a multipotential cell capable of differentiating into a germ cell, yolk sac and embryo, and that the anaplastic seminoma cells might represent a stage on the continuum of cellular differentiation from the large mononuclear cells to germ cells. The multinuclear giant cell does not appear to be essential for the production of either AFP or HCG in seminoma.

A Case of Systemic Chemotherapy in Advanced Yolk Sac Carcinoma / 대한비뇨기과학회지

The majority of testicular tumors in children are of germ cell origin and the predominant pathologic type is the yolk sac carcinoma. Initial treatment of radical orchiectomy is not in question. However, because of its presumed less virulent character, confusion remains as to adjunctive treatment for yolk sac carcinoma. Recently we experienced a case of advanced yolk sac carcinoma treated with multiple systemic chemotherapy regimen.