Treatment of testicular yolk sac carcinoma in the young child

The majority of testicular tumors in children will be 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, especially in children less than 2 years old, confusion remains as to adjunctive treatment for yolk sac carcinoma. We have studied retrospectively 21 children with testis tumors encountered within the last 10 years. Of these cases 12 were classified pathologically as yolk sac carcinoma. All children were less than 3 years old and 10 of 12 were less than 2 years old. Of the 12 cases 4 had positive lymph node dissections and 3 of these 4 children were less than 2 years old. 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 should be treated with an extended unilateral lymphadenectomy for staging and appropriate treatment regimens.