Ultrasonic misdiagnosis of giant pediatric testicular yolk sac tumor: A case report and literature review
BackgroundYolk sac tumor is the most common malignant nonseminomatous germ-cell tumor in children characterized by elevated level of α-fetoprotein (AFP), accounting for 70%–80% of all cases. However, giant yolk sac tumors that involve the entire testicle may be misdiagnosed by color Doppler ultrason...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-12-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2022.1058037/full |
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| author | Zilong Wang Fuding Lu Changze Song Xinkun Wang Naifa Li Jiawen Zhai Baohong Jiang Jianpeng Yuan Zheng Yang Xujun Xuan Xujun Xuan |
| author_facet | Zilong Wang Fuding Lu Changze Song Xinkun Wang Naifa Li Jiawen Zhai Baohong Jiang Jianpeng Yuan Zheng Yang Xujun Xuan Xujun Xuan |
| author_sort | Zilong Wang |
| collection | DOAJ |
| description | BackgroundYolk sac tumor is the most common malignant nonseminomatous germ-cell tumor in children characterized by elevated level of α-fetoprotein (AFP), accounting for 70%–80% of all cases. However, giant yolk sac tumors that involve the entire testicle may be misdiagnosed by color Doppler ultrasonography as orchitis. Therefore, we described a case of a 2-year-old pediatric patient with a giant testicular yolk sac tumor that was misdiagnosed by ultrasonography as orchitis, in order to evaluate the role of measuring AFP levels in the initial diagnosis to aid in the accuracy of the definitive diagnosis of testicular yolk sac tumor.Case presentationA 2-year-old boy received outpatient visits for unintentional swelling of the right scrotum for 7 days. Physical examination showed a rubbery swelling of the right scrotum with rejective touch. Then, the patient underwent perineal color Doppler ultrasonography in outpatient visits. The result showed a right testicle size of 29 mm × 22 mm × 20 mm with heterogeneous echogenicity and abundant blood flow, supporting the initial diagnosis of orchitis. However, the initial surgeon was skeptical of the ultrasonography diagnosis. Thus, the patient was admitted to the Department of Andrology on day 2 for further serological and imaging examination. The serum AFP level on day 3 was 323.77 ng/ml. The results of CT and MRI showed a giant tumor of the right testis (26 mm × 21 mm × 29.6 mm) with multiple lymphoid hyperplasia in the inguinal region bilaterally. The patient received radical orchidectomy without lymph node dissection on day 9. The results of postoperative pathological examination confirmed giant testicular yolk sac tumor (T1N0M0S1, Stage Is) and was positive for AFP and SALL4 in immunohistochemistry staining. The patient received three courses of bleomycin–etoposide–cisplatin chemotherapy in the Department of Pediatrics after multidisciplinary team meeting on postoperative days 14, 37, and 58, respectively. During chemotherapy and follow-up, the patient's AFP and lactate dehydrogenase levels continued to decline, and eventually remained within normal range on postoperative day 84.ConclusionMeasuring the AFP level was necessary for initial diagnosis and follow-up in pediatric cases of testicular enlargement. Radical orchidectomy combined with postoperative bleomycin–etoposide–cisplatin adjuvant chemotherapy was an effective treatment strategy for pediatric giant testicular yolk sac tumors. |
| first_indexed | 2024-04-12T00:45:56Z |
| format | Article |
| id | doaj.art-485a95e1cdba4bfa8db04c5208451c3a |
| institution | Directory Open Access Journal |
| issn | 2296-2360 |
| language | English |
| last_indexed | 2024-04-12T00:45:56Z |
| publishDate | 2022-12-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj.art-485a95e1cdba4bfa8db04c5208451c3a2022-12-22T03:54:53ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602022-12-011010.3389/fped.2022.10580371058037Ultrasonic misdiagnosis of giant pediatric testicular yolk sac tumor: A case report and literature reviewZilong Wang0Fuding Lu1Changze Song2Xinkun Wang3Naifa Li4Jiawen Zhai5Baohong Jiang6Jianpeng Yuan7Zheng Yang8Xujun Xuan9Xujun Xuan10Department of Andrology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, ChinaDepartment of Andrology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, ChinaDepartment of Andrology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, ChinaDepartment of Andrology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, ChinaDepartment of Andrology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, ChinaDepartment of Andrology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, ChinaDepartment of Andrology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, ChinaDepartment of Radiology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, ChinaDepartment of Pathology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, ChinaDepartment of Andrology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, ChinaNational Research Center for Assisted Reproductive Technology and Reproductive Genetics, Cheeloo College of Medicine, Shandong University, JinanBackgroundYolk sac tumor is the most common malignant nonseminomatous germ-cell tumor in children characterized by elevated level of α-fetoprotein (AFP), accounting for 70%–80% of all cases. However, giant yolk sac tumors that involve the entire testicle may be misdiagnosed by color Doppler ultrasonography as orchitis. Therefore, we described a case of a 2-year-old pediatric patient with a giant testicular yolk sac tumor that was misdiagnosed by ultrasonography as orchitis, in order to evaluate the role of measuring AFP levels in the initial diagnosis to aid in the accuracy of the definitive diagnosis of testicular yolk sac tumor.Case presentationA 2-year-old boy received outpatient visits for unintentional swelling of the right scrotum for 7 days. Physical examination showed a rubbery swelling of the right scrotum with rejective touch. Then, the patient underwent perineal color Doppler ultrasonography in outpatient visits. The result showed a right testicle size of 29 mm × 22 mm × 20 mm with heterogeneous echogenicity and abundant blood flow, supporting the initial diagnosis of orchitis. However, the initial surgeon was skeptical of the ultrasonography diagnosis. Thus, the patient was admitted to the Department of Andrology on day 2 for further serological and imaging examination. The serum AFP level on day 3 was 323.77 ng/ml. The results of CT and MRI showed a giant tumor of the right testis (26 mm × 21 mm × 29.6 mm) with multiple lymphoid hyperplasia in the inguinal region bilaterally. The patient received radical orchidectomy without lymph node dissection on day 9. The results of postoperative pathological examination confirmed giant testicular yolk sac tumor (T1N0M0S1, Stage Is) and was positive for AFP and SALL4 in immunohistochemistry staining. The patient received three courses of bleomycin–etoposide–cisplatin chemotherapy in the Department of Pediatrics after multidisciplinary team meeting on postoperative days 14, 37, and 58, respectively. During chemotherapy and follow-up, the patient's AFP and lactate dehydrogenase levels continued to decline, and eventually remained within normal range on postoperative day 84.ConclusionMeasuring the AFP level was necessary for initial diagnosis and follow-up in pediatric cases of testicular enlargement. Radical orchidectomy combined with postoperative bleomycin–etoposide–cisplatin adjuvant chemotherapy was an effective treatment strategy for pediatric giant testicular yolk sac tumors.https://www.frontiersin.org/articles/10.3389/fped.2022.1058037/fullyolk sac tumorultrasonic misdiagnosisAFPBEP chemotherapyorchidectomycase report |
| spellingShingle | Zilong Wang Fuding Lu Changze Song Xinkun Wang Naifa Li Jiawen Zhai Baohong Jiang Jianpeng Yuan Zheng Yang Xujun Xuan Xujun Xuan Ultrasonic misdiagnosis of giant pediatric testicular yolk sac tumor: A case report and literature review Frontiers in Pediatrics yolk sac tumor ultrasonic misdiagnosis AFP BEP chemotherapy orchidectomy case report |
| title | Ultrasonic misdiagnosis of giant pediatric testicular yolk sac tumor: A case report and literature review |
| title_full | Ultrasonic misdiagnosis of giant pediatric testicular yolk sac tumor: A case report and literature review |
| title_fullStr | Ultrasonic misdiagnosis of giant pediatric testicular yolk sac tumor: A case report and literature review |
| title_full_unstemmed | Ultrasonic misdiagnosis of giant pediatric testicular yolk sac tumor: A case report and literature review |
| title_short | Ultrasonic misdiagnosis of giant pediatric testicular yolk sac tumor: A case report and literature review |
| title_sort | ultrasonic misdiagnosis of giant pediatric testicular yolk sac tumor a case report and literature review |
| topic | yolk sac tumor ultrasonic misdiagnosis AFP BEP chemotherapy orchidectomy case report |
| url | https://www.frontiersin.org/articles/10.3389/fped.2022.1058037/full |
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