Primary paratesticular yolk sac tumor: A case report and review of literature
A 12-month-old boy presented with painless progressive swelling of the right scrotum of 1 month duration. There was no history of trauma, fever, weight loss or any constitutional symptoms. The general physical examination revealed an active playful child with normal developmental milestones. On local examination, a right scrotal mass of size 3.5 cm × 4.5 cm, non-tender, firm to hard in consistency with smooth surface and regular margin was felt just above and separately from the testes. However, mobility of the testis appeared to be restricted. Overlying skin was normal and there was no inguinal lymphadenopathy. The abdominal examination was unremarkable.\nAn ultrasonography (USG) revealed a large heterogeneous mass lesion in the right hemiscrotum, separately seen from the right testis. The chest radiograph was normal and computed tomography (CT) scan of the abdomen and pelvis did not reveal any retroperitoneal lymphadenopathy. There was no abnormal osteoblastic activity on bone scan. The serum alpha fetoprotein (AFP) level was found to be markedly elevated for age (555.1 ng/ml) with normal beta human chorionic gonadotrophin (HCG). Through an inguinal incision, the tumor mass (which appeared to be slightly adherent to the testes) along with the testes was delivered with an intact tunica vaginalis. The spermatic cord was found to be congested. High inguinal orchiectomy was done []. The gross sectioned specimen showed the paratesticular location of the tumor with normal tunica albuginea []. The histopathological examination revealed a tumor arranged predominantly in glandular-alveolar pattern with formation of Schiller-Duval bodies with occasional solid and papillary pattern with hyperchromatic nucleus and moderate amount of clear cytoplasm [] suggestive of yolk sac (endodermal sinus) tumor without any other germ cell component. The testis, spermatic cord and resection margins were free of tumor.\nAt 18 months follow-up, the patient was doing well with AFP level of 5 ng/ml and no radiological evidence of metastasis.