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© 2021 The Authors. Société Internationale d'Urologie Journal, published by the Société Internationale d'Urologie, Canada.

Key Words Competing Interests Article Information

Testis, yolk sac, germ cell tumor,  
alpha-fetoprotein

None declared.

Patient Consent: Obtained.

Received on July 22, 2021 
Accepted on July 27, 2021

Soc Int Urol J.2021;2(5):327

DOI: 10.48083/ VIGD9881

Pure yolk sac tumor (YST) is most commonly seen in 
infants and young children, accounting for 80% of all 
germ cell tumors in this age group[1]. Pure YST is rare 
in adults, constituting up to 2.4% of tumors, and is 
associated with a less favorable prognosis in adults than 
in children[2-3]. Here, we describe a rare case of pure 
YST of the testis in an adult with scrotal invasion.

A 62-year-old male presented with a 3-month history 
of an enlarging scrotal mass. On examination, the 
patient was found to have a 10 cm to 12cm fungating 
and necrotic mass with superficial bleeding, ulceration, 
and breakdown of the overlying skin (Figure 1). 
Only the left testicle was palpable. Bilateral inguinal 
lymphadenopathy with mobile, firm, rubbery lymph 
nodes was noted. Given the lymphatic drainage 
networks of the scrotum, these may represent reactive 
adenopathy from infection or regional metastases[4].

Serum tumor markers included AFP 17 418 ng/mL, 
β-hCG <0.06 IU/L, LDH 234 U/L. Contrast-CT was 
negative for lymphadenopathy of the chest, abdomen, 
and pelvis. No abdominal and pelvic visceral metastases 
were visualized. In the scrotum, there was a 10.9 cm 
heterogenous mass without demonstration of the right 
testicle. Radiologic lymphadenopathy of the bilateral 
inguinal regions was confirmed. The patient was taken 
to the operating room for biopsy, and surgical pathology 
demonstrated extensive necrosis and pure yolk sac 
pathology. Immunohistochemistry was positive for 
Sall4, Glypican-3, AFP, and CD117, and negative for 
OCT3/4 and CD30. Microscopic inspection revealed 
classic Schiller-Duval bodies.

The patient was initiated on neoadjuvant chemo-
therapy with etoposide and cisplatin for 4 cycles. 
Bleomycin was withheld from the regimen because the 
patient had a long-standing smoking history. He tolerated 
the treatment protocol without significant adverse events. 

FIGURE 1. 

Anterior view of the large fungating, ulcertative scrotal 
mass with breakdown of the overlying skin 

On follow-up, the patient had experienced a reduction in 
the size of the scrotal mass and resolution of the inguinal 
lymphadenopathy, and he will be scheduled for surgical 
consolidation. 

Pure Yolk Sac Tumor of the Testis With  
Scrotal Invasion in an Adult Male
Jas Singh

Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, United States

References
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a role for precision medicine in testicular cancer. Clin Genitourin 
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2. Khan S, Jetley S, Pujani M, Neogi S. Pure yolk sac tumor of testis in an 
adult: a rare occurrence. J Postgrad Med.2014;60:351–353.

3. Pagaro PM, Bedarshi B. Pure yolk sac tumor of testis in a 50 years 
old: a rare case report. Med J DY Patil Univ.2016;9(4):499–502. doi: 
10.4103/0975-2870.186078

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involvement with testicular nonseminomatous germ cell tumour.  
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