Testicular yolk sac tumours (also known as endodermal sinus tumour of the testis) is the most common childhood testicular tumour (80%), with most cases occurring before the age of two years 1. In adults, pure yolk sac tumour is extremely rare, however mixed germ cell tumour are commonly seen.
Totipotent cells, which later form extraembryonic fetal membranes, give rise to yolk sac tumours.
Perivascular structures called Schiller-Duval bodies can be found in 50% of tumours and are pathognomonic.
AFP (alpha fetoprotein) is elevated in >90% cases of yolk sac tumour. Macroscopically, the testis is replaced by a gelatinous mass. Microscopically, a positive reaction for AFP is seen in tumour cells.
Prospective radiologic characterisation of yolk sac tumour is difficult, however a heterogeneous testicular mass favours non-seminomatous germ cell tumour (NSGCT), and at age <2 years, yolk sac tumour is the favoured diagnosis.
Diffusely enlarged heterogeneous testis.
Heterogeneous testicular mass lesion with post-contrast heterogeneous enhancement, with areas of hemorrhage/necrosis 2.
Treatment and prognosis
If the tumour is restricted to the testis, and if the serum AFP is not elevated, orchiectomy is complete treatment, with close follow-up. If relapse occurs, chemotherapy is the treatment of choice. The lungs are most common site of recurrence.
Ultrasound - testicular and scrotal
- ultrasound (introduction)
testicular and scrotal ultrasound
unilateral testicular lesion
- testicular torsion
- testicular rupture
- germ cell tumours of the testis
- sex cord / stromal tumours of the testis
- bilateral testicular lesion
- paratesticular lesions
- tubular ectasia of the rete testis
- cystadenoma of the rete testis
- testicular sarcoidosis
- testicular tuberculosis
- spermatic cord
- fibrous pseudotumour of the scrotum
- scrotal leiomyosarcoma
- testicular adrenal rest tumours (TARTs)
- tunica vaginalis testis mesothelioma
- splenogonadal fusion
- unilateral testicular lesion
- 1. Woodward PJ, Sohaey R, O'donoghue MJ et-al. From the archives of the AFIP: tumors and tumorlike lesions of the testis: radiologic-pathologic correlation. Radiographics. 22 (1): 189-216. Radiographics (full text) - Pubmed citation
- 2. Tsili AC, Tsampoulas C, Giannakopoulos X et-al. MRI in the histologic characterization of testicular neoplasms. AJR Am J Roentgenol. 2007;189 (6): W331-7. doi:10.2214/AJR.07.2267 - Pubmed citation