Pediatric Testicle Tumor

  • Etiology:
    — First decade is yolk sac tumor (endodermal sinus tumor) and teratoma
    — Second decade is choriocarcinoma
  • Imaging US Choriocarcinoma: Heterogenous mass
  • Imaging US Teratoma:
    — Cystic mass with heterogenous echoes in fluid due to mucinous or sebaceous material with or without hair follicles
    — Solid components representing fat can be hyperechoic and shadowing
  • Imaging US Yolk sac tumor: Diffusely enlarged heterogenous testis
  • DDX:
  • Complications: Metastases to lymphatic system, lung, liver, bone
  • Treatment: Surgical
  • Clinical:
    — Presentation is scrotal swelling or testicular lump
    — Choriocarcinoma peaks around 20 years old, b-HCG levels elevated
    — Teratoma is 5% of testicular tumors
    — Yolk sac tumor most common pediatric testicular tumor (80%) usually occurring before 2 years old with AFP elevated in greater than 90% of cases

Radiology Cases of Testicle Tumor

Radiology Cases of Embryonal Cell Testicle Tumor

US of embryonal cell testicle tumor
Transverse US of the scrotum (above) shows a focal hypoechoic lesion along the medial border of the left testicle which on the sagittal US of the left testicle (below) appears to have an echogenic posterior aspect, representing calcification.

Radiology Cases of Yolk Sac Testicle Tumor

US of testicular yolk sac tumor
Transverse color doppler US of the scrotum (above) shows the left testicle is hypervascular and much larger in size than the right testicle. Sagittal US of the left testicle (below) shows the testicular enlargement is due to a large round mass in the superior aspect of the testicle that is discrete from the normal testicle inferiorly.
CXR and CT of lung metastases from embryonal cell carcinoma of testicle
CXR PA and lateral (above) shows a large round solid lesion in the right upper lobe. Axial CT without contrast of the chest (below left) shows a large solid lesion in the right upper lobe and a small solid lesion in the left upper lobe posteriorly. There is an additional solid lesion in the right lower lobe (below right).