A 4-year-old boy is brought by his parents with a painless left scrotal mass. Ultrasound shows a heterogeneous solid testicular mass. Serum AFP is markedly elevated at 8,500 ng/mL. His age-adjusted AFP must be considered because AFP is physiologically elevated in infants. The most likely diagnosis and correct initial management is:
- A Testicular teratoma — orchidectomy then observation
- B Rhabdomyosarcoma — incisional biopsy via scrotal approach for histology
- C Yolk sac tumour (endodermal sinus tumour) — inguinal orchidectomy followed by staging and chemotherapy if Stage >I ✓
- D Leydig cell tumour — testis-sparing surgery
Explanation
Yolk sac tumour (endodermal sinus tumour) is the most common testicular malignancy in prepubertal boys (ages 1-5 years) and characteristically produces very high AFP levels. Physiologically elevated AFP in infants (<6 months) must be distinguished, but at age 4 years and AFP 8,500 ng/mL this is clearly pathological. Correct management is inguinal orchidectomy (never scrotal approach — risk of lymphatic seeding altering drainage to inguinal nodes). Post-orchidectomy staging determines need for chemotherapy (BEP regimen for Stage II+). Leydig cell tumours are benign and AFP-negative.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.