Case Report: Rare Presentation of Mixed Germ Cell Tumor in an Infant

Abstract

The estimated incidence of pediatric testis tumor is 0.5-2.0 per 100,000 children, accounting for 1-2% of all pediatric tumors. Mixed germ cell tumors (MGCT) in prepubertal males are exceedingly rare, with only one previous case report found in the literature. We report a case of a MGCT in an infant. For prepubertal males, GCTs typically present with a painless scrotal mass, though trauma, testis torsion and hydrocele are also common presentations. Similar to such tumors in postpubertal males, ultrasonography, computed tomography, and tumor markers are integral to determine the best treatment. The patient described in this report presented with a painless scrotal mass. Following orchiectomy, the patient was found to have MGCT that was limited to the testis. With prudent management, these patients tend to have favorable prognoses.

Keywords: germ cell tumor; pediatric cancer; pediatric urology; surgery; testicular tumor.

Figure 1

(A) Color Doppler ultrasonography showed an enlarged, heterogeneous, macronodular right testicle with cystic areas. Both arterial and venous flow were preserved, but hyperemia of the abnormal testis was present. (B) The testis and spermatic cord were accessed via an inguinal incision.

Figure 2

(A) The majority of the tumor comprises immature teratoma with a predominance of primitive neuroepithelium (bottom right) and a smaller primitive mesenchymal component (nodule of immature cartilage on the left). (B) There were rare small foci of yolk sac tumor with primitive glandular structures as well as a hepatoid focus demonstrating cords of immature cells with more abundant eosinophilic cytoplasm and occasional small nucleoli. (C) This focus is strongly AFP-positive.