Prepubertal Testicular Tumors in Children: Single Center 17 Years Experience

Abstract

Aim:Testicular tumors are rare in children and have a bimodal distribution. The first peak is at two years of age in boys and comprises mainly non-GCNIS derived tumors (pre-pubertal teratoma and yolk sac lesions). Here, the clinical features and treatment of testicular tumors in pre-pubertal children in our center are presented.Materials and Methods:The clinical records of those patients treated for testicular tumors younger than 18 years in our institution from January, 2006 to June, 2022 were reviewed retrospectively.Results:A total of 12 patients were included in this study. All of the patients were younger than 3 years, except for one patient, who was 8 years old. The median age at primary diagnosis was 17 months (1-107 months). The most common clinical presentation was testicular swelling (n=9). Three patients were diagnosed incidentally. Serum α-fetoprotein (AFP) was increased in 3 patients with yolk sac tumors (>1,000 ng/dL) and in one patient with mature cystic teratoma (1 month-old infant with an AFP concentration of 629 ng/dL). Preoperative β-hCG levels were normal in all patients (<1.2 mIU/mL). Of the 11 patients whose preoperative scrotal ultrasound could be obtained, 5 solid-cystic lesions, 3 cystic lesions, and 2 solid lesions were reported. Calcification was detected in 4 patients. All 4 patients with malignant tumors and 3 patients with benign tumors underwent radical inguinal orchiectomy. Of the 5 tumors removed by testis preserving surgery, 2 were mature teratomas, 2 were epidermoid cyst and 1 was a benign multi-cystic lesion. There was a patient with yolk sac tumor who died in the fifth month postoperatively while receiving chemotherapy. The remaining patients had no metastatic or local primary testicular tumor recurrence during a mean follow-up of 92 months (2-198 months).Conclusion:Most pre-pubertal tumors are benign and testicular sparing surgery can be performed in patients with negative serum tumor markers. Inguinal radical orchiectomy is sufficient in the treatment of yolk sac tumor.

Keywords

• child
• orchiectomy
• organ sparing treatments
• testicular germ cell tumor
• testicular neoplasms