Publish in this journal
Journal Information
Vol. 88. Num. 5.01 May 2018Pages 237-290
Share
Share
Download PDF
More article options
ePub
Visits
49
Vol. 88. Num. 5.01 May 2018Pages 237-290
Original Article
DOI: 10.1016/j.anpede.2017.05.009
Testicular tumours in children: Indications for testis-sparing surgery
Tumores testiculares en la edad pediátrica: indicaciones de la cirugía conservadora
Visits
49
Martha Isabel Romo Muñoza,
Corresponding author
march3x@gmail.com

Corresponding author.
, Vanesa Núñez Cerezoa, Mariela Dore Reyesa, Alejandra Vilanova Sáncheza, Pilar González-Peramatob, Pedro López Pereirac, María José Martínez Urrutiac
a Departamento de Cirugía Pediátrica, Hospital La Paz, Madrid, Spain
b Departamento de Patología, Hospital La Paz, Madrid, Spain
c Departamento de Cirugía Pediátrica, Servicio de Urología infantil, Hospital La Paz, Madrid, Spain
This item has received
49
Visits
Article information
Abstract
Full Text
Bibliography
Download PDF
Statistics
Tables (1)
Table 1. Summary of clinical cases.
Abstract
Introduction and objectives

Although standard surgical treatment of a testicular tumour is orchiectomy, use can be made of testis-sparing surgery in selected cases, based on tumour markers, tumour size, and histopathological findings. Our objective is to become acquainted with the indications of testis-sparing surgery as a treatment for the incidental finding of a palpable and non-palpable testicular mass.

Material and methods

A retrospective study was conducted on 22 patients younger than 18 years diagnosed with a testicular tumour between 2000 and 2014. An assessment was made of the condition, the history, ultrasound, histopathology, tumour markers (BHCG, AFP), therapeutic approach, and outcome.

Results

Of the 22 patients (10 prepubertal age) studied, 82% had palpable mass, and 18% were incidental findings. Two had cryptorchidism. The BHCG was increased in 27% and AFP in 45% of cases. There were 18 tumorectomies and 4 orchiectomies performed. The histopathology found 72% germ cell, 14 orchiectomy, and 2 tumorectomies (2 teratomas), with 27% non-germ cell tumours in 4 orchiectomies and 2 tumorectomies (2 cells of Leydig). Six patients received post-surgical chemotherapy (mixed tumours). The median tumour size was 1 (0.4–1.5) cm in tumorectomies, and 2.5 (0.5–14) cm in orchiectomies. The mean follow-up was 5 (1–15) years. One patient died due to metastatic disease. There was no local recurrence in the follow up of the tumorectomies.

Conclusions

A change in the trend of our therapeutic approach is demonstrated. We propose that testis-sparing surgery is indicated in prepubertal patients who meet the benignity criteria of the testicular mass (small size and negative tumour markers).

Keywords:
Testicular tumour
Orchiectomy
Tumorectomy
Resumen
Introducción y objetivos

El tratamiento quirúrgico estándar del tumor testicular es la orquiectomía, sin embargo, se podría recurrir a la cirugía conservadora en casos seleccionados, basándonos en la edad del paciente, marcadores tumorales, tamaño tumoral y hallazgos histopatológicos. Nuestro objetivo es dar a conocer cuáles son las variables que tener en cuenta para indicar una cirugía conservadora como tratamiento de una masa testicular palpable y no palpable encontrada como hallazgo incidental.

Material y métodos

Estudio retrospectivo en 22 pacientes menores de 18 años, diagnosticados de tumor testicular entre 2000 y 2014. Revisamos el motivo de consulta, antecedentes, ecografía, estudio histopatológico, marcadores tumorales (BHCG, AFP), actitud terapéutica y evolución.

Resultados

De los 22 pacientes (10 prepuberales), el 82% presentaron masa palpable y el 18% fueron hallazgos incidentales. Dos presentaban criptorquidia. La BHCG estaba aumentada en el 27% y la AFP en el 45%. Se realizaron 18 orquiectomías y 4 tumorectomías. La histología fue en un 72% de células germinales, 14 orquiectomías y 2 tumorectomías (2 teratomas); y en un 27% de tumores de células no germinales, en 4 orquiectomías y 2 tumorectomías (2 tumores de células de Leyding). Seis pacientes recibieron quimioterapia postoperatoria (tumores mixtos). La mediana del tamaño de la tumoración fue de un cm (0,4-1,5) en las tumorectomías y de 2,5cm (0,5-14) en las orquiectomías. El seguimiento fue de 5 años (1-15). Un paciente falleció por enfermedad metastásica. No hubo recidiva local en la evolución de las tumorectomías.

Conclusiones

Ponemos de manifiesto una tendencia al cambio en nuestra actitud terapéutica. Planteamos una cirugía conservadora mediante tumorectomía en los pacientes que cumplan con los criterios de benignidad de la masa testicular (pequeño tamaño y marcadores tumorales negativos).

Palabras clave:
Tumor testicular
Orquiectomía
Tumorectomía

Article

These are the options to access the full texts of the publication Anales de Pediatría (English Edition)
Member
If you are a member of the Asociación Española de Pediatría:
Go to the members area of the website of the AEPED, (http://www.aeped.es/biblioteca )and login.

Next go to the journal


Subscriber
Subscriber

If you already have your login data, please click here .

If you have forgotten your password you can you can recover it by clicking here and selecting the option “I have forgotten my password”
Idiomas
Anales de Pediatría (English Edition)

Subscribe to our Newsletter

Article options
Tools
Cookies policy
To improve our services and products, we use cookies (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here.