Testicular tumours in children: Indications for testis-sparing surgery

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Note the macrocystic and microcystic pattern of the yolk sac." ] ] ] "textoCompleto" => "IntroductionTesticular tumours account for 1–2% of all paediatric solid tumours, with 2 peaks in age of onset: the first one at ages 2–4 years, and the second at around age 15 years.<a class="elsevierStyleCrossRef" href="#bib0100">1</a> Its incidence in the general population is of 0.5–2 cases per 100,000 inhabitants, with an increase in the adult population in recent years.<a class="elsevierStyleCrossRefs" href="#bib0105">2,3</a>Testicular tumours are divided into 6 groups (World Health Organization histological classification of tumours, 2016)<a class="elsevierStyleCrossRef" href="#bib0115">4</a>: (1) germ-cell tumours derived from germ cell neoplasia in situ (GCNIS) including seminoma, embryonal carcinoma, postpubertal-type yolk sac tumour, trophoblastic tumour and germ cell tumours of unknown type (‘burnt-out’ tumours); (2) germ cell tumours unrelated to GCNIS, including spermatocytic tumour, prepubertal-type teratoma, prepubertal-type yolk sac tumour and prepubertal-type mixed teratoma and yolk sac tumour; (3) sex-cord-stromal tumours (Leydig cell, Sertoli cell or granulosa cell tumours); (4) tumours containing both germ cell and sex cord-stromal elements; (5) miscellaneous tumours of the testis and (6) haematolymphoid tumours. This new classification differentiates between 2 types of teratomas (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>) and yolk sack tumours: prepubertal type (unrelated to GCNIS) and postpubertal type (derived from GCNIS), with the prognosis being significantly better in the former. There is a clear predominance (90–95%) of germ cell tumours, and prepubertal-type teratomas and yolk sac tumours are the most frequent testicular tumours in children<a class="elsevierStyleCrossRefs" href="#bib0120">5–8</a> (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Prepubertal-type teratomas are usually cystic and have an organoid arrangement (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>). This type includes epidermoid cysts, dermoid cysts and well-differentiated neuroendocrine tumours.<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia>Due to the routine use of ultrasound examination, there has been an increase in the detection of cases of nonpalpable testicular masses<a class="elsevierStyleCrossRefs" href="#bib0140">9,10</a> (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>).<elsevierMultimedia ident="fig0025"></elsevierMultimedia>Radical orchiectomy has been traditionally considered the gold standard of treatment for testicular masses at any age. However, given that these masses are frequently benign in children,<a class="elsevierStyleCrossRefs" href="#bib0100">1,10,11</a> the medical and surgical approach to their management has been re-evaluated in recent years. This involves a change in the initial treatment approach, with consideration of conservative surgery (tumourectomy)<a class="elsevierStyleCrossRefs" href="#bib0150">11–13</a> based on tumour marker values (beta-hCG, AFP), tumour size and histological findings.<a class="elsevierStyleCrossRefs" href="#bib0165">14–19</a>The decision of performing a conservative tumourectomy must be made jointly by the physicians in charge of the patient (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>), and the intervention must be performed in a centre with experience.<a class="elsevierStyleCrossRef" href="#bib0105">2</a><elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Our objective was to determine the variables that need to be taken into account in the indication of conservative surgery for treatment of palpable and nonpalpable testicular masses found incidentally.Materials and methodsWe conducted a retrospective study of cases of testicular tumours in 22 patients aged less than 18 years diagnosed and managed in our hospital between 2000 and 2014. We excluded cases in patients with gonadal dysgenesis, as they require a different treatment and followup. We analysed the age at diagnosis, clinical presentation, ultrasound findings, histopathological findings, tumour marker values (beta-hCG, AFP), therapeutic approach (orchiectomy vs tumourectomy) and followup, which was performed as needed in the urology and oncology clinics.ResultsThe mean age of the 22 patients was 9.6 years (range, 2 months-18 years), 10 cases were diagnosed prepubertally. As for the clinical presentation, a palpable mass was the most frequent finding, in 18 (82%) of cases, 2 of which were diagnosed in the context of a routine paediatric checkup. In 4 cases (18%), the diagnosis resulted from an incidental finding, 3 of ultrasound examinations ordered for evaluation of short stature, orchiodynia and contralateral cryptorchidism, and 1 in the examination of a surgical specimen from a patient that had undergone surgery for cryptorchidism with removal of an atrophied testis.Two patients had a history of cryptorchidism, bilateral in 1, and contralateral to the tumour in the other.During the diagnostic evaluation, the level of beta-hCG was measured in 18 patients (82%), and the level of AFP in 21 (95%), and they were found to be elevated in 27% and 45% of tested patients, respectively.An ultrasound examination was performed in 90% of patients. The median size of the palpable masses was 3.5cm (1.2–7) and the median size of nonpalpable masses was 1cm (0.4–1.5).A total of 18 orchiectomies and 4 tumourectomies were performed in our patients. The approach was through an inguinal incision in all. The indication for tumourectomy was based on tumour size (<2cm) and negative results of tests for tumour markers.The distribution by tumour histology was: 72% of germ cell tumours, treated with 14 orchiectomies (7 mixed germ cell tumours [6 with a choriocarcinoma or embryonal carcinoma component], 5 teratomas, 2 yolk sac tumours) and 2 tumourectomies (2 teratomas); and 27% of non-germ cell tumours, treated with 4 orchiectomies (2 granulosa cell tumours, 1 Sertoli cell tumour, 1 non-Hodgkin lymphoma) and 2 tumourectomies (2 Leydig cell tumours). The median tumour size was 1cm (0.4–1.5) in the cases treated with tumourectomy and 2.5cm (0.5–14) in the cases treated with orchiectomy.Elevation of beta-hCG at diagnosis corresponded to choriocarcinomatous tumours, and elevation of AFP to tumours with a yolk sac component.The followup of these patients consisted of visits in our clinic at 1 week, 1 month and 6 months post surgery, and yearly thereon. In every visit, patients underwent a testicular ultrasound examination to assess parenchymal morphology and a blood test with measurement of tumour markers to ascertain their decline. All patients were referred to the Department of Haematology and Oncology, whose staff determined how patients should be managed and the need for followup in the department's clinics based on the histopathological findings.Six patients, all with mixed germ cell tumour histology, received postoperative chemotherapy consisting of 2 cycles of bleomycin/etoposide/cisplatin. During the followup, tumour marker levels because negative in all patients except one that died of metastatic disease. The duration of followup was 5 years (1–15); 4 patients remain in followup per protocol in the hospital that was the source of referral.One patient died; he had a mixed germ cell tumour (with a choriocarcinoma component comprising 50%) and developed metastases in the lung and liver, bone marrow failure secondary to chemotherapy and septic shock. None of the other patients experienced local recurrence or metastasis during the followup. Only 1 patient underwent surgery for insertion of a testicular prosthesis.DiscussionTesticular tumours are infrequent in the paediatric age group. The epidemiologic risk factors for the development of testicular tumours at any age describe in the literature are: history of cryptorchidism, Klinefelter syndrome, history of testicular cancer in first-degree relative, presence of contralateral tumour, and infertility.<a class="elsevierStyleCrossRef" href="#bib0105">2</a> In our sample, out of all these risk factors, we only found cryptorchidism in 2 patients.In our study, the most frequent presentation was palpable mass (82%), which was consistent with the previous literature.<a class="elsevierStyleCrossRefs" href="#bib0120">5,10</a> The tumour was found by ultrasound examination in 13% of cases. The widespread use of sonography has led to an increase in the incidental detection of small testicular masses of less than 2cm in diameter, defined as nonpalpable scrotal masses, and considered benign in 80% of cases,<a class="elsevierStyleCrossRef" href="#bib0155">12</a> which can consequently be treated with conservative surgery. In our sample, the postoperative histopathological examination confirmed the benign nature of these nonpalpable masses.As for tumour markers, we found evidence that AFP is elevated (> 10ng/mL) in 92–100% of patients with yolk sac tumours and that beta-hCG may be elevated in germ cell tumours (with mild elevation in embryonal carcinomas or seminomas containing syncytiotrophoblastic giant cells, and marked elevation in cases with a choriocarcinoma component).<a class="elsevierStyleCrossRef" href="#bib0110">3</a> In our study, at the time of diagnosis, AFP was elevated in 45% of cases (every yolk sac tumour and tumours with a teratoma component) and beta-hCG in 27% (every tumour with a choriocarcinoma component or with syncytiotrophoblastic giant cells). The levels of tumour markers normalised during the followup except in 1 patient that died of advanced metastatic disease. For the purposes of diagnosis and followup, it is important to consider that patients aged less than 12 months may exhibit a physiological elevation of AFP, with levels of up to 100ng/mL.<a class="elsevierStyleCrossRef" href="#bib0135">8</a>The histology of testicular tumours varies depending on the cell line from which they originate. Germ cell tumours are the most frequent type, amounting to 95% of total cases in adults and 65% of cases in the paediatric age group.<a class="elsevierStyleCrossRef" href="#bib0120">5</a> In our series, germ cell tumours constituted 75% of the sample.Teratomas are usually benign in prepubertal patients, so they may be treated with tumourectomy in cases where ultrasound examination reveals viable normal testicular tissue and with normal levels of AFP, or, in infants aged less than 12 months, elevated AFP levels that do not exceed 100ng/mL.<a class="elsevierStyleCrossRef" href="#bib0135">8</a> Yolk sac tumours are the most frequent type of malignant tumour in children, and, like embryonal carcinomas, usually develop before age 2 years.<a class="elsevierStyleCrossRefs" href="#bib0120">5–8</a> They are treated with radical orchiectomy. Radical retroperitoneal lymph node dissection is performed routinely in adult patients, but in children this depends on staging, as most cases in prepubertal patients (85%) are stage I. At present, the lymph nodes are not routinely removed, except in patients with more advanced disease. Stromal tumours are rare in the prepubertal age group and may be associated with precocious puberty. The tumours that recur most frequently are Sertoli cell tumours, whose incidence peaks at age 6 months. Thirty percent of Sertoli cell tumours are associated to endocrine syndromes or abnormalities (Peutz-Jeghers syndrome, Carney complex, Cushing disease, pituitary adenomas). Tumour resection is usually curative in children.<a class="elsevierStyleCrossRef" href="#bib0105">2</a> Malignant cases are rare and usually occur in older children, and therefore performance of radical orchiectomy with postoperative followup is recommended in patients aged 5 years and older.<a class="elsevierStyleCrossRef" href="#bib0145">10</a> Leydig cell tumours develop between ages 5 and 10 years, are generally benign and tumour resection is usually curative. Juvenile granulosa cell tumours usually appear in the first year of life, most commonly in the first 6 months; it is the most frequent testicular tumour in newborns and has a good prognosis in this age group, unlike granulosa cell tumours that develop in postpubertal patients.<a class="elsevierStyleCrossRef" href="#bib0145">10</a>Orchiectomy was the surgical approach used in 18 patients (82% of our sample). Six of them (5 of postpubertal age), all of who had mixed tumours with a choriocarcinoma or embryonal carcinoma component, received postoperative chemotherapy consisting of 2 cycles of bleomycin/etoposide/cisplatin.A conservative surgical approach with tumourectomy has been performed in our hospital since 2009 and was the approach used in 18% of our sample. The decision to change the approach to the management of testicular masses was motivated by the possibility of sparing a large amount of testicular tissue thanks to the benign course of the disease in the prepubertal age group, the higher prevalence of favourable histology, and the low probability of recurrence.<a class="elsevierStyleCrossRefs" href="#bib0100">1,3,7–11</a>We conducted a retrospective analysis of cases in a sample of our patients and found that 3 patients could have been treated with tumourectomy instead, as they met the criteria for management with this procedure (prepubertal, negative tumour markers, tumour size<2cm).One of the patients died during the followup of advanced disease with distant metastasis. We found no other cases of recurrence in either the orchiectomy or the tumourectomy, which demonstrates the high cure rate in both patients with favourable histology and patients with unfavourable histology.<a class="elsevierStyleCrossRefs" href="#bib0105">2,12,14–19</a>In conclusion, testicular masses in prepubertal patients are different from those in postpubertal patients, as they have a different epidemiology, histology and prognosis. Therefore, the approach to their management should not be the same: we can consider a conservative surgical approach with tumourectomy in patients that meet the benign testicular tumour criteria (small size and negative tumour markers).Conflicts of interestThe authors have no conflicts of interest to declare" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres1021199" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction and objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec979440" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1021200" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción y objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec979441" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-02-01" "fechaAceptado" => "2017-05-25" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec979440" "palabras" => array:3 [ 0 => "Testicular tumour" 1 => "Orchiectomy" 2 => "Tumorectomy" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec979441" "palabras" => array:3 [ 0 => "Tumor testicular" 1 => "Orquiectomía" 2 => "Tumorectomía" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "Introduction and objectivesAlthough 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 methodsA 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. ResultsOf 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. ConclusionsA 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)." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction and objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "Introducción y objetivosEl 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 métodosEstudio 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. ResultadosDe 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. ConclusionesPonemos 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)." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción y objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Romo Muñoz MI, Núñez Cerezo V, Dore Reyes M, Vilanova Sánchez A, González-Peramato P, López Pereira P, et al. Tumores testiculares en la edad pediátrica: indicaciones de la cirugía conservadora. An Pediatr (Barc). 2018;88:253–258." ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1229 "Ancho" => 1582 "Tamanyo" => 196774 ] ] "descripcion" => array:1 [ "en" => "Gross photograph of a prepubertal-type teratoma in the testicle of a boy aged 6 years. The main features are its cystic appearance and yellow homogeneous mass." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1319 "Ancho" => 1625 "Tamanyo" => 298208 ] ] "descripcion" => array:1 [ "en" => "Gross photograph of a postpubertal-type teratoma in a patient aged 16 years. Numerous cysts replace most of the parenchyma." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1458 "Ancho" => 1950 "Tamanyo" => 1111998 ] ] "descripcion" => array:1 [ "en" => "Micrograph of a prepubertal-type pure yolk sac tumour in a boy aged 1 year. Note the macrocystic and microcystic pattern of the yolk sac." ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1182 "Ancho" => 1625 "Tamanyo" => 477335 ] ] "descripcion" => array:1 [ "en" => "Micrograph of a prepubertal-type teratoma with organoid arrangement. Note the cysts sheathed by glandular mucosal lining and surrounded by smooth muscle. On the side, prepubertal testicular parenchyma without germ cell neoplasia in situ." ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1214 "Ancho" => 1625 "Tamanyo" => 180312 ] ] "descripcion" => array:1 [ "en" => "Chance finding on ultrasound of the right testis of a solid nodule 4.5mm in diameter with hyperechoic edge and changes in echogenicity in the surrounding area." ] ] 5 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "GCNIS, germ cell neoplasia in situ; N, negative; P, positive; X, not measured." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Case \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Age (years) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Risk factors \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Presentation \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Tumour markers (beta-hCG/AFP) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Surgical approach \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Tumour size (cm) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Histology \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Enlargement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">N/P \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Orchiectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mixed germ cell \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Enlargement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">P/P \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Orchiectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mixed germ cell \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Enlargement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">P/N \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Orchiectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mixed germ cell \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Enlargement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">X/P \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Orchiectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Granulosa cell \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Enlargement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">N/P \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Orchiectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yolk sac \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Enlargement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">P/P \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Orchiectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mixed germ cell \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ultrasound finding \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">N/N \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Tumourectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Leydig cell \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.83 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Enlargement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">N/N \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Tumourectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Prepubertal-type teratoma \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Enlargement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">P/P \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Orchiectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mixed germ cell \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Enlargement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">X/N \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Orchiectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Prepubertal-type teratoma \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Enlargement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">N/N \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Orchiectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Prepubertal-type teratoma \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ultrasound finding \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">N/N \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Orchiectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Prepubertal-type teratoma \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cryptorchidism \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ultrasound finding \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">N/N \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Tumourectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Leydig cell \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Enlargement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">N/N \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Orchiectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Non-Hodgkin lymphoma \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.91 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Enlargement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">N/P \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Orchiectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yolk sac \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Enlargement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">P/N \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Orchiectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mixed germ cell \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Enlargement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">N/P \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Orchiectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Postpubertal-type teratoma+GCNIS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Enlargement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">N/N \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Orchiectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Prepubertal-type teratoma \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Enlargement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">N/N \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Tumourectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Teratoma \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Enlargement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">P/P \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Orchiectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mixed germ cell \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cryptorchidism \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Surgical pathology \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">X/X \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Orchiectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Sertoli \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Enlargement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">X/P \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Orchiectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Granulosa cell \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1735029.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Summary of clinical cases." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:19 [ 0 => array:3 [ "identificador" => "bib0100" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Testicular tumors in children and adolescents" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S. 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Original Article

Testicular tumours in children: Indications for testis-sparing surgery

Tumores testiculares en la edad pediátrica: indicaciones de la cirugía conservadora

Martha Isabel Romo Muñoza,

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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

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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Micrograph of a prepubertal-type pure yolk sac tumour in a boy aged 1 year&#46; Note the macrocystic and microcystic pattern of the yolk sac&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Testicular tumours account for 1&#8211;2&#37; of all paediatric solid tumours&#44; with 2 peaks in age of onset&#58; the first one at ages 2&#8211;4 years&#44; and the second at around age 15 years&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">1</span></a> Its incidence in the general population is of 0&#46;5&#8211;2 cases per 100&#44;000 inhabitants&#44; with an increase in the adult population in recent years&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">2&#44;3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Testicular tumours are divided into 6 groups &#40;World Health Organization histological classification of tumours&#44; 2016&#41;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">4</span></a>&#58; &#40;1&#41; germ-cell tumours derived from germ cell neoplasia in situ &#40;GCNIS&#41; including seminoma&#44; embryonal carcinoma&#44; postpubertal-type yolk sac tumour&#44; trophoblastic tumour and germ cell tumours of unknown type &#40;&#8216;burnt-out&#8217; tumours&#41;&#59; &#40;2&#41; germ cell tumours unrelated to GCNIS&#44; including spermatocytic tumour&#44; prepubertal-type teratoma&#44; prepubertal-type yolk sac tumour and prepubertal-type mixed teratoma and yolk sac tumour&#59; &#40;3&#41; sex-cord-stromal tumours &#40;Leydig cell&#44; Sertoli cell or granulosa cell tumours&#41;&#59; &#40;4&#41; tumours containing both germ cell and sex cord-stromal elements&#59; &#40;5&#41; miscellaneous tumours of the testis and &#40;6&#41; haematolymphoid tumours&#46; This new classification differentiates between 2 types of teratomas &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1 and 2</a>&#41; and yolk sack tumours&#58; prepubertal type &#40;unrelated to GCNIS&#41; and postpubertal type &#40;derived from GCNIS&#41;&#44; with the prognosis being significantly better in the former&#46; There is a clear predominance &#40;90&#8211;95&#37;&#41; of germ cell tumours&#44; and prepubertal-type teratomas and yolk sac tumours are the most frequent testicular tumours in children<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">5&#8211;8</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; Prepubertal-type teratomas are usually cystic and have an organoid arrangement &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46; This type includes epidermoid cysts&#44; dermoid cysts and well-differentiated neuroendocrine tumours&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Due to the routine use of ultrasound examination&#44; there has been an increase in the detection of cases of nonpalpable testicular masses<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">9&#44;10</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#41;&#46;</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Radical orchiectomy has been traditionally considered the gold standard of treatment for testicular masses at any age&#46; However&#44; given that these masses are frequently benign in children&#44;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">1&#44;10&#44;11</span></a> the medical and surgical approach to their management has been re-evaluated in recent years&#46; This involves a change in the initial treatment approach&#44; with consideration of conservative surgery &#40;tumourectomy&#41;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">11&#8211;13</span></a> based on tumour marker values &#40;beta-hCG&#44; AFP&#41;&#44; tumour size and histological findings&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">14&#8211;19</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The decision of performing a conservative tumourectomy must be made jointly by the physicians in charge of the patient &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#44; and the intervention must be performed in a centre with experience&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">2</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Our objective was to determine the variables that need to be taken into account in the indication of conservative surgery for treatment of palpable and nonpalpable testicular masses found incidentally&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0035" class="elsevierStylePara elsevierViewall">We conducted a retrospective study of cases of testicular tumours in 22 patients aged less than 18 years diagnosed and managed in our hospital between 2000 and 2014&#46; We excluded cases in patients with gonadal dysgenesis&#44; as they require a different treatment and followup&#46; We analysed the age at diagnosis&#44; clinical presentation&#44; ultrasound findings&#44; histopathological findings&#44; tumour marker values &#40;beta-hCG&#44; AFP&#41;&#44; therapeutic approach &#40;orchiectomy vs tumourectomy&#41; and followup&#44; which was performed as needed in the urology and oncology clinics&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0040" class="elsevierStylePara elsevierViewall">The mean age of the 22 patients was 9&#46;6 years &#40;range&#44; 2 months-18 years&#41;&#44; 10 cases were diagnosed prepubertally&#46; As for the clinical presentation&#44; a palpable mass was the most frequent finding&#44; in 18 &#40;82&#37;&#41; of cases&#44; 2 of which were diagnosed in the context of a routine paediatric checkup&#46; In 4 cases &#40;18&#37;&#41;&#44; the diagnosis resulted from an incidental finding&#44; 3 of ultrasound examinations ordered for evaluation of short stature&#44; orchiodynia and contralateral cryptorchidism&#44; and 1 in the examination of a surgical specimen from a patient that had undergone surgery for cryptorchidism with removal of an atrophied testis&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Two patients had a history of cryptorchidism&#44; bilateral in 1&#44; and contralateral to the tumour in the other&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">During the diagnostic evaluation&#44; the level of beta-hCG was measured in 18 patients &#40;82&#37;&#41;&#44; and the level of AFP in 21 &#40;95&#37;&#41;&#44; and they were found to be elevated in 27&#37; and 45&#37; of tested patients&#44; respectively&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">An ultrasound examination was performed in 90&#37; of patients&#46; The median size of the palpable masses was 3&#46;5<span class="elsevierStyleHsp" style=""></span>cm &#40;1&#46;2&#8211;7&#41; and the median size of nonpalpable masses was 1<span class="elsevierStyleHsp" style=""></span>cm &#40;0&#46;4&#8211;1&#46;5&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">A total of 18 orchiectomies and 4 tumourectomies were performed in our patients&#46; The approach was through an inguinal incision in all&#46; The indication for tumourectomy was based on tumour size &#40;&#60;2<span class="elsevierStyleHsp" style=""></span>cm&#41; and negative results of tests for tumour markers&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The distribution by tumour histology was&#58; 72&#37; of germ cell tumours&#44; treated with 14 orchiectomies &#40;7 mixed germ cell tumours &#91;6 with a choriocarcinoma or embryonal carcinoma component&#93;&#44; 5 teratomas&#44; 2 yolk sac tumours&#41; and 2 tumourectomies &#40;2 teratomas&#41;&#59; and 27&#37; of non-germ cell tumours&#44; treated with 4 orchiectomies &#40;2 granulosa cell tumours&#44; 1 Sertoli cell tumour&#44; 1 non-Hodgkin lymphoma&#41; and 2 tumourectomies &#40;2 Leydig cell tumours&#41;&#46; The median tumour size was 1<span class="elsevierStyleHsp" style=""></span>cm &#40;0&#46;4&#8211;1&#46;5&#41; in the cases treated with tumourectomy and 2&#46;5<span class="elsevierStyleHsp" style=""></span>cm &#40;0&#46;5&#8211;14&#41; in the cases treated with orchiectomy&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Elevation of beta-hCG at diagnosis corresponded to choriocarcinomatous tumours&#44; and elevation of AFP to tumours with a yolk sac component&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The followup of these patients consisted of visits in our clinic at 1 week&#44; 1 month and 6 months post surgery&#44; and yearly thereon&#46; In every visit&#44; patients underwent a testicular ultrasound examination to assess parenchymal morphology and a blood test with measurement of tumour markers to ascertain their decline&#46; All patients were referred to the Department of Haematology and Oncology&#44; whose staff determined how patients should be managed and the need for followup in the department&#39;s clinics based on the histopathological findings&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Six patients&#44; all with mixed germ cell tumour histology&#44; received postoperative chemotherapy consisting of 2 cycles of bleomycin&#47;etoposide&#47;cisplatin&#46; During the followup&#44; tumour marker levels because negative in all patients except one that died of metastatic disease&#46; The duration of followup was 5 years &#40;1&#8211;15&#41;&#59; 4 patients remain in followup per protocol in the hospital that was the source of referral&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">One patient died&#59; he had a mixed germ cell tumour &#40;with a choriocarcinoma component comprising 50&#37;&#41; and developed metastases in the lung and liver&#44; bone marrow failure secondary to chemotherapy and septic shock&#46; None of the other patients experienced local recurrence or metastasis during the followup&#46; Only 1 patient underwent surgery for insertion of a testicular prosthesis&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0090" class="elsevierStylePara elsevierViewall">Testicular tumours are infrequent in the paediatric age group&#46; The epidemiologic risk factors for the development of testicular tumours at any age describe in the literature are&#58; history of cryptorchidism&#44; Klinefelter syndrome&#44; history of testicular cancer in first-degree relative&#44; presence of contralateral tumour&#44; and infertility&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">2</span></a> In our sample&#44; out of all these risk factors&#44; we only found cryptorchidism in 2 patients&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">In our study&#44; the most frequent presentation was palpable mass &#40;82&#37;&#41;&#44; which was consistent with the previous literature&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">5&#44;10</span></a> The tumour was found by ultrasound examination in 13&#37; of cases&#46; The widespread use of sonography has led to an increase in the incidental detection of small testicular masses of less than 2<span class="elsevierStyleHsp" style=""></span>cm in diameter&#44; defined as nonpalpable scrotal masses&#44; and considered benign in 80&#37; of cases&#44;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">12</span></a> which can consequently be treated with conservative surgery&#46; In our sample&#44; the postoperative histopathological examination confirmed the benign nature of these nonpalpable masses&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">As for tumour markers&#44; we found evidence that AFP is elevated &#40;&#62; 10<span class="elsevierStyleHsp" style=""></span>ng&#47;mL&#41; in 92&#8211;100&#37; of patients with yolk sac tumours and that beta-hCG may be elevated in germ cell tumours &#40;with mild elevation in embryonal carcinomas or seminomas containing syncytiotrophoblastic giant cells&#44; and marked elevation in cases with a choriocarcinoma component&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">3</span></a> In our study&#44; at the time of diagnosis&#44; AFP was elevated in 45&#37; of cases &#40;every yolk sac tumour and tumours with a teratoma component&#41; and beta-hCG in 27&#37; &#40;every tumour with a choriocarcinoma component or with syncytiotrophoblastic giant cells&#41;&#46; The levels of tumour markers normalised during the followup except in 1 patient that died of advanced metastatic disease&#46; For the purposes of diagnosis and followup&#44; it is important to consider that patients aged less than 12 months may exhibit a physiological elevation of AFP&#44; with levels of up to 100<span class="elsevierStyleHsp" style=""></span>ng&#47;mL&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">8</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">The histology of testicular tumours varies depending on the cell line from which they originate&#46; Germ cell tumours are the most frequent type&#44; amounting to 95&#37; of total cases in adults and 65&#37; of cases in the paediatric age group&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">5</span></a> In our series&#44; germ cell tumours constituted 75&#37; of the sample&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Teratomas are usually benign in prepubertal patients&#44; so they may be treated with tumourectomy in cases where ultrasound examination reveals viable normal testicular tissue and with normal levels of AFP&#44; or&#44; in infants aged less than 12 months&#44; elevated AFP levels that do not exceed 100<span class="elsevierStyleHsp" style=""></span>ng&#47;mL&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">8</span></a> Yolk sac tumours are the most frequent type of malignant tumour in children&#44; and&#44; like embryonal carcinomas&#44; usually develop before age 2 years&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">5&#8211;8</span></a> They are treated with radical orchiectomy&#46; Radical retroperitoneal lymph node dissection is performed routinely in adult patients&#44; but in children this depends on staging&#44; as most cases in prepubertal patients &#40;85&#37;&#41; are stage I&#46; At present&#44; the lymph nodes are not routinely removed&#44; except in patients with more advanced disease&#46; Stromal tumours are rare in the prepubertal age group and may be associated with precocious puberty&#46; The tumours that recur most frequently are Sertoli cell tumours&#44; whose incidence peaks at age 6 months&#46; Thirty percent of Sertoli cell tumours are associated to endocrine syndromes or abnormalities &#40;Peutz-Jeghers syndrome&#44; Carney complex&#44; Cushing disease&#44; pituitary adenomas&#41;&#46; Tumour resection is usually curative in children&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">2</span></a> Malignant cases are rare and usually occur in older children&#44; and therefore performance of radical orchiectomy with postoperative followup is recommended in patients aged 5 years and older&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">10</span></a> Leydig cell tumours develop between ages 5 and 10 years&#44; are generally benign and tumour resection is usually curative&#46; Juvenile granulosa cell tumours usually appear in the first year of life&#44; most commonly in the first 6 months&#59; it is the most frequent testicular tumour in newborns and has a good prognosis in this age group&#44; unlike granulosa cell tumours that develop in postpubertal patients&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">10</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Orchiectomy was the surgical approach used in 18 patients &#40;82&#37; of our sample&#41;&#46; Six of them &#40;5 of postpubertal age&#41;&#44; all of who had mixed tumours with a choriocarcinoma or embryonal carcinoma component&#44; received postoperative chemotherapy consisting of 2 cycles of bleomycin&#47;etoposide&#47;cisplatin&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">A conservative surgical approach with tumourectomy has been performed in our hospital since 2009 and was the approach used in 18&#37; of our sample&#46; The decision to change the approach to the management of testicular masses was motivated by the possibility of sparing a large amount of testicular tissue thanks to the benign course of the disease in the prepubertal age group&#44; the higher prevalence of favourable histology&#44; and the low probability of recurrence&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">1&#44;3&#44;7&#8211;11</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">We conducted a retrospective analysis of cases in a sample of our patients and found that 3 patients could have been treated with tumourectomy instead&#44; as they met the criteria for management with this procedure &#40;prepubertal&#44; negative tumour markers&#44; tumour size<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>cm&#41;&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">One of the patients died during the followup of advanced disease with distant metastasis&#46; We found no other cases of recurrence in either the orchiectomy or the tumourectomy&#44; which demonstrates the high cure rate in both patients with favourable histology and patients with unfavourable histology&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">2&#44;12&#44;14&#8211;19</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">In conclusion&#44; testicular masses in prepubertal patients are different from those in postpubertal patients&#44; as they have a different epidemiology&#44; histology and prognosis&#46; Therefore&#44; the approach to their management should not be the same&#58; we can consider a conservative surgical approach with tumourectomy in patients that meet the benign testicular tumour criteria &#40;small size and negative tumour markers&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflicts of interest</span><p id="par0140" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare</p></span></span>"
    "textoCompletoSecciones" => array:1 [
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          "identificador" => "xres1021199"
          "titulo" => "Abstract"
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            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Introduction and objectives"
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          "titulo" => "Keywords"
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          "titulo" => "Resumen"
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            0 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Introducci&#243;n y objetivos"
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              "titulo" => "Material y m&#233;todos"
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              "titulo" => "Resultados"
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              "titulo" => "Conclusiones"
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          "titulo" => "Palabras clave"
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          "titulo" => "Introduction"
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          "titulo" => "Materials and methods"
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          "titulo" => "Conflicts of interest"
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        9 => array:1 [
          "titulo" => "References"
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    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2017-02-01"
    "fechaAceptado" => "2017-05-25"
    "PalabrasClave" => array:2 [
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec979440"
          "palabras" => array:3 [
            0 => "Testicular tumour"
            1 => "Orchiectomy"
            2 => "Tumorectomy"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec979441"
          "palabras" => array:3 [
            0 => "Tumor testicular"
            1 => "Orquiectom&#237;a"
            2 => "Tumorectom&#237;a"
          ]
        ]
      ]
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    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction and objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Although standard surgical treatment of a testicular tumour is orchiectomy&#44; use can be made of testis-sparing surgery in selected cases&#44; based on tumour markers&#44; tumour size&#44; and histopathological findings&#46; 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&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A retrospective study was conducted on 22 patients younger than 18 years diagnosed with a testicular tumour between 2000 and 2014&#46; An assessment was made of the condition&#44; the history&#44; ultrasound&#44; histopathology&#44; tumour markers &#40;BHCG&#44; AFP&#41;&#44; therapeutic approach&#44; and outcome&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Of the 22 patients &#40;10 prepubertal age&#41; studied&#44; 82&#37; had palpable mass&#44; and 18&#37; were incidental findings&#46; Two had cryptorchidism&#46; The BHCG was increased in 27&#37; and AFP in 45&#37; of cases&#46; There were 18 tumorectomies and 4 orchiectomies performed&#46; The histopathology found 72&#37; germ cell&#44; 14 orchiectomy&#44; and 2 tumorectomies &#40;2 teratomas&#41;&#44; with 27&#37; non-germ cell tumours in 4 orchiectomies and 2 tumorectomies &#40;2 cells of Leydig&#41;&#46; Six patients received post-surgical chemotherapy &#40;mixed tumours&#41;&#46; The median tumour size was 1 &#40;0&#46;4&#8211;1&#46;5&#41; cm in tumorectomies&#44; and 2&#46;5 &#40;0&#46;5&#8211;14&#41; cm in orchiectomies&#46; The mean follow-up was 5 &#40;1&#8211;15&#41; years&#46; One patient died due to metastatic disease&#46; There was no local recurrence in the follow up of the tumorectomies&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A change in the trend of our therapeutic approach is demonstrated&#46; We propose that testis-sparing surgery is indicated in prepubertal patients who meet the benignity criteria of the testicular mass &#40;small size and negative tumour markers&#41;&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction and objectives"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Material and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n y objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El tratamiento quir&#250;rgico est&#225;ndar del tumor testicular es la orquiectom&#237;a&#44; sin embargo&#44; se podr&#237;a recurrir a la cirug&#237;a conservadora en casos seleccionados&#44; bas&#225;ndonos en la edad del paciente&#44; marcadores tumorales&#44; tama&#241;o tumoral y hallazgos histopatol&#243;gicos&#46; Nuestro objetivo es dar a conocer cu&#225;les son las variables que tener en cuenta para indicar una cirug&#237;a conservadora como tratamiento de una masa testicular palpable y no palpable encontrada como hallazgo incidental&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo en 22 pacientes menores de 18 a&#241;os&#44; diagnosticados de tumor testicular entre 2000 y 2014&#46; Revisamos el motivo de consulta&#44; antecedentes&#44; ecograf&#237;a&#44; estudio histopatol&#243;gico&#44; marcadores tumorales &#40;BHCG&#44; AFP&#41;&#44; actitud terap&#233;utica y evoluci&#243;n&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">De los 22 pacientes &#40;10 prepuberales&#41;&#44; el 82&#37; presentaron masa palpable y el 18&#37; fueron hallazgos incidentales&#46; Dos presentaban criptorquidia&#46; La BHCG estaba aumentada en el 27&#37; y la AFP en el 45&#37;&#46; Se realizaron 18 orquiectom&#237;as y 4 tumorectom&#237;as&#46; La histolog&#237;a fue en un 72&#37; de c&#233;lulas germinales&#44; 14 orquiectom&#237;as y 2 tumorectom&#237;as &#40;2 teratomas&#41;&#59; y en un 27&#37; de tumores de c&#233;lulas no germinales&#44; en 4 orquiectom&#237;as y 2 tumorectom&#237;as &#40;2 tumores de c&#233;lulas de Leyding&#41;&#46; Seis pacientes recibieron quimioterapia postoperatoria &#40;tumores mixtos&#41;&#46; La mediana del tama&#241;o de la tumoraci&#243;n fue de un cm &#40;0&#44;4-1&#44;5&#41; en las tumorectom&#237;as y de 2&#44;5<span class="elsevierStyleHsp" style=""></span>cm &#40;0&#44;5-14&#41; en las orquiectom&#237;as&#46; El seguimiento fue de 5 a&#241;os &#40;1-15&#41;&#46; Un paciente falleci&#243; por enfermedad metast&#225;sica&#46; No hubo recidiva local en la evoluci&#243;n de las tumorectom&#237;as&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Ponemos de manifiesto una tendencia al cambio en nuestra actitud terap&#233;utica&#46; Planteamos una cirug&#237;a conservadora mediante tumorectom&#237;a en los pacientes que cumplan con los criterios de benignidad de la masa testicular &#40;peque&#241;o tama&#241;o y marcadores tumorales negativos&#41;&#46;</p></span>"
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            "identificador" => "abst0030"
            "titulo" => "Material y m&#233;todos"
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            "titulo" => "Resultados"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Romo Mu&#241;oz MI&#44; N&#250;&#241;ez Cerezo V&#44; Dore Reyes M&#44; Vilanova S&#225;nchez A&#44; Gonz&#225;lez-Peramato P&#44; L&#243;pez Pereira P&#44; et al&#46; Tumores testiculares en la edad pedi&#225;trica&#58; indicaciones de la cirug&#237;a conservadora&#46; An Pediatr &#40;Barc&#41;&#46; 2018&#59;88&#58;253&#8211;258&#46;</p>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Gross photograph of a prepubertal-type teratoma in the testicle of a boy aged 6 years&#46; The main features are its cystic appearance and yellow homogeneous mass&#46;</p>"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Gross photograph of a postpubertal-type teratoma in a patient aged 16 years&#46; Numerous cysts replace most of the parenchyma&#46;</p>"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Micrograph of a prepubertal-type pure yolk sac tumour in a boy aged 1 year&#46; Note the macrocystic and microcystic pattern of the yolk sac&#46;</p>"
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Micrograph of a prepubertal-type teratoma with organoid arrangement&#46; Note the cysts sheathed by glandular mucosal lining and surrounded by smooth muscle&#46; On the side&#44; prepubertal testicular parenchyma without germ cell neoplasia in situ&#46;</p>"
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Chance finding on ultrasound of the right testis of a solid nodule 4&#46;5<span class="elsevierStyleHsp" style=""></span>mm in diameter with hyperechoic edge and changes in echogenicity in the surrounding area&#46;</p>"
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          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">GCNIS&#44; germ cell neoplasia in situ&#59; N&#44; negative&#59; P&#44; positive&#59; X&#44; not measured&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Case&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Age &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Risk factors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Presentation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Tumour markers &#40;beta-hCG&#47;AFP&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Surgical approach&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Tumour size &#40;cm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Histology&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Enlargement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#47;P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Orchiectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mixed germ cell&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Enlargement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">P&#47;P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Orchiectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mixed germ cell&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Enlargement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">P&#47;N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Orchiectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mixed germ cell&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Enlargement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleSmallCaps">X</span>&#47;P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Orchiectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Granulosa cell&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Enlargement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#47;P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Orchiectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yolk sac&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Enlargement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">P&#47;P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Orchiectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mixed germ cell&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ultrasound finding&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#47;N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Tumourectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Leydig cell&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Enlargement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#47;N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Tumourectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prepubertal-type teratoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Enlargement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">P&#47;P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Orchiectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mixed germ cell&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Enlargement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleSmallCaps">X</span>&#47;N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Orchiectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prepubertal-type teratoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Enlargement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#47;N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Orchiectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prepubertal-type teratoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ultrasound finding&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#47;N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Orchiectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prepubertal-type teratoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cryptorchidism&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ultrasound finding&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#47;N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Tumourectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Leydig cell&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Enlargement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#47;N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Orchiectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Non-Hodgkin lymphoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Enlargement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#47;P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Orchiectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yolk sac&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Enlargement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">P&#47;N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Orchiectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mixed germ cell&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Enlargement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#47;P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Orchiectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Postpubertal-type teratoma<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>GCNIS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Enlargement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#47;N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Orchiectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prepubertal-type teratoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Enlargement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#47;N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Tumourectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Teratoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Enlargement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">P&#47;P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Orchiectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mixed germ cell&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cryptorchidism&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Surgical pathology&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleSmallCaps">X&#47;X</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Orchiectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Sertoli&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Enlargement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleSmallCaps">X</span>&#47;P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Orchiectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Granulosa cell&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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Article information

ISSN: 23412879
Original language: English

DOI:10.1016/j.anpede.2017.05.009

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Year/Month	Html	Pdf	Total

2024 November	4	5	9
2024 October	107	57	164
2024 September	85	50	135
2024 August	93	71	164
2024 July	96	38	134
2024 June	96	43	139
2024 May	69	44	113
2024 April	107	38	145
2024 March	113	38	151
2024 February	105	43	148
2024 January	114	33	147
2023 December	143	21	164
2023 November	122	28	150
2023 October	116	25	141
2023 September	90	22	112
2023 August	103	24	127
2023 July	98	35	133
2023 June	138	40	178
2023 May	146	27	173
2023 April	108	40	148
2023 March	116	42	158
2023 February	129	26	155
2023 January	135	32	167
2022 December	87	35	122
2022 November	121	31	152
2022 October	113	45	158
2022 September	139	44	183
2022 August	145	88	233
2022 July	122	52	174
2022 June	146	52	198
2022 May	176	60	236
2022 April	225	50	275
2022 March	250	63	313
2022 February	258	46	304
2022 January	247	54	301
2021 December	153	50	203
2021 November	189	65	254
2021 October	137	91	228
2021 September	129	48	177
2021 August	121	43	164
2021 July	125	44	169
2021 June	108	39	147
2021 May	158	67	225
2021 April	302	87	389
2021 March	141	57	198
2021 February	105	32	137
2021 January	88	42	130
2020 December	89	39	128
2020 November	103	34	137
2020 October	118	33	151
2020 September	85	26	111
2020 August	95	20	115
2020 July	84	29	113
2020 June	126	29	155
2020 May	110	34	144
2020 April	83	25	108
2020 March	108	35	143
2020 February	137	31	168
2020 January	101	30	131
2019 December	106	27	133
2019 November	82	25	107
2019 October	136	23	159
2019 September	84	19	103
2019 August	97	22	119
2019 July	100	41	141
2019 June	105	40	145
2019 May	208	24	232
2019 April	183	22	205
2019 March	105	21	126
2019 February	101	21	122
2019 January	85	27	112
2018 December	91	26	117
2018 November	129	38	167
2018 October	145	22	167
2018 September	67	18	85
2018 August	2	0	2
2018 July	4	0	4
2018 June	5	0	5
2018 May	0	2	2
2018 April	0	36	36

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