Prepubertal testicular and paratesticular tumors in China: a single-center experience over a 10-year period

doi:10.1016/j.jpedsurg.2011.11.005

Journal of Pediatric Surgery

Volume 47, Issue 8, August 2012, Pages 1576-1580

https://doi.org/10.1016/j.jpedsurg.2011.11.005 Get rights and content

Abstract

Objective

Prepubertal testicular tumors are rare and fundamentally distinct from adult testicular tumors. We reviewed our 11-year experience in a single medical center of China.

Material and Methods

This study reports the clinical characteristics, histopathologic diagnosis, treatment methods, and outcome in a series of 63 prepubertal boys who were treated between 1997 and 2008.

Results

A total of 63 primary prepubertal testicular and paratesticular tumors were identified. The median age at presentation was 11 months. Of these tumors, 27 (42.9%) were mature teratomas, 5 (7.9%) were immature teratomas, 21 (33.3%) were yolk sac tumors, 4 (6.3%) were epidermoid cyst, 2 (3.2%) were Leydig cell tumors, 1 (1.6%) was a mixed malignant germ cell tumor, and 3 (4.8%) were paratesticular tumors. The most common clinical presentation (95.2%) was a painless scrotal mass or swelling. Forty-eight tumors were treated with radical inguinal orchiectomy, and 15, with a testis-sparing procedure. Follow-up was available in 59 cases, range from 4 to 128 months (median, 50 months). One patient with yolk sac tumor had recurrence and progression to metastasis at the end of 4 months after surgery. Other patients were disease free at last follow-up.

Conclusions

Most of the prepubertal testicular lesions were benign, and the most common histologic subtype was teratoma. Our experience with testis-sparing procedures supports the current trends that less invasive treatment should be performed for benign lesions. This study confirms the excellent cure rates obtained in children with prepubertal testicular tumors.

Section snippets

Patients and methods

We analyzed the records of 63 prepubertal children (<14 years) with testicular tumors treated from March 1997 and July 2008 in the Children's Hospital, Zhejiang University, School of Medicine, China.

For every patient, the evaluation included age at presentation, medical history, clinical characteristics, diagnostic procedures, treatment methods, histopathologic findings, and outcomes. All patients received the examinations of color Doppler ultrasonography of the testis (Fig. 1) and the abdomen,

Results

A summary of the clinical data of total 63 patients is listed in Table 1.

All patients were prepubertal: 25 (39.7%) were 1 year or younger, 23 (36.5%) were older than 1 year but 3 years or younger, 9 (14.3%) were older than 3 years but 10 years or younger, and 6 (9.5%) were older than 10 years but 14 years or younger. The median age of presentation was 11 months (range, 0-12 years). The most common symptom was the finding of either a painless scrotal mass or swelling seen in 95.2% (60/63) cases.

Discussion

Testicular and paratesticular tumors in the prepubertal population are distinct from those of the adults [1], [2]. Consistent with previous literatures [9], [10], [11], we observed that benign tumors formed the majority (63.5%) of all tumors, with the most common histologic type being teratoma, which is considered malignant in postpubertal males but benign in prepubertal populations, either mature or immature [13], [14]. Four patients (6.3%) had an epidermoid cyst, which was reported to account

Conclusion

Our experiences showed that most of the prepubertal testicular lesions were benign, and the most common histologic subtype was teratoma. Testis-sparing surgery should be performed for these tumors. We suggest further studies in Asian hospitals and cancer registries to examine the stable incidence and histopathologic variants of testicular and paratesticular tumors.

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Cited by (19)

Testis-sparing surgery in children with testicular tumors: A systematic review and meta-analysis
2021, Asian Journal of Surgery
Citation Excerpt :
In another series of testicular preservation surgery, 15 children had teratoma, epidermoid cyst or Leydig cell tumor. After an average follow-up of 10 years, there was no recurrence of tumors.22 In our study, 3 patients developed local recurrence.
Testis-sparing surgery (TSS) has been increasingly used for treating a variety of testicular tumors (TTs) in children. However, the indications and feasibility associated with TSS remain uncertain. This study aimed to present the clinical outcomes of TSS in children with TTs. The PubMed, Cochrane Library, and Embase databases were reviewed for relevant articles on the clinical outcomes of TSS in children. Recurrence rate, benign rate, rate of TSS and its 95% confidence interval (CI) were calculated. A total of nine relevant studies with 320 patients were included in this study. The recurrence rate was 5.8% (95% CI: 2.3%–14.1%), benign rate was 70.9% (95% CI: 56.3%–82.1%), the rate of TSS (RTSS) was 36.2% (95% CI: 26.1%–47.8%), RTSS in benign tumor was 48.4% (95% CI: 34.3%–62.9%) and rate of elevated AFP was 29.3% (95% CI: 19.7%–41.3%) in children with TTs. Regarding the distribution of TTs, 159 (49.6%) were teratomas, 74 (23.1%) were yolk sac tumors, 36 (11.3%) were epidermoid cysts, 3 (0.9%) were rhabdomyosarcomas, 7 (2.2%) were leydig cell tumor, 6 (1.8%) were sex-cord stromal tumor, 8(2.5%) were mixed malignant germ cell tumors, 3(0.9%) were hemangioma, and 4(1.3%) were adrenal rest tumors. The findings of this meta-analysis suggested that most of the TTs in children were benign, and the most common histologic subtype was teratoma. TSS should be provided to children with benign lesions. This study confirmed that very low rates of tumor recurrence were observed in children with TTs.
Testicular Yolk Sac Tumor and Mature Teratoma: Synchronous Bilateral Occurrence in an Infant
2018, Urology
Yolk sac tumor (YST) is a rare malignancy typically occurring in children. However, bilateral testicular YSTs are a quite rare situation, which can occur metachronously or synchronously with same histologic type, as well as different histology. We present a case of synchronous YST of the left testis and mature teratoma of the right in a 7-month-old infant treated with testis-sparing surgery at right testis and high radical orchiectomy at left. By follow-up of 28th month, no atrophy, or residual tumor in right testis and no recurrence or evidence of disease in left scrotum was found.
Testicular tumours in children: Indications for testis-sparing surgery
2018, Anales de Pediatria
El tratamiento quirúrgico estándar del tumor testicular es la orquiectomía, sin embargo, se podría recurrir a la cirugía conservadora en casos seleccionados, basándonos en la edad del paciente, marcadores tumorales, tamaño tumoral y hallazgos histopatológicos. Nuestro objetivo es dar a conocer cuáles son las variables que tener en cuenta para indicar una cirugía conservadora como tratamiento de una masa testicular palpable y no palpable encontrada como hallazgo incidental.
Estudio retrospectivo en 22 pacientes menores de 18 años, diagnosticados de tumor testicular entre 2000 y 2014. Revisamos el motivo de consulta, antecedentes, ecografía, estudio histopatológico, marcadores tumorales (BHCG, AFP), actitud terapéutica y evolución.
De los 22 pacientes (10 prepuberales), el 82% presentaron masa palpable y el 18% fueron hallazgos incidentales. Dos presentaban criptorquidia. La BHCG estaba aumentada en el 27% y la AFP en el 45%. Se realizaron 18 orquiectomías y 4 tumorectomías. La histología fue en un 72% de células germinales, 14 orquiectomías y 2 tumorectomías (2 teratomas); y en un 27% de tumores de células no germinales, en 4 orquiectomías y 2 tumorectomías (2 tumores de células de Leyding). Seis pacientes recibieron quimioterapia postoperatoria (tumores mixtos). La mediana del tamaño de la tumoración fue de un cm (0,4-1,5) en las tumorectomías y de 2,5 cm (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.
Ponemos de manifiesto una tendencia al cambio en nuestra actitud terapéutica. Planteamos una cirugía conservadora mediante tumorectomía en los pacientes que cumplan con los criterios de benignidad de la masa testicular (pequeño tamaño y marcadores tumorales negativos).
Although standard surgical treatment of a testicular tumour is orchiectomy, use can be made of testis-sparing surgery in selected cases, based on tumour markers, tumour size, and histopathological findings. Our objective is to become acquainted with the indications of testis-sparing surgery as a treatment for the incidental finding of a palpable and non-palpable testicular mass.
A retrospective study was conducted on 22 patients younger than 18 years diagnosed with a testicular tumour between 2000 and 2014. An assessment was made of the condition, the history, ultrasound, histopathology, tumour markers (BHCG, AFP), therapeutic approach, and outcome.
Of the 22 patients (10 prepubertal age) studied, 82% had palpable mass, and 18% were incidental findings. Two had cryptorchidism. The BHCG was increased in 27% and AFP in 45% of cases. There were 18 tumorectomies and 4 orchiectomies performed. The histopathology found 72% germ cell, 14 orchiectomy, and 2 tumorectomies (2 teratomas), with 27% non-germ cell tumours in 4 orchiectomies and 2 tumorectomies (2 cells of Leydig). Six patients received post-surgical chemotherapy (mixed tumours). The median tumour size was 1 (0.4-1.5) cm in tumorectomies, and 2.5 (0.5-14) cm in orchiectomies. The mean follow-up was 5 (1-15) years. One patient died due to metastatic disease. There was no local recurrence in the follow up of the tumorectomies.
A change in the trend of our therapeutic approach is demonstrated. We propose that testis-sparing surgery is indicated in prepubertal patients who meet the benignity criteria of the testicular mass (small size and negative tumour markers).
Epidemiologic study of 230 cases of testicular/paratesticular tumors or masses: 15-year experience of a single center
2017, Journal of Pediatric Surgery
This study retrospectively investigated the cases of testicular tumors/masses treated in our center from 2002 to 2017 and analyzed their epidemiologic features.
Data were collected by searching our center's database using “testicular tumor” or “testicular mass” as keywords. Patients not operated in our hospital were excluded. Preoperative serum alpha-fetoprotein (AFP) levels were reviewed in germ cell tumor (GCT) cases and analyzed to predict malignancy in various age groups.
In total, 230 cases were identified: 151 were benign (78 in the left, 72 in the right, and 1 bilateral) with 3.63 years mean age during the operation, and 79 were malignant (42 in the left, 36 in the right, and 1 bilateral) with 2.21 years mean age during the operation. Main pathological diagnoses were mature teratoma (92, 40.00%), yolk sac tumor (53, 23.04%), dermoid cyst (23, 10.00%), embryonic carcinoma (15, 6.53%), immature teratoma (14, 6.09%), benign cyst (8, 3.48%), Leydig cell tumor (6, 2.61%), and paratesticular rhabdomyosarcoma (5, 2.17%). All GCT cases with AFP > 1000 ng/ml, > 100 ng/ml, > 20 ng/ml were malignant in < 7-, 7–9-, and ≥ 10-month-old groups, respectively.
Radical inguinal orchiectomy without biopsy is suggested in 7–9- and ≥ 10-month-old cases with AFP > 100 ng/ml and > 20 ng/ml, respectively.
Retrospective Study.
Level III-IV.
Testis sparing surgery for Leydig cell pathologies in children
2017, Journal of Pediatric Urology
Citation Excerpt :
The major concerns about gonadectomies were long-term use of hormones for replacement, issues about decreased fertility, and cosmetic and psychologic concerns during the teenage period [2]. For these reasons, organ-sparing surgical strategies for benign testicular and ovarian masses have gained importance and popularity in recent years [2–5]. The aim was describe cases of testis-sparing surgery and to discuss the feasibility, safety, and long-term outcome of this treatment modality.
The aim was to analyze testis-sparing surgical procedures in boys with Leydig cell pathologies.
The hospital records of four boys with Leydig cell hyperplasia who underwent testis-sparing surgery for testicular masses between 2000 and 2012 were analyzed retrospectively. Tumor markers were evaluated and all boys underwent scrotal ultrasonography preoperatively. The hormonal profile was also analyzed for symptoms of precocious puberty. The testis was delivered through a high transverse inguinal incision and the tumor was excised by enucleation. After confirming the benign nature of the tumor with frozen-section examination, the testis was reinserted and fixed into the scrotum with absorbable sutures. All cases were followed-up with physical examination, scrotal ultrasonography, and measurement of β-human chorionic gonadotropin (HCG), α-fetoprotein, and hormone levels.
The mean age of the patients was 9.4 years (1.5–15 years). Testicular mass and scrotal asymmetry were detected in all cases. Ultrasonography was the main initial diagnostic modality for detecting testicular masses (Table). β-HCG and α-fetoprotein levels were normal. Three cases had Leydig cell hyperplasia and one patient was diagnosed to have a Leydig cell tumor. Signs of precocious puberty were detected in the four patients. The mean follow-up period was 4.8 years (2–8 years). Neither recurrence nor testicular atrophy developed in the follow-up. Findings of precocious puberty continued in one patient with Leydig cell hyperplasia, in whom a 2-mm contralateral metachronous lesion was detected and enucleated successfully.
Testis-sparing surgery with its potential long-term psychological, cosmetic, and functional advantages should be used in pediatric patients in whom a benign Leydig cell pathology is confirmed histopathologically.
This intervention with good long-term results can easily be applied through a proper dissection plane in the testicle. Since testicular Leydig cell tumors in childhood have small rates of recurrence, this choice of treatment is efficient in patients with salvageable testicular tissues and normal levels of tumor markers.
Diagnostic Imaging: Pediatrics
2017, Diagnostic Imaging: Pediatrics

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Original articlePrepubertal testicular and paratesticular tumors in China: a single-center experience over a 10-year period

Abstract

Objective

Material and Methods

Results

Conclusions

Section snippets

Patients and methods

Results

Discussion

Conclusion

J Urol

Urology

J Urol

Urol Clin North Am

J Urol

J Pediatr Urol

J Pediatr Surg

Lancet Oncol

J Pediatr Surg

Prepubertal testicular tumours and efficacy of testicular preserving surgery

BJU Int

Paediatric testicular cancer: an updated review of incidence and conditional survival from the Surveillance, Epidemiology and End Results database

BJU Int

Clinical behavior and a contemporary management algorithm for prepubertal testis tumors: a summary of the Prepubertal Testis Tumor Registry

J Urol

Original article
Prepubertal testicular and paratesticular tumors in China: a single-center experience over a 10-year period