Abstract:

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

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