Prepubertal Testicular Tumors In Children: Single Center 17 Years Experience

INTRODUCTION: Testicular tumors are rare in children and have a bimodal distribution. The first peak is in two years of age and comprising mainly non-germ cell neoplasia in situ derived tumors. Here is presented clinical features and treatment of testicular tumors in prepubertal children in our center.
METHODS: The clinical records of patients treated testicular tumours 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 patients were younger than 3 years, except one patient, who was 8 years old. The median age at primer 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 tumor (>1000 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 level was normal in all patients.
Of 11 patients whose preoperative scrotal ultrasound could be reached, 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 orchidectomy. Of the 5 tumors removed by testis preserving surgery 2 were mature teratomas, 2 were epidermoid cyst and 1 was benign multicystic lesion.
There was a patient with yolk sac tumor who died in the fifth month postoperatively while receiving chemotherapy, and the remaining patients had no metastatic or local primary testicular tumor recurrence during a mean follow-up of 92 months (2-198 months).

DISCUSSION AND CONCLUSION: Most prepubertal tumors are benign and testicular sparing surgery can be performed in patients with negative serum tumor markers. Inguinal radical orchidectomy is sufficient in the treatment of yolk sac tumor.