Management of primary testicular tumors in children

Clinical experience with yolk sac tumors and teratoma in children

Between 1971 and 1993, 12 children with testicular germ cell tumors were treated at the Department of Urology, Faculty of Medicine, Kyoto University. Seven patients had yolk sac tumors and 5 had mature teratoma. Of the 7 patients with yolk sac tumors 6 had stage I and 1 had stage III tumors. Initial management of the stage I tumors consisted of high orchiectomy in 5 patients and high orchiectomy plus retroperitoneal lymph node dissection in 1 patient. Of these 6 patients, 4 were cured by surgery alone but lung metastases developed in the other 2 patients. One of them was salvaged with thoracotomy and chemotherapy but the other died of tumor. The patient with stage III tumor had bulky tumor spread to lung and retroperitoneum, but seems to have been cured by chemotherapy followed by resection of the residual mass although follow-up is still inadequate (14 months). Six of the 7 patients (85.7%) are alive 13 months to 21 years after diagnosis. Five patients with mature teratoma were treated by high orchiectomy or, more recently, enucleation and all are alive 4 months to 22 years after surgery.

Neonatal testis tumors: a review of the Prepubertal Testis Tumor Registry

Since 1980, 338 testis tumors have been registered in the Prepubertal Testis Tumor Registry of the American Academy of Pediatrics, Section on Urology. Of these tumors 22 occurred in neonates less than 1 month old, of which 7 (31%) were diagnosed at birth. The distribution of lesions in this group revealed 6 yolk sac tumors, 6 gonadal stromal tumors, 6 juvenile granulosa cell tumors, 2 gonadoblastomas, 1 teratoma and 1 hamartoma. Preoperative serum alpha-fetoprotein levels were available for 10 patients and ranged from 23 to 61,700 ng/ml., which is within normal limits. No patient had evidence of metastatic disease at presentation. Of the 18 children in whom follow up is available 17 have no evidence of disease and 1, who was diagnosed with a yolk sac tumor before the advent of chemotherapy, died of metastatic disease before reaching age 1 year. Although neonatal testis tumors are rare, they should be considered in the differential diagnosis and management of a newborn with a scrotal mass.