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Stein R, Dürken M, Zahn K, Younsi N. [Testicular tumors in prepubertal boys-organ preservation possible more often than expected]. Urologe A 2020; 59:278-283. [PMID: 32020239 DOI: 10.1007/s00120-020-01120-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In prepubertal boys, testicular tumors are rare with an incidence between 2 and 5/million. In contrast to testicular tumors in adolescents and adults, more than 2/3 of these tumors are benign. Unfortunately, in Germany in most cases, only malignant tumors (usually yolk sac tumors) are reported to the study center (MAKEI IV and now V). Therefore, the incidence in Germany is unknown. Since the introduction of polychemotherapy in the 1970s, the prognosis of malignant testicular tumors has improved enormously and has become a curable disease, even in the case of recurrence. Today the orchiectomy, which was usually carried out in the past, appears to be no longer justified in most prepubertal boys due to the high incidence of benign tumors. It has been shown in various studies that organ-sparing surgery in germ cell tumors (epidermoid cysts, teratoma); gonadal stoma tumors (Sertoli, Leydig and granulosa cell tumors) and cystic lesions (intratesticular cysts and tubular ectasia of the rete testis) is reliable and safe. In cases with preoperative significantly increased AFP (caution: norm values not valid in the first year of life) and a clear testicular tumor in the ultrasound (yolk sac tumor) or if no testicular parenchyma is sonographically detectable, orchiectomy can still be carried out. Today orchiectomies in prepubertal boys should be an exception and the reasons for an orchiectomy must be well documented.
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Affiliation(s)
- R Stein
- Zentrum für Kinder‑, Jugend- und rekonstruktive Urologie, Medizinische Fakultät Mannheim, der Universität Heidelberg, Universitätsklinikum Mannheim GmbH, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
| | - M Dürken
- Klinik für Kinder- und Jugendmedizin, Medizinische Fakultät Mannheim, der Universität Heidelberg, Universitätsklinikum Mannheim GmbH, Mannheim, Deutschland
| | - K Zahn
- Zentrum für Kinder‑, Jugend- und rekonstruktive Urologie, Medizinische Fakultät Mannheim, der Universität Heidelberg, Universitätsklinikum Mannheim GmbH, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - Nina Younsi
- Zentrum für Kinder‑, Jugend- und rekonstruktive Urologie, Medizinische Fakultät Mannheim, der Universität Heidelberg, Universitätsklinikum Mannheim GmbH, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
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Nistal M, Paniagua R, González-Peramato P, Reyes-Múgica M. Perspectives in Pediatric Pathology, Chapter 8. Persistence of Embryonal Remnants in the Testis and Epididymis. Pediatr Dev Pathol 2015; 18:353-61. [PMID: 25105942 DOI: 10.2350/14-04-1467-pb.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Manuel Nistal
- 1 Pathology, Hospital La Paz, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo #2, Madrid 28029, Spain
| | - Ricardo Paniagua
- 2 Department of Cell Biology, Universidad de Alcala, Madrid, Spain
| | - Pilar González-Peramato
- 1 Pathology, Hospital La Paz, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo #2, Madrid 28029, Spain
| | - Miguel Reyes-Múgica
- 3 Department of Pathology, Children's Hospital of Pittsburgh of University of Pennsylvania Medical Center, One Children's Hospital Drive, 4401 Penn Avenue, Pittsburgh, PA 15224, USA
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3
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Chung JM, Lee SD. Overview of pediatric testicular tumors in Korea. Korean J Urol 2014; 55:789-96. [PMID: 25512812 PMCID: PMC4265712 DOI: 10.4111/kju.2014.55.12.789] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 10/28/2014] [Indexed: 11/24/2022] Open
Abstract
Prepubertal testicular tumors are rare compared with postpubertal testicular tumors. The incidence of prepubertal testicular tumors peaks at 2 years of age, tapers off after 4 years of age, and then begins to rise again at puberty. Prepubertal and postpubertal testicular tumors show many differences, including the typical tumor histology, molecular biological differences, and the malignant potential of tumors at different ages. Pediatric testicular tumors are classified as benign or malignant on the basis of their clinical behavior and histologically are divided into germ cell and gonadal stromal (nongerm cell) tumors. Many histological and biological studies have further confirmed the distinct nature of prepubertal and postpubertal testicular tumors. These differences have led to various management strategies for prepubertal and postpubertal tumors. Because overall about 75% of prepubertal testicular tumors are benign, a testis-sparing approach is becoming more common in children. Orchiectomy and observation with very selective use of chemotherapy has become the standard approach when a malignant tumor is identified. Retroperitoneal lymph node dissection and radiation therapy play very limited roles.
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Affiliation(s)
- Jae Min Chung
- Department of Urology, Pusan National University School of Medicine, Yangsan, Korea
| | - Sang Don Lee
- Department of Urology, Pusan National University School of Medicine, Yangsan, Korea
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Makari JH, Ramachandra P, Ferrer FA. Pediatric urologic oncology: organ-sparing surgery in kidney and testis. Urol Clin North Am 2010; 37:287-98. [PMID: 20569806 DOI: 10.1016/j.ucl.2010.03.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Technological advances in imaging as well as increased knowledge of tumor-specific biology have promoted the role of organ-sparing approaches to pediatric renal and testicular tumors. Application of these techniques continues to evolve as data on long-term follow-up become available and as protocol-guided investigation provides answers to therapeutic outcomes of these approaches. Optimally, organ-sparing surgery will continue to provide increased potential for preservation of both renal function and fertility.
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Affiliation(s)
- John H Makari
- Department of Surgery, University of Connecticut School of Medicine, Farmington, CT 06030, USA
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Ceylan H, Karaca I, Sari I, Ortaç R, Ozokutan BH, Kervancioğlu S. Simple testicular cyst: a rare cause of scrotal swelling in infancy. Int J Urol 2004; 11:352-4. [PMID: 15147558 DOI: 10.1111/j.1442-2042.2004.00789.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A simple testicular cyst is a rare cause of scrotal swelling in infancy. Only 10 cases have been reported in children less than two years of age in the English literature. Pathogenesis of the lesion is unclear. Preoperative diagnosis is possible using ultrasonography (US). Testis-sparing surgery with simple enucleation of the cyst has a favorable outcome. We report two patients with a simple testicular cyst, who were 9 and 8 months of age. The first case was referred with a presumptive diagnosis of hydrocele, and the second infant was admitted with a history of testicular swelling. Ultrasonography provided accurate preoperative diagnosis in both of the cases. The patients were successfully treated with testis-sparing surgery with outstanding long-term results. This unusual lesion of infancy should be considered in the differential diagnosis of a scrotal mass.
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Affiliation(s)
- Haluk Ceylan
- Department of Pediatric Surgery, Faculty of Medicine, University of Gaziantep, Gaziantep, Turkey.
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Metcalfe PD, Farivar-Mohseni H, Farhat W, McLorie G, Khoury A, Bägli DJ. Pediatric testicular tumors: contemporary incidence and efficacy of testicular preserving surgery. J Urol 2004; 170:2412-5; discussion 2415-6. [PMID: 14634440 DOI: 10.1097/01.ju.0000097383.09743.f9] [Citation(s) in RCA: 113] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Testicular tumors in the pediatric population are fundamentally distinct from their adult counterparts. We reviewed a contemporary single series from a large pediatric health science center. We also examined our experience with testis conserving surgery and then used it to develop a preoperative management algorithm. MATERIALS AND METHODS A retrospective review was performed of all testicular tumors at a single institution from 1984 to 2002. Data were compiled using the American Academy of Pediatrics testis tumor registry data collection form. We further examined partial orchiectomies for indications and outcomes with respect to cancer control and testicular viability. RESULTS A total of 51 primary testicular lesions were identified. Patient age was prenatal to 16 years with a scrotal mass the most common presentation (81%). Mature teratoma, rhabdomyosarcoma, epidermoid cyst, yolk sac and germ cell tumors accounted for 43%, 26%, 10%, 8% and 6% of cases, respectively. This distribution was markedly different from the last reported American Academy of Pediatrics data base. Organ preserving surgery was planned and achieved in 13 cases. All surgeries were successful with respect to cancer control and testicular preservation. CONCLUSIONS We believe that the higher incidence of teratoma is more representative of this population and yolk sac tumor is a minority diagnosis. The single institution review eliminates the interinstitutional referral heterogeneity that may have skewed larger data bases. Furthermore, the concept of testicular preserving surgery becomes an attractive option since we present its safety and efficacy. The management algorithm should facilitate the preoperative decision to perform less radical surgery and help preserve testicular tissue.
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Affiliation(s)
- Peter D Metcalfe
- Division of Urology, Hospital for Sick Children, University of Toronto, Ontario, Canada
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Shukla AR, Woodard C, Carr MC, Huff DS, Canning DA, Zderic SA, Kolon TF, Snyder HM. Experience with testis sparing surgery for testicular teratoma. J Urol 2004; 171:161-3. [PMID: 14665867 DOI: 10.1097/01.ju.0000101185.90327.b4] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Testicular teratoma is a rare neoplasm affecting the pediatric population and has classically been reported to be the second most common testis tumor in children behind yolk sac tumors. Testicular teratomas are benign and partial orchiectomy may be considered. We describe our single institution experience with testicular teratoma and definitive treatment with testis preserving surgery. MATERIALS AND METHODS We reviewed the pathology records at our institution for all testicular and paratesticular tumors diagnosed between 1976 and November 2002 in males younger than 18 years. We specifically examined the prepubertal incidence of teratoma, including epidermoid cysts, and our experience with testis preserving surgery. Preoperative and postoperative ultrasonography images were used to calculate the atrophy index following surgery. Patients were contacted for long-term followup. RESULTS Of 77 primary testicular and paratesticular tumors 38 were diagnosed in prepubertal boys (age younger than 13 years) including 11 mature teratomas and 5 epidermoid cysts. Mean patient age at treatment was 34.4 months (range 4 months to 10 years). All boys presented with a painless scrotal mass, cystic foci within an intratesticular mass on ultrasound and a normal alpha-fetoprotein level. Of the 16 boys with benign teratomas 13 (81%) were treated with a testis sparing procedure. At a mean 7-year followup no patient has presented with recurrent tumor in the ipsilateral or contralateral testicle. Postoperative physical examination and scrotal ultrasound were obtained in 9 patients at a median followup of 10.2 months, and there was no evidence of testicular atrophy or persistent discomfort. CONCLUSIONS Unlike previously published series based on tumor registries, benign teratoma was the most common pediatric testicular tumor treated at our institution. Our single institution experience with testis preservation and long-term followup confirms the role and safety of this technique. Testis sparing surgery remains our technique of choice for testicular teratoma.
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Affiliation(s)
- Aseem R Shukla
- Division of Pediatric Urology, The Children's Hospital of Philadelphia, Pennsylvania 19104, USA
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Casaccia G, Spagnoli A, Ferro F. Simple intratesticular cysts in infancy: testis-sparing surgery by a scrotal approach. Urology 2000; 56:854-5. [PMID: 11068317 DOI: 10.1016/s0090-4295(00)00768-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- G Casaccia
- Andrologic Surgery Unit, Department of Pediatric Surgery, Bambino Gesù Children's Hospital, Research Institute, Rome, Italy
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10
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Abstract
One can strongly suspect a benign lesion in a prepubertal child on the basis of preoperative sonographic, biochemical, and clinical evaluation; however, when considering a testis-sparing enucleation, the definitive diagnosis must be established by pathologic frozen section of the tumor. The high incidence of benign testicular lesions in the prepubertal patient, the absence of associated carcinoma in situ in prepubertal germ cell tumors, and the universally benign behavior of the specific tumors described in this article are supportive evidence for testis-sparing surgery versus orchiectomy, for these benign lesions.
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Affiliation(s)
- C Walsh
- Department of Urology, George Washington University School of Medicine, Washington, DC, USA
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Cornel EB, de Gier RP, van Die CE, Feitz WF. Testicular simple cyst and teratoma: asynchronous bilateral occurrence within the first year of life. Urology 1999; 54:366. [PMID: 10754134 DOI: 10.1016/s0090-4295(99)00059-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Benign and malignant testicular tumors are rare in infancy. Moreover, only a few cases of bilateral testicular tumors in children have been reported to date. To our knowledge, we report the first case of an asynchronous bilateral simple testicular cyst and testicular teratoma in an infant. This case demonstrates that although both lesions are benign in the prepubertal child, treatment decisions should be made carefully.
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Affiliation(s)
- E B Cornel
- Paediatric Urology Center Nijmegen, University Hospital Nijmegen, The Netherlands
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Crankson SJ, Shabra S, Al Hawashim N. Dermoid cyst of the testis. Ann Saudi Med 1997; 17:634-5. [PMID: 17338013 DOI: 10.5144/0256-4947.1997.634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- S J Crankson
- Departments of Surgery and Pathology, King Fahad National Guard Hospital, Riyadh, Saudi Arabia
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Abstract
Von Hippel-Lindau disease (VHL) is an autosomal-dominant condition that often involves cystic changes within many organs, including the epididymis. However, no previous report of a patient with VHL and a benign intratesticular cyst has been published. We report on a 28-year-old man with otherwise stable VHL who presented with a symptomatic 3-cm intratesticular benign cyst. The cyst was successfully treated by partial orchiectomy.
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Affiliation(s)
- J A Brown
- Department of Urology, Mayo Clinic, Rochester, Minnesota 55905, USA
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Lam KY. Bilateral intratesticular cysts--a specific entity. SCANDINAVIAN JOURNAL OF UROLOGY AND NEPHROLOGY 1996; 30:329-31. [PMID: 8908659 DOI: 10.3109/00365599609182317] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A case of bilateral testicular simple cysts was seen in a 79-year-old Chinese man. The cysts contained clear fluid and were lined with simple cuboidal epithelia. The histochemical and immunohistochemical findings of this case were presented with an effort to clarify the nature of the cyst. In addition, the clinicopathological features, differential diagnosis and proposed histogenesis of the documented testicular simple cysts in the literature were also reviewed.
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Affiliation(s)
- K Y Lam
- Department of Pathology, Queen Mary Hospital, Hong Kong
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Loo CK, Yung T. Cystic dysplasia of the testis: a report of three cases and review of the literature. PEDIATRIC PATHOLOGY & LABORATORY MEDICINE : JOURNAL OF THE SOCIETY FOR PEDIATRIC PATHOLOGY, AFFILIATED WITH THE INTERNATIONAL PAEDIATRIC PATHOLOGY ASSOCIATION 1995; 15:885-93. [PMID: 8705199 DOI: 10.3109/15513819509027025] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
We describe the clinical and pathologic findings in three cases of cystic dysplasia of the testis and compare our findings to others in the English literature. The condition is characterized by dilatation of the rete testis with or without similarly affected adjacent structures. It is important to recognize this lesion for two reasons. First, it is associated with a high frequency of ipsilateral renal anomalies. Second, it is important to consider this condition in the differential diagnosis of cystic testicular mass in a neonate or a child. The management of this condition is quite different from the management of other testicular masses such as a hydrocele, testicular germ cell tumor, or infiltrative disorder (e.g., lymphoma, inflammation, torsion, or hematoma). Testicular cystic dysplasia is benign and the lesion can be removed surgically, leaving the rest of the testis intact. A discussion of the lesion's possible pathogenesis is also presented.
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Affiliation(s)
- C K Loo
- Anatomical Pathology Department, Westmead Hospital, Australia
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Abstract
The authors report on a 5-month-old boy who had a simple cyst of the testis and was treated by testis-sparing cyst excision. Preoperative ultrasonography was diagnostic of a simple cyst. The patient has been without recurrence for over 2 years, and examinations have shown a normal size testis. A literature review showed only four cases of infantile simple cysts of the testis, only one of which was diagnosed preoperatively and treated by cyst excision. Four of the 5 reported cases (including ours) were diagnosed at 5 months of age. We recommend organ-preserving cyst excision in males under 1 year of age who are found to have an intratesticular lesion that is a simple cyst by ultrasound criteria.
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Affiliation(s)
- S J Peretsman
- Department of Urology, Wilford Hall Medical Center, Lackland AFB, TX 78236-5300, USA
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Abstract
The authors report the first case of a simple testicular cyst presenting in a neonate. Diagnostic criteria are outlined and theories concerning etiology are discussed. The authors show an absence of elastin staining in the specimen, and suggest this precludes germinal tubules as a source. The rationale for testicular-sparing surgery is discussed.
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Affiliation(s)
- B Slaughenhoupt
- Division of Pediatric Urology, Floating Hospital for Children at New England Medical Center, Boston, MA, USA
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Abstract
Benign testicular masses are recognized with increasing frequency and testis-sparing surgery, based on benign frozen section diagnosis, is practiced more often. However, there is a paucity of information in the medical literature regarding the accuracy of frozen section diagnoses of testicular tumors, and misdiagnoses could have dire consequences. We reviewed thirty frozen section examinations that were performed between 1962 and 1991, a period in which five hundred inguinal orchiectomies were performed. The entire testicle was available for histologic evaluation in 26 cases. Frozen sections correctly identified all of twenty-four malignant and two benign testicular masses. This study demonstrates that frozen section examinations can accurately diagnose testicular cancer.
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Affiliation(s)
- R Tokuc
- Department of Urology, Wayne State University School of Medicine, Detroit, Michigan
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Abstract
An 11-year-old boy presented with bilateral testicular masses that consisted of hyperechoic centers with hypoechoic rims on ultrasound. Surgical exploration revealed bilateral epidermoid cysts. To our knowledge this is the first reported case of bilateral epidermoid cysts in a child. Recognition of this entity requires surgical confirmation but it may obviate removal of the testicle.
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Rushton HG, Belman AB, Sesterhenn I, Patterson K, Mostofi FK. Testicular sparing surgery for prepubertal teratoma of the testis: a clinical and pathological study. J Urol 1990; 144:726-30. [PMID: 2388338 DOI: 10.1016/s0022-5347(17)39567-8] [Citation(s) in RCA: 105] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We report on 5 patients 14 months to 6 1/2 years old with prepubertal teratoma of the testis treated by testicular sparing tumor enucleation. All 5 patients had no evidence of recurrence at a mean followup of 96 months. Recognizing that this is not accepted therapy for testis tumors, 17 orchiectomy specimens containing teratoma from children were histologically analyzed in cooperation with the Armed Forces Institute of Pathology Tumor Registry. All patients were prepubertal at orchiectomy (3 months to 8 years old) and all are well with a mean followup of 174 months. Histological examination revealed no foci of teratoma separate from the main tumor in any specimens. Immunohistochemical studies with placental alkaline phosphatase, a marker for malignant germ cells, were done to detect carcinoma in situ in the seminiferous tubules of these testes. This test did not reveal any intratubular malignant germ cells (carcinoma in situ). Based on our clinical experience with testicular sparing tumor enucleation, the histological findings on Armed Forces Institute of Pathology review demonstrating no associated carcinoma in situ and the universally benign behavior of prepubertal testicular teratomas, we recommend a testicular sparing operation rather than orchiectomy for testicular teratoma in prepubertal patients.
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Affiliation(s)
- H G Rushton
- Department of Urology, Children's Hospital, Washington 20010
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Abstract
We report 5 cases of simple cyst of the testis, the largest series to date, and review the literature. Included are 2 autopsy cases, a case of a multilocular simple cyst and 1 case treated nonoperatively. Based on our experience, simple cyst of the testis should be suspected particularly in an enlarged but otherwise palpably normal testis. High resolution real-time scrotal sonography revealing an anechoic mass in the testis with well defined walls, and enhanced posterior through transmission and edge shadowing is diagnostic for a simple cyst. An asymptomatic simple cyst of the testis may be treated with observation alone. The symptomatic simple cyst should be treated ideally with local parenchyma-sparing excision.
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Affiliation(s)
- R R Dmochowski
- Department of Surgery, University of Texas Medical School, Houston
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