Mature teratoma arising in intraabdominal undescended testis in an infant with previous inguinal exploration: case report and review of intraabdominal testicular tumors in children

Intratesticular prepubertal‑type mature teratoma in an infant: A case report and mini‑review of the literature

Testicular tumors are rare in children, representing a small percentage of pediatric solid tumors, with an incidence of 2 cases per 100,000 males. Teratomas, which are the most prevalent tumors in infants, may manifest in mature, immature, or malignant forms. While mature teratomas are typically found in the abdomen, intratesticular prepubertal-type teratomas in infants are infrequent. The present study describes the case of an infant with an intratesticular mature teratoma. A 6-month-old male infant presented with right-sided scrotal swelling, which was noted by his parents. There was no family history of similar conditions, and an investigation of his medical history did not reveal any notable findings. A physical examination revealed a non-reducible, solid mass indistinguishable from the right testicle, with no signs of inflammation or systemic symptoms. A scrotal sonography confirmed a large intratesticular cyst. The levels of α-fetoprotein and β-human chorionic gonadotropin were normal. Surgical tumor enucleation was performed, and the histopathological examination revealed a benign, prepubertal-type teratoma composed entirely of mature elements. Surgical intervention is commonly used for the management of benign testicular tumors in pediatric patients, including prepubertal teratomas. This approach demonstrates an excellent prognosis as it does not elevate the likelihood of recurrence. Prepubertal-type teratomas have rarely been reported in the infantile testis. They may present as a solid mass indistinguishable from the testicle, with no signs of inflammation.

Histopathological Analysis in Testicular Tumors: 10 Years of Experience

Introduction. This study aims to review the morphological and immunohistochemical features of testicular tumors and compare them with prognostic parameters. Methods. Testicular tumors diagnosed between January 2011 and September 2021 were reviewed. Patient age, tumor subtype, size, spread, lateralization, number of foci, and immunohistochemical results were recorded. Results. A total of 121 tumors were detected, of which 108 (89%) were germ cell tumors (GCTs). Of the germ cell tumors, 70 (65%) were found to be pure type, and 38 (35%) were mixed germ cell tumors. The ratio of pure seminoma among GCTs was 56/108 (52%). Lymphatic/vascular invasion (LVI) was detected in 48/121 (40%), rete testis invasion in 32/121 (26%), hilar soft tissue invasion in 10/121 (8%), epididymal invasion in 5/121 (4%), and spermatic cord invasion in 5/121 (4%) patients. Lymphatic/vascular invasion was observed in 6 (22%) of 27 germ cell tumors smaller than 3 cm in size, and rete testis invasion was observed in 2 (7%), while in 40 (55%) of the 73 germ cell tumors of 3 cm and above, lymphatic/vascular invasion was seen, and 26 (36%) of them had rete testis invasion. Immunohistochemical results contributed significantly to the determination of tumor components and rates, especially in mixed germ cell tumors. Conclusion. Most of the tumors were germ cell tumors, and the majority were seminomas. Lymphatic/vascular invasion and rete testis invasion rates increase as the tumor diameter increases, which is more evident when the 3 cm cut-off value is taken into account (P < 0.005).

Testicular tumor arising from an intra-abdominal undescended testis in a 1-year-old child: a case report and literature review

Objectives

Testicular tumors in the intra-abdominal undescended testis are rare in children, and their management remains challenging. The aim was to present a case report and review of the literature about diagnosis and treatment of testicular tumors arising from undescended intra-abdominal testis in children.

Methods

In this study, we retrospectively analyzed the clinical records of a 1-year-old male patient admitted to pediatric surgery in March 2022 with a testicular tumor originating in the intra-abdominal undescended testis. Furthermore, medical literature published in English during the last three decades was systematically searched through the databases of Medline, PubMed, and Google Scholar.

Results

The patient underwent laparoscopic orchiopexy and tumor excision. The operation was uneventful, and the patient recovered well without complications. An 8-month follow-up showed no recurrence of the teratoma after postoperative pathology. The literature search resulted in the retrieval of 16 non-duplicate articles, and 16 patients were included in this review. The cases included six cases of left cryptorchidism and 10 cases of right cryptorchidism, with an average age of 15.3 months. The largest transverse diameter of the tumors ranged from 1.8 to 12.5 cm, with an average tumor length of 6.7 cm. All patients underwent surgical treatment, including three cases of laparoscopic orchiectomy, a sole case of a conversion of inguinal incision to laparotomy and orchiectomy, and 12 cases of laparotomy and orchiectomy. Postoperative pathology revealed 12 cases of mature teratoma, two cases of immature teratoma, one case of yolk sac tumor, and a single case of embryonic carcinoma combined with yolk sac tumor. 11 patients were followed up, and one of them recurred.

Conclusion

Abdominal ultrasound (US) or abdominal computer tomography (CT) should be performed in cases of undescended testis suspected to have testicular tumors on clinical findings. The most common type of intra-abdominal testicular tumor is mature teratomas. Early diagnosis and prompt surgical intervention resulted in an excellent outcome.

Sentinel nubbin: A potential pitfall in the management of undescended testis secondary to epididymo-testicular nonunion

INTRODUCTION

Epididymal anomalies are common in boys with undescended testis. Epididymo-testicular non-union with a nubbin in the scrotum is a rare anomaly and may be confusing during management of cryptorchidism. The non-fused epididymis and vas deferens which are descended to the scrotum, may be regarded as nubbin tissue secondary to testicular atrophy and proximal testis may be overlooked.

OBJECTIVE

To evaluate a relatively rare anomaly of epididymo-testicular non-union in which vas deferens and epididymis are descended to the scrotum resembling a nubbin tissue, while a separate testis remains in a proximal peritoneal fold (hernia or processus vaginalis)which could potentially be missed during the management of patients with undescended testis.

STUDY DESIGN

The charts of the fourteen patients with epididymo-testicular non-union and a scrotal nubbin are retrospectively evaluated.

RESULTS

Median age of the patiens was 1.5 years (0.5-12), 11 were left and 3 were right. No connection could be demonstrated between the testis and vaso-epididymal unit in any of the patients. Orchidopexy was performed in 13 patients while orchidectomy in1 patient. The scrotal nubbin tissue is excised in 4 patients and histological examination revealed sections of vas deferens and epididymis. One of the patients underwent inguinal exploration and orchidectomy for assumed testicular atrophy elsewhere but histological examination revealed vas deferens and epididymis without any sign suggesting an atrophic testis. An intrabdominal testis was found incidentally in this patient and he underwent 2 additional procedures for orchidopexy.

DISCUSSION

Although epididymo-testicular anomalies are common in boys with undescended testis, nonunion is the rarest type of this anomaly. Similar cases are reported in the literature as simple fusion anomalies with indefinite clinical significance or even polyorchidism although no accessory testis could be demonstrated. However, the scrotal nubbin tissue which actually contains epididymis and vas is a potential decoy and may result in missing of the proximal testis if regarded as a sign of testicular atrophy and further evaluation is obviated. As this is retrospective study, actual incidence of the condition is yet to be determined.

CONCLUSION

A scrotal nubbin tissue may be secondary to epididymo-testicular nonunion as well as testicular atrophy. As feasibility of radiological imaging studies are limited, a laparoscopic exploration may be considered to confirm or to exclude a separate testis in patients with scrotal nubbin. Prospective studies are needed to evaluate the actual incidence of the condition and gain-loss analysis of laparoscopic exploration.

Hepatic splenosis mimicking liver metastases in a patient with history of childhood immature teratoma

Background

Hepatic splenosis is rare condition, preceded by splenectomy or spleen trauma, the term refers to nodular implantation of normal splenic tissue in the liver. In patients with history of malignancy in particular, it can be mistaken for metastases and can lead to unnecessary diagnostic procedures or inappropriate treatment.

Case report

Twenty-two-year old male was treated for immature teratoma linked to undescended right testicle after birth. On regular follow-up examinations no signs of disease relapse or long-term consequences were observed. He was presented with incidental finding of mature cystic teratoma after elective surgery for what appeared to be left-sided inguinal hernia. The tumour was most likely a metastasis of childhood teratoma. Origin within remaining left testicle was not found. Upon further imaging diagnostics, several intrahepatic lesions were revealed. Based on radiologic appearance they were suspicious to be metastases. The patient underwent two ultrasound guided fine-needle aspiration biopsies. Cytologic diagnosis was inconclusive. Histology of laparoscopically obtained tissue disclosed presence of normal splenic tissue and led to diagnosis of hepatic splenosis.

Conclusions

Though hepatic splenosis is rare, it needs to be included in differential diagnosis of nodular hepatic lesions. Accurate interpretation of those lesions is crucial for appropriate management of the patient. If diagnosis eludes after cytologic diagnostics alone, laparoscopic excision of nodular lesion is warranted before considering more extensive liver resection.

Retroperitoneal mature cystic teratoma arising from intra-abdominal undescended testis in an adult

Teratomas are a type of germ-cell tumour which may contain embryological tissues from more than one germ-cell layer, usually occurring in the gonads. Primary retroperitoneal teratomas account for 1-11% of retroperitoneal neoplasms and are most commonly found in neonates and young adults. In the clinical literature, retroperitoneal mature cystic teratoma arising from an intra-abdominal undescended testis in adult males has been very rarely reported. We report a case of surgically proven retroperitoneal mature cystic teratoma arising from an intra-abdominal undescended testis in an adult male by multislice helical computed tomography and magnetic resonance imaging.

Mature teratoma arising from an intraabdominal testis in a 2-month-old boy: case report and review of intraabdominal testicular tumors in children

Tumors arising in an undescended testis are rare in infants. We report a mature teratoma in an intraabdominal testis of a 2-month-old boy. He presented with a large left-sided abdominal mass and nonpalpable left testis. Abdominal ultrasound and computed tomography showed a well-defined, sizable cystic tumor with focal calcification in the lower abdomen. Tumor markers were all within normal limits. Surgical resection revealed a large tumor arising from an intraabdominal left testis, and histologic analysis identified a mature teratoma. The tumor was completely removed, and there was no recurrence at follow-up 3 years later. The histologic condition of prepubertal intraabdominal testicular (IAT) tumors is quite different from that of testicular tumors in childhood descended testes and postpubertal IAT tumors. A total of 30 cases of IAT tumors in children, including our case, were reviewed to elucidate this issue.

A case of immature teratoma originating in intra-abdominal undescended testis in a 3-month-old infant

Teratomas in an undescended testis are rare in infants. This report was the youngest case of immature teratoma originating in intra-abdominal undescended testis. A 3-month-old infant with cryptorchism was seen because of an asymptomatic palpable mass in the right abdomen. Ultrasonography and computed tomography revealed a multicystic large tumor with focal calcifications in the right side and serum tumor markers within normal limits. Complete resection of the tumor was performed and the histopathological diagnosis was made as immature teratoma of the right testis. Because retroperitoneal lymph nodes metastasis was observed in 3-month follow-up postoperatively, retroperitoneal lymphadenectomy and chemotherapy including bleomycin, etoposide, and cisplatin were performed. Presently, the infant has been free of recurrence for 3 years. We suggest that nonpalpable testis should undergo a careful evaluation and prompt resolution and that the subsequent finding of an intra-abdominal mass should make us think on the possibility of intra-abdominal testicular germ cell tumor. Postoperative adjuvant chemotherapy in combination with complete resection of the tumor is necessary for pediatric immature teratomas originating in intra-abdominal undescended testis.