Testicular Tumors in Children
Kenan Ashouri
Fawaz M. Ashouri
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Pediatric testicular tumors are rare in the prepubescent male (Figure 54.1).
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Germ cell tumors (GCTs) comprise the majority of testicular tumors in the pediatric population.
EPIDEMIOLOGY AND ETIOLOGY
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Yolk sac tumors are malignant and express alpha fetoprotein (AFP).
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Epidermoid cysts are another common benign testicular tumor in children.
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The next most common category is gonadal stromal tumors, including sertoli cell tumors, leydig cell tumors, and juvenile granulosa cell tumors, in respective order of approximate incidence.
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Seminomatous GCTs are rare in children.
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Paratesticular rhabdomyosarcomas are the most common malignant tumor of the paratesticular structures.
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Often arise from the spermatic cord, tunicae, or epididymis.
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Highly aggressive and warrant retroperitoneal lymph node dissection (RPLND) and metastatic workup.4
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Secondary tumors are most commonly leukemia or lymphoma.
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Cryptorchidism is classically associated with an increased relative risk of GCT (RR˜3-8) in the undescended testicle, which is only reduced but not eliminated (RR˜2-3) after prepubertal orchiopexy.5
Figure 54.1 Inguinal anatomy. Note: Scarpa fascia (not depicted) is more predominant both near the pelvis and in children. (Reprinted with permission from Detton AJ. Grant’s Dissector. 16th ed. Philadelphia, PA: Wolters Kluwer; 2017.) |
CLINICAL PRESENTATION
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Testicular tumors typically present as a painless testicular mass incidentally found by the patient or parent or on clinical examination.
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There is often an associated hydrocele occurring in ˜1 in 5 patients.6
DIAGNOSIS
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AFP is elevated in yolk sac tumors (YSTs) and is critical in diagnosing, staging, and monitoring recurrence of YSTs; however, it can be physiologically elevated in infants for up to 1 year.7
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If AFP is elevated, chest X-ray and CT abdomen/pelvis are needed for staging.1
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Ultrasonography is useful in differentiating a testicular tumor from other testicular pathology, such as torsion or paratesticular tumor (Figure 54.2).
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