Testicular Tumors in Children
Fawaz M. Ashouri
Pediatric testicular tumors are rare in the prepubescent male (Figure 54.1).
Germ cell tumors (GCTs) comprise the majority of testicular tumors in the pediatric population.
EPIDEMIOLOGY AND ETIOLOGY
The most common type of GCT in the pediatric population is yolk sac tumors, followed by teratomas.1
Yolk sac tumors are malignant and express alpha fetoprotein (AFP).
Epidermoid cysts are another common benign testicular tumor in children.
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.
Seminomatous GCTs are rare in children.
Paratesticular rhabdomyosarcomas are the most common malignant tumor of the paratesticular structures.
Often arise from the spermatic cord, tunicae, or epididymis.
Highly aggressive and warrant retroperitoneal lymph node dissection (RPLND) and metastatic workup.4
Secondary tumors are most commonly leukemia or lymphoma.
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
Testicular tumors typically present as a painless testicular mass incidentally found by the patient or parent or on clinical examination.
There is often an associated hydrocele occurring in ˜1 in 5 patients.6
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
If AFP is elevated, chest X-ray and CT abdomen/pelvis are needed for staging.1
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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