Editorial Comment

Abstract

Testis tumors in children are rare, with an incidence of 0.5-2.0 per 100, 000.1Ross J.H. Prepubertal testicular tumors.Urology. 2009; 74: 94-99Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar Treatment of testis tumors in children has evolved from radical orchiectomy, as is done in adults and adolescents, to testis sparing surgeries in most children with benign testis lesions found before puberty. Although the Prepubertal Testis Tumor Registry found that yolk sac tumors are the most frequently reported pediatric testis tumor,2Ross J.H. Rybicki L. Kay R. Clinical behavior and a contemporary management algorithm for prepubertal testis tumors: a summary of the Prepubertal Testis Tumor Registry.J Urol. 2002; 168: 1675-1679Abstract Full Text Full Text PDF PubMed Google Scholar other investigators have found that teratoma tumors are actually more common in their facilities pediatric tumor occurrence.3Pohl H.G. Shukla A.R. Metcalf P.D. et al.Prepubertal testis tumors: actual prevalence rate of histological types.J Urol. 2004; 172: 2370-2372Abstract Full Text Full Text PDF PubMed Scopus (160) Google Scholar, 4Taskinen S. Fagerholm R. Aronniemi J. et al.Testicular tumors in children and adolescents.J Ped Urol. 2008; 4: 134-137Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar, 5Metcalf P.D. Farivar-Mohseni H. Farhat W. et al.Pediatric testicular tumors: contemporary incidence and efficacy of testicular preserving surgery.J Urol. 2003; 170: 2412-2416Abstract Full Text Full Text PDF PubMed Scopus (128) Google Scholar, 6Valla J. Testis-sparing surgery for benign testicular tumors in children.J Urol. 2001; 165: 2280-2283Abstract Full Text Full Text PDF PubMed Google Scholar The incidence of teratoma, generally mature teratoma, is 39%-48% in these series. Evaluation of children before surgical treatment will give the urologic surgeon a better idea on whether the testis might be salvaged with tumor enucleation or excision. Preoperative examination of the testes with ultrasound imaging was discussed in some of the other series but no particular descriptions were given on typical ultrasound findings in testes with teratoma.4Taskinen S. Fagerholm R. Aronniemi J. et al.Testicular tumors in children and adolescents.J Ped Urol. 2008; 4: 134-137Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar, 5Metcalf P.D. Farivar-Mohseni H. Farhat W. et al.Pediatric testicular tumors: contemporary incidence and efficacy of testicular preserving surgery.J Urol. 2003; 170: 2412-2416Abstract Full Text Full Text PDF PubMed Scopus (128) Google Scholar, 6Valla J. Testis-sparing surgery for benign testicular tumors in children.J Urol. 2001; 165: 2280-2283Abstract Full Text Full Text PDF PubMed Google Scholar The authors describe ultrasound findings in children with mature teratoma testis tumors as commonly having varying degrees of cystic elements, calcifications, and rare vascularity in the mass. All children were also evaluated with alpha-fetoprotein (AFP) serum tumor marker assessment as is recommended to assure that the testis tumor is not malignant with yolk sac elements. Although this series was small with only 7 cases, all the cases were found to have mature teratoma on final pathology. It is reasonable to deduce that mature teratoma with endodermal mesodermal and ectodermal tissue derivatives would have cystic and calcified elements found on ultrasound according to its composition. It is worthwhile noting that although mature teratoma can be treated by testis sparing surgery in most instances, immature teratoma should not be considered or treated the same as mature teratoma. Although there have not been any reported cases of metastasis or recurrence in children younger than 12 years with mature teratoma, that has been a reported case of metastatic immature teratoma with neuroectodermal elements.7Kato K. Ijiri R. Tanaka Y. et al.Testicular immature teratoma with primitive neuroectodermal tumor in early childhood.J Urol. 2000; 164: 2068-2069Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar This tumor represents <10% of tumors reported to the Pediatric Oncology Group/Children's Cancer Group. It was recommended to completely remove this tumor and not to perform testis sparing surgery. All testis tumors, regardless of ultrasound findings, should at a minimum have an AFP serum marker test and surgical excision with an inguinal approach, vascular control with a tourniquet, and excisional biopsy with frozen section pathologic assessment of the mass performed with a nonmalignant assessment of the testis tissue done before consideration for testis sparing surgery. If there is an abnormal elevation of the AFP or any tissue components suspicious for malignancy, the entire testis should be removed. The authors have given us some reassuring ultrasound element assessments found in mature teratoma which help in planning a testis surgical procedure for the patient, barring elevated AFP or tissue findings not consistent with a benign testis tumor in childhood. Mature Testicular Teratoma in Children: Multifaceted Tumors on UltrasoundUrologyVol. 83Issue 1PreviewTo describe the different ultrasound (US) findings of mature testicular hamartomas in children. Full-Text PDF