Pediatric Germ Cell Tumors- Pathological Variations and Challenges

Abstract

Aims:Germ cell tumors (GCT) are uncommon in children and adolescent but when they appear, gonads are the most frequent site. Testicular tumors constitute 1-2% of all pediatric solid tumors among them 84% are GCT. Incidence of ovarian GCT is 67%. This study from a single center focus on highlighting clinical features, investigations, treatment and outcome of GCTs in children to look for peri operative challenges and long term prognosis.MethodsA prospective study of 45 patients with GCTs was done from March 2018 to January 2022. The detailed data of each patient was scrutinized including history, physical examination, investigations, management, and follow-up. Forty-five patients presented during this period. Fifteen male (33.3%) and 30(66.7%) female with median age of 4.8 years. Twenty-eight( 62.2%) patients presented with abdominal mass, 15(34.88%) with scrotal swelling and 2(4.65%) with acute abdomen. Hematological and radiological investigations were done in all patients. α-fetoprotein level was high in 30 patients. All patients were managed combinedly with Paediatric Oncology. After being discussed in multidisciplinary tumor board, surgical excision was done.Results:On gross, 75% were mixed and 25% were solid tumors. Median size of testicular tumors ranged from 3cm to 8cm while ovarian tumors ranged from 5cm to 23cm. on histology, Twenty six(57.8%) were mature teratoma, 6 (15.5%) immature teratoma, 8(17.7%) yolk sac tumors, while 1(2.32%) mixed stromal tumor, 1 (2.32%) sex cord tumor and 1(2.2%) Leydig cell tumor also reported. Neo-adjuvant chemo was given in 4 (8.88%) patients while 6 (13.33%) patients received chemotherapy postoperatively. Rest of the patients didnot receive chemotherapy as they had stage I & II disease. Thirty-three patients are doing fine, 11 had lost follow up and 1 patient expired due to sepsis. Long term follow-up with tumor markers and radiological investigations showed no recurrence in majority of patients (73%).ConclusionGCTs in Pediatric population are not uncommon. However good prognosis can be expected if diagnosed at early stage. Majority of tumors doesn’t require post-operative chemotherapy. Tumor markers especially alpha-fetoprotein seems reasonable prognostic marker on follow up in centers where other genetic studies aren’t available due to limited resources.