Testicular neoplasms in the prepubertal male

Abstract

Unlike adult neoplasms, prepubertal testicular tumors are frequently benign. Yolk sac tumors, which are always malignant, constitute the majority among the histological types of neoplasm reported in the literature. Teratomas are benign in the pediatric population and are the second-most commonly reported testicular tumors. The remaining tumors are exceedingly rare and almost always benign; however, juvenile granulosa cell tumors, undifferentiated stromal tumors, and Sertoli cell tumors may rarely possess metastatic potential. Therefore, testicular neoplasms are varied, rare and often benign. However, even when they are malignant, long-term survival is excellent with prompt diagnosis and treatment. Following an English-based Medline literature search, this article reviews a concise approach towards the management of these individual tumors based on an analysis of the literature in the English language that addresses testicular neoplasms in prepubertal males.

Ultrasound of a prepubertal Leydig cell tumour of the testis

“…Tumour markers and sex hormone levels are of value in differentiating testicular tumours. Alpha fetoprotein level is elevated in nearly 100% of yolk sac tumours and therefore useful for diagnosis and post‐operative monitoring . Leydig cell tumours usually cause elevated testosterone level and can precipitate precocious puberty in prepubertal boys; less commonly, these tumours secrete oestradiol and may produce gynaecomastia and breast tenderness.…”

“…Leydig cell tumours of the testis can have a varied appearance on ultrasound, although commonly appear as well circumscribed, hypoechoic lesions without internal calcifications . A range of diameters are described in the literature, with dimensions between 30 and 50 mm noted in studies of predominately adult cohorts; however, dimensions less than 10 mm appear more typical in children . Colour imaging often shows hypervascularity of the tumour with prominent peripheral and circumferential blood.…”

“…Treatment of testicular Leydig cell tumours has traditionally required complete orchidectomy; but for small benign or presumed benign tumours, conservative organ‐sparing surgery is now preferred to avoid subsequent androgen deprivation . In boys who present with precocious puberty, symptoms and androgenic changes may not reverse following resection because of activation of the hypothalamic–pituitary–gonadal axis . These tumours are considered universally benign in children, and there is no uniform follow‐up protocol for this condition…”

“…Testicular tumours in prepubertal boys account for 1–2% of all solid paediatric neoplasms, occurring in approximately 1 in every 100 000 children . Leydig cell tumours are rare, comprising only between 0.4% and 9% of all paediatric testicular neoplasms, with cases usually presenting between 5 and 10 years of age .…”

Benign cystic lesions in the testis of children

“…Intratesticular epidermoid cysts represent 3e14% of all pediatric testicular tumors [1,23,37]. They are universally benign in children and adults.…”