Tumores testiculares primarios en niños

Abstract

Primary testicular tumors in childrenThe cases of 37 children with testicular germ cell tumors attended at a metropolitan hospital of Santiago, Chile, between the years 1968 and 1984 are analized. The histologic types of their tumors were in 26 cases infantile embrional carcinoma (IEC), in 7 inmature teratoma and in 4 mature teratoma. The 26 IEC patients were treated with orchiectomy: 5/26 with orchiectomy alone, 5/26 with orchiectomy plus lymphadenectomy (negative histology) and 16/26 with orchiectomy plus chemoterapy using methotrexate, D actinomycin and cyclosphosphamide (MAC). 2/7 patients with inmature teratoma were treated with oichiectomy alone, 2/7 with orchiectomy plus lymphadenectomy and 3/7 with orchiectomy and chemotherapy (MAC). 4/4 cases of mature teratoma were treated with surgery. Four of the 33 patients with malign germ cell tumors died, all of them with IEC: two were in stage II and they were treated with orchiectomy alone; the other two, instage I, were managed by orchiectomy and lymphadenectomy, relapsed and died; 29/33 patients aie alive without evidence of disease after 1 to 16 years of follow up. Five IEC cases relapsed and 3 were treated with PVB (Cis-platinum, vinblastine and bleomicine) with good results. We think that malign germ cell tumors of the tesies at stage I can be treated with surgery alone and must be followed by alphafetoprotein levels and chest radiograph. If they relapse (15%) they can be treated and cured with chemotheraphy (PVB). (Key words: Testicular tumors, prognosis, treatment, alphafetoprotein}.Los tumores testiculares (TT) representan el 1 a 2% de los tumores solidos malignos 1 en la infancia y estan en el septimo lugar en orden de frecuencia. Su baja incidencia explica la razon por la que su tratamiento aun no este bien definido. La mayoria de estos tumores (75 a 80%) son de origen germinal 2 y entre estos predomina el carcinoma embrionario infantil (CEI) 'o carcinoma del saco vitelino. Su diseminacion se efectua especialmente por via hematogena 2 -3 ' 4 , a diferencia de los TT malignos del adulto que lo hacen por vi'a linfatica, por lo que se justifica un mayor uso de quimioterapia sistemica y uno menor de linfadenectomia retroperintoneal y radioterapia. Uno de los principales avances en los ultimos anos es el desarrollo de radioinmuno-analisis para los marcadores sericos: Alfafetoproteina (AFP) y gonadotrofina corionica humana (HGC.) que contribuyen al diagnostico, clasificacion y seguimiento de los tumores de celulas germinales 5 -6 .La mas utilizada es la AFP que esta ligada a la presencia del componente vitelino en el CEI.