The Diagnosis And Treatment Of Testicular Tumor In Children(137 Cases)

Objective:To analyze and improve the clinical diagnosis and therapy level of pediatric patients with testicular tumor at the Chongqing Medical University Affiliated Children’s hospital.Method:This study involved a retrospective review of the records of 137 pediatric patients who presented with testicular tumor at our institution between 1995 and 2014.Results:1.The 137 pediatric patients include 64 teratomas,61 yolk sac tumors, 4 leukocytic testicular tumors,3 adenomatoid tumors,3 epidermoid cyst,1 sex cord- mesenchymal tumor, and 1 lymphoma.2.134 of 137 pediatric patients presented with a scrotal mass, the rest 3 was finally confirmed as testicular tumors when diagnosed as cryptorchidism for scrotal empty.3.Preoperative AFP levels were elevated in immature teratoma,yolk sac tumors and sex cord-mesenchymal tumor.4.Ultrasonography depicted the testicular yolk sac tumor as solid mass, CDFI showed rich blood flow inside and around the mass. The teratoma showed mixed abnormal sound and calcification or necrosis inside in sonography. X ray of the scrotum showed some patchy or arc-shaped high density image(n=28). Leukocytic testicular tumors showed both test’s and epididymis are enlarged with rich perfusion in Color ultrasonography.3 epidermoid cyst of testis presented an abnormal echo structure, no echo inside demonstrating onion-like sign, no blood flow signal. Adenomatoid tumors, sex cord-mesenchymal tumor, and lymphoma showed non-specific manifestation.5.60 yolk sac tumors,20 teratomas,4 leukocytic testicular tumors,3 adenomatoid tumors,1 sex cord-mesenchymal tumor, and 1 lymphoma were all treated with testicular high level resection. Testis-sparing surgery were performed in 40 teratoma,3 epidermoid cyst of testis,1 yolk sac tumor.4 patients with teratoma gave up the surgery.6.Pathologic examination were performed in all cases. Reticular, acinous,and papillous structures are often detected in yolk sac tumor,. Mature teratoma showed 3 mature germ layer, immature teratoma showed component of immature germ layer, such as primitive neural tube. Leukocytic tumor metastasis presented leukemic cell. Cavity with squamous epithelium was seen in epidermoid cyst of testis. Adenomatoid tumors presented with adenomatoid tissue beside normal testis tissue, obvious boundary between tumor and testis, no atypia and karyomitosis inside tumor cell. Lymphoma showed evident karyomitosis.7.Postoperative chemotherapy was inessential in mature teratoma, epidermoid cyst of testis,and adenomatoid tumors. Patients with yolk sac tumor, immature teratoma, or sex cord- mesenchymal tumor received a combination of cisplatinum, etoposide, and bleomycin (PEB).8. The average length of follow up was 48 months. Of these,4 patients with yolk sac tumor experienced relapse and 1 patient with sex cord-mesenchymal tumor experienced retroperitoneal metastasis and relapse. All relapses treated with another surgery and postoperative chemotherapy (PEB and cyclophosphamide) showed no relapse again. No death or relapse was found in the rest patients.Conclusion:1.AFP ofter showed abnormal in cases with testicular yolk sac tumor, teratoma, and sex cord- mesenchymal tumor while showed normal in some of teratoma, adenomatoid tumor, leukocytic testicular tumor and epidermoid cyst of testis.2.Ultrasonography helps confirm the diagnosis.3.Testicular high level resection was preferred in yolk sac tumors, leukocytic testicular tumors, adenomatoid tumors, sex cord-mesenchymal tumor. Mainly, teratoma and epidermoid cyst were treated with Testis-sparing surgery(TSS). Intraoperative analyses of frozen-sections assisted to identify the operation extent.4. Postoperative chemotherapy was recommended in yolk sac tumor, sex cord-mesenchymal tumor, adenomatoid tumor, leukocytic testicular tumor, immature teratoma and lymphoma while not necessary in mature teratoma and epidermoid cyst of testis.