Testicular Tumors

Abstract

Prepubertal testis tumors are distinct from their adolescent and adult counterparts in histological characteristics, molecular biology, and clinical behavior. In the absence of an age-adjusted elevation in alpha-fetoprotein (AFP), the initial surgical approach for pediatric testis tumors should be an inguinal exploration with excisional biopsy and frozen section analysis. Most of these patients will have a benign tumor and require no further evaluation or treatment. Those patients that harbor the most common malignancy – yolk sac tumor – usually have stage I disease that can be managed with observation. Patients with metastatic disease and those stage I patients who progress on observation can almost always be cured with platinum based multiagent chemotherapy. Indeed, the outlook for prepubertal patients with testicular tumors is even better than that for adults and the emphasis in recent years has been on reducing the morbidity of both the surgical and adjuvant therapies for these children. For adolescents with malignant germ cell tumors, management usually follows that recommended for adults with an inguinal orchiectomy as the initial approach unless there is a high suspicion of a benign tumor. Postsurgical management for stage I tumors generally involves surveillance with consideration of a staging retroperitoneal lymph node dissection (RPLND) in high risk patients and those with marker-negative stage IIA disease. Most patients with metastatic disease receive platinum-based chemotherapy. Any residual mass following chemotherapy in the setting of normal tumor markers should be excised and a bilateral nerve-sparing RPLND should be considered.