Prepubertal testicular tumors in Korea : a single surgeon experience of more than 20 years

Abstract

Introduction: To provide clinical and histological features of prepubertal testicular( PTT ) through the analysis of long – term experiences of single surgeon Methods: Charts were retrospectively reviewed in 48 children who were treated for testicular tumors from 1986 to 2010. All patients underwent radical orchiectomy. The patients age, clinical presentation, histopathological findings, kinetics of tumor marker and outcome were recorded. Results: The median age at initial diagnosis was 19.5 (3-84) months. All patients were presented either palpating mass (76%) or scrotal size discrepancy (24%). Compared to palpating mass, scrotal size discrepancy led to delay in diagnosis by 5 months. Regarding histology, yolk sac tumor and teratoma accounted for 53% and 36% of the patients, respectively. The mean preoperative AFP was significantly higher in yolk sac tumor than teratoma (4,600 ng/ml vs, 6.3ng/ml) and only one case of teratoma showed their preoperative AFP more than 20 ng/ml. Following the radical orchiectomy, 72%, 8% and 16% patients with yolk sac tumor showed normalization, persistent elevation and relapse after transient lowering of AFP, respectively. Preoperative AFP was greater in patients with non-normalization than those with normalization. Five out of six patients with non-normalization showed the evidence of either vascular invasion or endolymphatic tumor emboli. Conclusions: Our experience showed the higher number of yolk sac tumor than teratoma. AFP was found to be the most useful marker in the diagnosis and follow-up of childhood yolk sac tumor. Relapsed yolk sac tumor often showed pathological evidence of aggressiveness.