Testis-sparing surgery for benign testicular tumors in children

In this retrospective survey we identify preoperative and intraoperative criteria of nonmalignancy and analyze the result of conservative treatment of a testicular mass.

A total of 22 surgeons responded to a questionnaire concerning lesions treated during the last 15 years in children between 0 and 15 years old. By definition alpha fetoprotein and beta human chorionic gonadotropin are within the normal limits at this age. The results were evaluated regarding evolution, growth of the preserved testis and local or distant recurrences.

Benign tumor of the testis (83 cases) represented 48% of all cases. Orchiectomy was performed in 27 cases and conservative treatment in 56. The final histopathological diagnosis was benign germinal tumor in 48 cases, cysts in 18, gonadal stromal tumor in 13 and rare lesions (lipoma, hemangioma) in 4. No definitive clinical criteria of nonmalignancy were identified but some symptoms were suggestive of nonmalignancy. Ultrasound results were more conclusive and provided the diagnosis of teratoma, epidermoid cyst and particularly simple cyst. The conservative treatment performed 56 times was a simple biopsy in 2 children with bilateral lesions and enucleation in 52. Enucleation was performed in 43% of cases using a pedicle clamp and in 50% with frozen section. The frozen section was changed in 12 cases due to therapeutic decision for preservation (10) and orchiectomy (2). There were no contradictions between the definitive histopathological examination and frozen section. Secondary orchiectomy was performed for neonatal granular tumor. Average followup in 56 cases of conservative treatment was 4.8 years (range 6 months to 15 years). Neither secondary testicular atrophy nor any local or distant recurrence was recorded.

A testicular tumor in children has a 50% chance of being benign. Treatment selection according to some clinical, biological, radiological and frozen section findings should allow us to decide on testis-sparing surgery without additional oncological risk, and with an aesthetic, psychological and functional benefit.