Testicular and paratesticular pathology in children: a 12-year histopathological review

Our institution is the principal pediatric surgical referral center for a population of 1.6 million. The objective of this study was to determine the spectrum and incidence of pediatric testicular and paratesticular pathology in this population.

Pathology results of all testicular and paratesticular specimens between August 1995 to September 2007 were analyzed. Clinical details were retrieved retrospectively from the computerized database, recording age, mode of presentation, laterality, and associated inguinoscrotal pathology.

Over 12 years 2 months, 474 patients (502 specimens) were identified. Testicular and paratesticular pathology was most frequent in patients aged 1-2 years (11%) and 11-12 years (10.5%). In all, 442 patients had non-neoplastic pathology, with 60.4% presenting acutely. The most common non-neoplastic pathologies were hydatid of Morgagni (42.6%) and "vanishing testis" (14.3%). Vanishing and atrophic testes were frequently explored between 1 and 2 years of age, with a left predominance. Most atrophic testes were undescended (54.8%). Testicular torsion occurred in 11.2%, with bimodal peak ages of <1 year and 13-14 years. Interestingly, testicular torsion also occurred more on the left side (68%). A total of 32 patients had neoplasms. Of 27 patients with testicular neoplasms, 55.6% were malignant (29.6% primary and 26% secondary), the principal primary malignancy was yolk sac tumor; the most common benign neoplasms were epidermoid cysts and teratomas. Five patients had paratesticular neoplasms, with rhabdomyosarcoma in 80%.

The variety of scrotal and testicular pathology in children is considerable, with acute pathologic conditions comprising the bulk in the older (7-15 years) children, whereas impalpable testes and neoplasms comprise most of the lesions in infants. Interestingly testicular torsion, vanishing testes, and atrophic testes occur mainly on the left side. Benign testicular neoplasms occur more frequently than primary malignancies.