1 in 100 000.
1 – 2 % of solid tumours in children.
Usually present as painless scrotal swelling – occasionally as hydrocele or hernia.
Majority (60 – 70 %) of childhood testicular tumours are benign (cf. adults). Metastasis quite rare.
Risk factors – cryptorchidism, family or personal history of testis cancer, GCNIS, certain forms of DSD (partial androgen insensitivity syndrome, Denys-Drash, Frasier)
Types
Teratoma
- 40 % – most common tumour
- Typically benign
- Negative tumour markers
- Pre-puberty : excision alone generally all that is needed
Yolk sac tumour
- Most common malignant tumour in infants and pre-pubertal boys
- AFP generally elevated
- Treat with radical orchidectomy
- If nodal mets -> chemo
- Histologically -> Schiller-Duval bodies
Other differential diagnoses
- Gonadoblastoma
- Mostly in DSD patients
- Sex cord stromal tumours
- Leydig cell tumours (Reinke crystals) and Sertoli cell tumours
- Juvenile granulosa cell tumour
- Rhabdomyosarcoma
- Lymphomas and leukaemias
- Epidermoid cysts
- Other germ cell tumours – seminoma
Work-up:
- Tumour markers
- Ultrasound
- CT abdomen pelvis
Management
- If suspicion of benign tumour (negative tumour markers and staging, ultrasound features) -> frozen section with view to testis sparing surgery is appropriate
- Otherwise radical inguinal orchidectomy
- Chemotherapy (BEP) if scrotal violation or nodal disease in malignancy
- Follow AFP post-operatively for teratoma – keeping in mind age adjusted levels / AFP may be raised normally in infancy