Multicenter retrospective study on benign testicular tumors in children: save as much as you can please.

BACKGROUND: Testicular tumors (TT) are infrequent in pediatric patients, representing 1% of pediatric solid tumors; benign testicular tumors (BTT) are the most common. We present a multicenter study aiming to describe the incidence, histology and surgical technique of BTT, with special emphasis on which approach could present better outcomes. METHODS: The records of pediatric patients diagnosed with BTT between 2005 and 2020 from 8 centers in 5 different countries in Latin-America, were reviewed. RESULTS: Sixty two BTTs were identified. 73% tumors presented as a testicular mass, and 97% underwent testicular ultrasound as the initial imaging study, all of them had findings suggestive of a benign tumor. 87% had preoperative tumor markers (AFP and BHCG). In 66%, an intraoperative biopsy was done and 98% of the intraoperative biopsies were concordant with the final pathology report. Tumorectomy was performed in 81% of patients and total orchiectomy in the remaining 19%. Six percentage of patients underwent a subsequent orchiectomy. Mean follow-up was 39 months (1-278 months) where no cases of atrophy were observed clinically or on ultrasound. Fertility was not evaluated in this series. CONCLUSIONS: Proper management of BTTs is essential to avoid unnecessary orchiectomies. Preoperative ultrasound associated with intraoperative biopsy seems accurate in identifying benign pathology, thus enabling conservative testicular surgery with safety margins. Based on this multicenter series, we suggest performing an intraoperative biopsy with subsequent tumorectomy preserving healthy testicular tissue in BTT.

Testis-sparing surgery for testicular tumors in children: a 20 year single center experience and systematic review of the literature.

PURPOSE: Although surgical therapy for testicular tumors (TT) is often radical orchidectomy, tumor resection with preservation of healthy testicular parenchyma has been proposed. This study herein reports a 20 year single center experience applying testicular sparing surgery (TSS) as a primary operative strategy in pediatric patients. A systematic literature review summarizes the utility and outcomes of TSS in appropriately selected patients. METHODS: Pediatric patients with TT who underwent TSS between 1997 and 2018 were studied. TSS was indicated if patients presented evidence of adequately spared healthy testicular parenchyma on preoperative ultrasound and negative serum tumor markers. A systematic review of the literature was also performed. RESULTS: 12 cases met full inclusion criteria with 10 of 12 subjects in the prepubertal age group. Follow-up was 73 months (range 18-278 months). Only a single male patient (GSCCT) presented with early recurrence and orchidectomy was then performed. No cases of postoperative testicular atrophy were identified. Sexual maturation (Tanner stage) expected for age in each patient was documented. Review of the literature identified 34 published studies including 269 patients (94% prepubertal). Pathologic lesions here were mainly mature teratoma(s)-(62%) with a follow-up period of 4 years. Recurrent tumors were observed in only three patients (1.1%) notably two Leydig Cell Tumors and one Teratoma. Testicular atrophy reportedly occurred in only one single case (0.37%). DISCUSSION: TSS is a feasible alternative to radical orchidectomy in pediatric male patients with localized TT and negative tumor markers. Long term follow-up is essential to monitor testicular growth, puberty with sexual development and psychological male health.