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Characteristics of Testicular Tumors in Children Aged 5–12 Years
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersINTRODUCTION
Testicular tumors in children have two peaks with different types of tumors; in the first 4 years of life a third to half are benign with increased risk of malignancy during puberty. The pathology of testicular tumors between these peaks, at the age of 5-12 years, is not known. We hypothesized that because of the low level of testosterone at this time, the incidence of malignant tumors is very low.
OBJECTIVE
To compare malignancy risk of primary testicular tumors in children in the prepubertal period (5-12 years) compared with younger (0-4 years) and pubertal (13-18 years) children.
STUDY DESIGN
We retrospectively (2002-2016) identified patients <18 years with surgery for primary testicular tumor. Patients with testicular tumor risk were excluded. Ultrasound studies were reviewed for contralateral testis volume, tumor morphology, and tumor maximal diameter, for three age groups: 0-4, 5-12, and 13-18 years. The Freeman-Halton extension of the Fisher exact probability test was adopted for categorical outcomes, and one-way ANOVA for continuous outcomes.
RESULTS
Fifty-two patients (mean age 11.0 years, range 6 days-18 years) were identified. Malignant tumor prevalence significantly differed (p < 0.01) among age groups (Fig).: 0-4 (72.7%, 8/11), 5-12 (0%, 0/16), and 13-18 years (44.0%, 11/25). The most common tumor types in 5-12 years were epidermoid cyst (31.3%, 5/16) and tumor mimics (37.5%, 6/16). Prevalence of cystic tumors in 5-12 year olds was not significantly different compared with other age groups. Contralateral testicular volume >4 mL (pubertal surge) significantly (p < 0.01) differed among groups: 0-4 years (0/11), 5-12 years (3/16), and 13-18 years (19/20). In children aged 13-18 years the mean tumor maximal diameter (29.8 ± 4.4 mm) was significantly larger (p < 0.01) compared with children 5-12 years (9.3 ± 5.5 mm) and all malignant tumors had contralateral testicular volume >4 mL.
DISCUSSION
We found that preadolescent children between the ages of 5 and 12 years have distinctive characteristics compared with the other age groups. Most importantly, no malignant testicular tumors were found in this age group. About a third of the children presented with an incidental testicular mass. The testicular tumors were significantly smaller (9.3 ± 6.7 mm) compared with those in children aged 13-18 years (29.8 ± 4.4 mm). There were limitations because of the retrospective nature of the study.
CONCLUSION
We found no malignant testicular tumors in children aged 5-12 years with no risk factors and prior to pubertal surge. Our study suggests use of more conservative treatment in this group of patients.
Additional Info
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Characteristics of Testicular Tumors in Prepubertal Children (Age 5–12 Years)
J Pediatr Urol 2018 Feb 13;[EPub Ahead of Print], B Karmazyn, DL Weatherly, SJ Lehnert, MP Cain, R Fan, SG Jennings, F Ouyang, M KaeferFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Although pediatric testis tumors are relatively rare, they present a clinical challenge in the decision to perform testis-sparing surgery for the common benign lesions found in this age group. In past years, the presumption was that orchiectomy was the safest approach in all children, based on tumor registry data. These data, however, missed the larger number of benign tumors simply because they were not commonly submitted for inclusion in the registry. Gil Rushton’s observation of a much higher rate of benign lesions than previously thought changed this perspective and this was reinforced by a multi-institutional study (Pohl et al). The high prevalence of benign lesions in prepubertal children is well-recognized, even if not stated in this report; yet this series offers a further refinement on this perspective by an examination of age-related malignant potential. The authors identify that, in children from 5 to 12 (or puberty), malignant tumors are indeed quite uncommon, whereas the very youngest children and adolescents have substantially higher risk. The observations related to contralateral testis size largely reflect the stage of pubertal development and reinforce the concept that children in the midst of puberty are at higher risk and there may be no specific age cutoff.
Diagnostic imaging offers significant clues to the potential for a benign lesion, yet none are absolute.
It is surprising to see several boys in the 5- to 12-year group who underwent surgery for “mixed maturation,” presumably differences in testicular growth. This is a well-recognized phenomenon, and in modern times it seems unlikely that a child should lose all or part of a testis for this condition.
The take-home message further emphasizes the perspective that prepubertal testicular masses are likely to be benign and can be managed with testis-sparing surgery, with the constant caveat that younger children may have a malignancy and this possibility must always be borne in mind—at any age.