Testicular Tumors in Children

Testicular tumors in children, constituting approximately 2% of solid pediatric malignant tumors, display distinct incidence peaks—before 3 years of age and during the postpubertal period. These tumors, often of germ cell origin, present a generally favorable prognosis, attributed to early detection and a robust response to chemotherapy. The classification encompasses yolk sac tumors, embryonal carcinomas, teratomas, gonadoblastomas, seminomas, choriocarcinomas, and mixed germ cell tumors. Germ cell tumors, predominantly benign teratomas, account for over 80% of cases in children under 3, with yolk sac tumors being the most common malignancy in this age group. Additionally, stromal origin tumors like granulosa, Leydig, or Sertoli cell tumors, though usually benign, may become malignant and produce hormones. The diagnostic process involves recognizing painless unilateral scrotal swelling or a palpable mass, with subsequent evaluations incorporating physical examination, ultrasonography, and tumor marker measurements. Scrotal ultrasonography distinguishes testicular tumors from benign conditions, while MRI is recommended for inconclusive cases. Tumor markers such as alpha-fetoprotein (AFP), beta-human chorionic gonadotropin (bHCG), and lactate dehydrogenase (LDH) aid in diagnosis, particularly in differentiating malignant and benign lesions. Postoperative staging utilizes the tumor, node, metastasis (TNM) and Children’s Oncology Group (COG) systems, encompassing primary tumor (T), lymph nodes (N), and distant metastases (M), with tumor marker levels guiding prognostic groupings (I–IV). Surgical approaches include inguinal en bloc orchiectomy and testis-sparing surgery, the latter considered for selected cases with benign characteristics. Retroperitoneal lymph node dissection is reserved for specific scenarios. The abstract highlights potential pitfalls, emphasizing the importance of managing incidental diagnosis, avoiding scrotal violation, and addressing huge testicular tumors cautiously. A surgeon checklist underscores key considerations in ensuring optimal preoperative, intraoperative, and postoperative practices, contributing to the successful management of testicular tumors in pediatric patients.