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Juvenile granulosa cell tumor of the testis: prenatal diagnosis and prescrotal approach.

Bulotta AL, Molinaro F, Angotti R, Ferrara F, Di Maggio G, Bindi E, Messina M - Ital J Pediatr (2012)

Bottom Line: As a benign neoplasm, radical orchiectomy is sufficient for treatment.After surgery, the histological diagnosis was juvenile granulosa cell tumor.To date the patient is healthy.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Pediatric Surgery, Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Siena, Italy.

ABSTRACT
Neonatal testicular tumors are rare and should be considered in the differential diagnosis of newborn scrotal masses. Juvenile granulosa cell tumor (JGCT) accounts for about 5% of all prepubertal testis tumors. As a benign neoplasm, radical orchiectomy is sufficient for treatment. We report a case of a newborn with a prenatal diagnosis of scrotal mass. After surgery, the histological diagnosis was juvenile granulosa cell tumor. To date the patient is healthy.

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Ultrasound image obtained at birth revealing enlarged left testicle (1.57 × 1.33 cm) and a well encapsulated, complex cystic mass.
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Figure 1: Ultrasound image obtained at birth revealing enlarged left testicle (1.57 × 1.33 cm) and a well encapsulated, complex cystic mass.

Mentions: A full term baby was born by natural delivery with a normal APGAR score and a birth weight of 3200 grams. Fetal ultrasound at 36th week of gestation showed a multicystic testicular mass on the left side. Postnatal ultrasound revealed increased size of the testicle (1.57 × 1.33 cm) due to a well encapsulated, complex cystic mass and a Doppler scan showed increased blood flow. The controlateral gonad was normal and showed homogeneous echotexture. After the birth, the baby was admitted to our department for the management of a "left scrotal mass". Family history included two cases of Down's syndrome and no other urogenital problems. The baby was in good health and without clinical evidence of dysmorphic features or ambiguous genitalia. The right testicle had descended, hypoplastic and the penis was normal. The left testicle was in situ and painless, with increased size and consistency. Bilateral inguinal hernia and palpable lymphadenopathy were absent. We performed ultrasonography of the abdomen and testis, as well as karyotype, blood chemistry and hormone profile. The abdominal ultrasound, blood chemistry and karyotype were normal. Testicular scans confirmed the presence of a cystic mass in the left gonad (Figure 1). Abnormal serum tumor markers were: alphafetoprotein (AFP) 6679 IU/ml, human chorionic gonadotropin 8 mIU/ml, testosterone 1.75 ng/ml and inhibin B 346 pg/ml. After long discussion with the parents, it was decided to perform left radical orchiectomy by sub-inguinal (prescrotal) skin incision (Figure 2). Macroscopic features of the testis suggested a neoplastic mass (Figure 3). The gonad had increased size with a pearly white surface and apparently complete capsule. No torsion of the tumor was found. Histological examination showed a juvenile granulosa cell tumor with immunohistochemical stain positive for inhibin and calretinin and negative for AFP. When incised, the gonad was spongy and yellow with many microcysts and no normal testicular parenchyma. There were no intra or postoperative complications. The baby was discharged three days later. Testicular and abdominal ultrasonography a month after surgery showed an empty left scrotum and an absence of pathological masses in the abdomen. Today the patient is healthy without any problems. It is planned to check the patient every year for at least 5 years. The parents were informed of the prognosis and the ongoing clinical examinations and tests required.


Juvenile granulosa cell tumor of the testis: prenatal diagnosis and prescrotal approach.

Bulotta AL, Molinaro F, Angotti R, Ferrara F, Di Maggio G, Bindi E, Messina M - Ital J Pediatr (2012)

Ultrasound image obtained at birth revealing enlarged left testicle (1.57 × 1.33 cm) and a well encapsulated, complex cystic mass.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3585781&req=5

Figure 1: Ultrasound image obtained at birth revealing enlarged left testicle (1.57 × 1.33 cm) and a well encapsulated, complex cystic mass.
Mentions: A full term baby was born by natural delivery with a normal APGAR score and a birth weight of 3200 grams. Fetal ultrasound at 36th week of gestation showed a multicystic testicular mass on the left side. Postnatal ultrasound revealed increased size of the testicle (1.57 × 1.33 cm) due to a well encapsulated, complex cystic mass and a Doppler scan showed increased blood flow. The controlateral gonad was normal and showed homogeneous echotexture. After the birth, the baby was admitted to our department for the management of a "left scrotal mass". Family history included two cases of Down's syndrome and no other urogenital problems. The baby was in good health and without clinical evidence of dysmorphic features or ambiguous genitalia. The right testicle had descended, hypoplastic and the penis was normal. The left testicle was in situ and painless, with increased size and consistency. Bilateral inguinal hernia and palpable lymphadenopathy were absent. We performed ultrasonography of the abdomen and testis, as well as karyotype, blood chemistry and hormone profile. The abdominal ultrasound, blood chemistry and karyotype were normal. Testicular scans confirmed the presence of a cystic mass in the left gonad (Figure 1). Abnormal serum tumor markers were: alphafetoprotein (AFP) 6679 IU/ml, human chorionic gonadotropin 8 mIU/ml, testosterone 1.75 ng/ml and inhibin B 346 pg/ml. After long discussion with the parents, it was decided to perform left radical orchiectomy by sub-inguinal (prescrotal) skin incision (Figure 2). Macroscopic features of the testis suggested a neoplastic mass (Figure 3). The gonad had increased size with a pearly white surface and apparently complete capsule. No torsion of the tumor was found. Histological examination showed a juvenile granulosa cell tumor with immunohistochemical stain positive for inhibin and calretinin and negative for AFP. When incised, the gonad was spongy and yellow with many microcysts and no normal testicular parenchyma. There were no intra or postoperative complications. The baby was discharged three days later. Testicular and abdominal ultrasonography a month after surgery showed an empty left scrotum and an absence of pathological masses in the abdomen. Today the patient is healthy without any problems. It is planned to check the patient every year for at least 5 years. The parents were informed of the prognosis and the ongoing clinical examinations and tests required.

Bottom Line: As a benign neoplasm, radical orchiectomy is sufficient for treatment.After surgery, the histological diagnosis was juvenile granulosa cell tumor.To date the patient is healthy.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Pediatric Surgery, Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Siena, Italy.

ABSTRACT
Neonatal testicular tumors are rare and should be considered in the differential diagnosis of newborn scrotal masses. Juvenile granulosa cell tumor (JGCT) accounts for about 5% of all prepubertal testis tumors. As a benign neoplasm, radical orchiectomy is sufficient for treatment. We report a case of a newborn with a prenatal diagnosis of scrotal mass. After surgery, the histological diagnosis was juvenile granulosa cell tumor. To date the patient is healthy.

Show MeSH
Related in: MedlinePlus