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Overview of pediatric testicular tumors in Korea.

Chung JM, Lee SD - Korean J Urol (2014)

Bottom Line: Because overall about 75% of prepubertal testicular tumors are benign, a testis-sparing approach is becoming more common in children.Orchiectomy and observation with very selective use of chemotherapy has become the standard approach when a malignant tumor is identified.Retroperitoneal lymph node dissection and radiation therapy play very limited roles.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Pusan National University School of Medicine, Yangsan, Korea.

ABSTRACT
Prepubertal testicular tumors are rare compared with postpubertal testicular tumors. The incidence of prepubertal testicular tumors peaks at 2 years of age, tapers off after 4 years of age, and then begins to rise again at puberty. Prepubertal and postpubertal testicular tumors show many differences, including the typical tumor histology, molecular biological differences, and the malignant potential of tumors at different ages. Pediatric testicular tumors are classified as benign or malignant on the basis of their clinical behavior and histologically are divided into germ cell and gonadal stromal (nongerm cell) tumors. Many histological and biological studies have further confirmed the distinct nature of prepubertal and postpubertal testicular tumors. These differences have led to various management strategies for prepubertal and postpubertal tumors. Because overall about 75% of prepubertal testicular tumors are benign, a testis-sparing approach is becoming more common in children. Orchiectomy and observation with very selective use of chemotherapy has become the standard approach when a malignant tumor is identified. Retroperitoneal lymph node dissection and radiation therapy play very limited roles.

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Algorithm for managing prepubertal testicular tumors. AFP, alphafetoprotein.
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Figure 2: Algorithm for managing prepubertal testicular tumors. AFP, alphafetoprotein.

Mentions: In a large-scale Korean study on prepubertal testicular tumors in 2004, the majority of patients (96.6%) were treated with radical orchiectomy, whereas 2.9% and 0.5% of patients underwent simple and partial orchiectomy, respectively. Of all patients, 71.8% were on surveillance only after surgery. Subsequently, 1.9% of this group received additional therapy, including chemotherapy and/or RPLND and/or radiation therapy owing to metastasis. After surgery, 9.1% and 1.4% of patients received chemotherapy alone or combination therapy (chemotherapy, RPLND, and radiotherapy), respectively. All patients with stage I yolk sac tumors were on surveillance only after surgery. Of these patients, 5.9% subsequently had metastasis. On the basis of these findings from Korea and other collaborative data reported in the literature, we suggest an algorithm for the management of prepubertal testicular tumors, which was suggested previously by the Korean Society of Pediatric Urology (Fig. 2) [9].


Overview of pediatric testicular tumors in Korea.

Chung JM, Lee SD - Korean J Urol (2014)

Algorithm for managing prepubertal testicular tumors. AFP, alphafetoprotein.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4265712&req=5

Figure 2: Algorithm for managing prepubertal testicular tumors. AFP, alphafetoprotein.
Mentions: In a large-scale Korean study on prepubertal testicular tumors in 2004, the majority of patients (96.6%) were treated with radical orchiectomy, whereas 2.9% and 0.5% of patients underwent simple and partial orchiectomy, respectively. Of all patients, 71.8% were on surveillance only after surgery. Subsequently, 1.9% of this group received additional therapy, including chemotherapy and/or RPLND and/or radiation therapy owing to metastasis. After surgery, 9.1% and 1.4% of patients received chemotherapy alone or combination therapy (chemotherapy, RPLND, and radiotherapy), respectively. All patients with stage I yolk sac tumors were on surveillance only after surgery. Of these patients, 5.9% subsequently had metastasis. On the basis of these findings from Korea and other collaborative data reported in the literature, we suggest an algorithm for the management of prepubertal testicular tumors, which was suggested previously by the Korean Society of Pediatric Urology (Fig. 2) [9].

Bottom Line: Because overall about 75% of prepubertal testicular tumors are benign, a testis-sparing approach is becoming more common in children.Orchiectomy and observation with very selective use of chemotherapy has become the standard approach when a malignant tumor is identified.Retroperitoneal lymph node dissection and radiation therapy play very limited roles.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Pusan National University School of Medicine, Yangsan, Korea.

ABSTRACT
Prepubertal testicular tumors are rare compared with postpubertal testicular tumors. The incidence of prepubertal testicular tumors peaks at 2 years of age, tapers off after 4 years of age, and then begins to rise again at puberty. Prepubertal and postpubertal testicular tumors show many differences, including the typical tumor histology, molecular biological differences, and the malignant potential of tumors at different ages. Pediatric testicular tumors are classified as benign or malignant on the basis of their clinical behavior and histologically are divided into germ cell and gonadal stromal (nongerm cell) tumors. Many histological and biological studies have further confirmed the distinct nature of prepubertal and postpubertal testicular tumors. These differences have led to various management strategies for prepubertal and postpubertal tumors. Because overall about 75% of prepubertal testicular tumors are benign, a testis-sparing approach is becoming more common in children. Orchiectomy and observation with very selective use of chemotherapy has become the standard approach when a malignant tumor is identified. Retroperitoneal lymph node dissection and radiation therapy play very limited roles.

Show MeSH
Related in: MedlinePlus