Multicenter study of benign testicular tumors in pediatrics: Resecting the minimun to preserve the maximum.
María Santos, MD1, Juan Bois, MD2, Paula Flores, MD3, Luz Garzón, MD4, Pedro F S Freitas, MD5, Iván Mendoza, MD6, Consuelo Sierralta, MD7, Jeny Arboleda-Bustan, MD8, Jorge García, MD8, Jorge Rodriguez, MD7, Carolina Acuña, MD1, Francisco Reed, MD6, Marcos Machado, MD5, Yair Cadena, MD4, Juan P. Corbetta, MD3, Juan Manuel Moldes, MD2, Pedro José Lopez, MD1.
1Clínica Alemana Santiago, Santiago, Chile, 2Hospital Italiano, Buenos Aires, Argentina, 3Hospital Garrahan, Buenos Aires, Argentina, 4Hospital Simon Bolivar, Bogotá, Colombia, 5Hospital de clinicas USP, Sao Paolo, Brazil, 6Hospital Exequiel González Cortés, Santiago, Chile, 7Hospital Luis Calvo Mackenna, Santiago, Chile, 8Hospital Dr Roberto Gilbert, Guayaquil, Ecuador.
Background: Testicular tumors (TT) are infrequent in pediatric patients, representing 1% of pediatric solid tumors; benign testicular tumors (BTT) are the most frequent. We present a multicenter study of BTT with the aim of describing the incidence, histology and surgical technique of BTT, with special emphasis on which approach could present better results. Methods: The records of pediatric patients diagnosed with BTT between 2005 and 2020 from 8 centers in 5 different countries of Latin American, were reviewed. Age, clinical presentation, preoperative study, surgical technique, histology, and follow-up were evaluated. Results: 62 BTTs were identified. The mean age at diagnosis was 65 months (3-204 months). 45/62 (73%) tumors presented as testicular mass and 60/62 (97%) underwent testicular ultrasound as the initial study, all of them had findings suggestive of a benign tumor. 53/62 (87%) had preoperative tumor markers (AFP and BHCG), being normal in all except two. The approach was inguinal in 48/62 (77%). In 41/62 (66%) an intraoperative biopsy was done and 40/41 (98%) of the intraoperative biopsies were concordant with the deferred biopsy. Only tumorectomy was performed in 50/62 (81%) of the tumors and total orchiectomy in the remaining 12 (19%); of these only 2/12 (17%) had an intraoperative biopsy. 26/62 (42%) were mature teratomas on deferred biopsy and 14/62 (23%) were epidermoid cysts. Only one intraoperative incident (bladder perforation) was reported, with no intraoperative or postoperative complications. 4/62 (6%) underwent posterior orchiectomy; 2/4 due to incomplete resection and 2/4 due to tumor recurrence; a Leydig cell tumor and a Sertoli cell tumor. The 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 rapid intraoperative biopsy seems to be fundamental to achieve conservative testicular surgery with safety margins and thus confirming benign pathology. Tumorectomy did not show intraoperative or postoperative complications. Based on this multicenter series, we suggest performing an intraoperative biopsy with subsequent tumorectomy preserving healthy testicular tissue in TTB.
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