Pre-pubertal Testis Tumor

These tumors peak in the two- to four-year-old range and are much more benign than adult testis tumors.

They present as a painless mass, although a history of trauma is often volunteered by the patient. Similar to paratesticular RMS, a serum ``HCG and AFP are obtained pre-operatively. A scrotal ultrasound is obtained pre-operatively, the tumor is resected by inguinal orchiectomy,and post-operatively a CT scan of the chest, abdomen, and pelvis is obtained.Yolk sac and teratoma are the most common pathologies reported.

Stage I yolk sac tumors (negative CT scan with appropriate drop in AFP) do not require chemotherapy. However, patients are required to maintain a vigorous program of surveillance with AFPs, chest X-rays, and CTs for two years. Patients with stage II disease receive cis-platinum, etopiside, bleomycin (PEB), no RT, and can expect a 99% survival. Patients with stage II disease with persistent mass or persistent elevated AFP after chemotherapy should have RPLND. Those in stage III (retroperitoneal lymph nodes) and stage IV (distant metastases) undergo chemotherapy and RPLND.

Overall survival for all stages approaches 100%.²⁹ Teratomas can be managed with testis-sparing surgery in the pre-pubertal patient, because they do not show metastatic behavior as they do in adults.The scrotal ultrasound will show a relatively heterogeneous mass compared with yolk sac tumor, and the AFP should be normal. If the patient is entering puberty, then a radical orchiectomy should be performed.