Malignant Testicular Tumors in Children: A Single Institution's 12-year Experience
Malignant Testicular Tumors in Children: A Single Institution's 12-year Experience
Background and Objectives. Testicular neoplasms are not commonly found in children, a
 formidable threat if treated inappropriately. However, there is no consensus concerning their
 management. The study aimed to present a holistic picture of the integrated treatment of
 malignant testicular tumors based on our 12 years' experience.

 Patients and Methods. This institutional-based retrospective cohort study evaluated clinical
 presentation, histopathologic diagnosis, treatment, and outcome in 42 boys with malignant
 neoplasm of testis treated between 2006 and 2019.
Study Design. We retrospectively investigated the outcomes of 42 boys aged 0-19 years
 presenting with testicular masses. Excluding patients with incomplete records, they were
 treated at a tertiary referral center between May 2006 and November 2019, which were reviewed
 and retrospectively analyzed based on their age at the time of admission, presenting
 complaints, clinical and radiological findings, tumor markers, management, and follow-up.
 Pathology was centrally reviewed (C.H.) in patients with a tissue biopsy, but confirmation by
 a central review was not required before enrollment. This retrospective study was unanimously
 approved by the institutional review board of Chang Gung Memorial Hospital. Their parents or
 legal guardians provided written informed consent through an opt-out method on our hospital
 website following the ethical principles for medical research involving human subjects in
 Taiwan.

 Data Collection. The evaluation included age at presentation, medical history, clinical
 characteristics, diagnostic procedures, treatment methods, histopathologic findings, and
 outcomes for every patient. All patients received the examinations of color Doppler
 ultrasonography of the testis and the abdomen, plain x-ray of the thorax, and serum
 α-fetoprotein (AFP) levels before operations. The AFP measurement is usually very high in
 newborns and does not decrease to normal adult levels until 8 months. Thus, the AFP levels of
 infants were evaluated according to reference ranges [4,5].

 Surgical Technique All 42 tumors were treated surgically. We explored the groin through an
 inguinal incision. The testicle is gently grasped and exteriorized, and the spermatic cord
 and vessels within the tunica vaginalis are clamped. The resected tumor mass was sent for
 frozen section examination (FSE). Testis-sparing surgery was considered in patients with
 non-germ cell tumors. If the tumor had replaced the entire testis, a radical orchiectomy was
 taken. All tumors received histologic analysis. The optimal follow-up protocol included
 regular control visits with the physical examination, AFP measurements, and testicular
 sonography. Adjuvant chemotherapy was administered, depending on histopathology and TNM
 criteria for tumor classification. If non-germ cell tumors were assessed accurately on FSE,
 testis-sparing surgery could be considered an alternative treatment modality.
Inclusion Criteria:

 -  aged 0-19 years presenting with malignant testicular masses

 Exclusion Criteria:

 -  patients with incomplete records