Malignancy Yield of Testis Pathology in Older Boys and Adolescents with Cryptorchidism

Abstract

Purpose:We performed a retrospective, single-institution study to characterize the pathological findings of testis tissue specimens from older boys and adolescents with cryptorchidism.Materials and Methods:With institutional review board approval, pathology reports were obtained for testicular specimens from patients age 10 years or older at a pediatric hospital from 1994 to 2016. Reports were excluded if they lacked clinical records, lacked testicular parenchyma, were from a descended testis or were from a patient with differences of sexual development. Variables of interest included age, testis location, procedure and pathological findings. Presence of malignancy among intra-abdominal versus extra-abdominal undescended testes was compared using Fisher’s Exact Test.Results:Seventy-one patients met inclusion criteria. The median age was 15.3 years (range 10.1–27.7). None had a history of testicular malignancy. Forty-five unilateral orchiectomies, 22 unilateral orchiopexies with biopsy and 4 bilateral procedures were performed. Seventeen testes (22.7%) were intra-abdominal, 42 (56.0%) were in the inguinal canal, 9 (12.0%) were at the external inguinal ring, 3 (4.0%) were in the superficial inguinal pouch and 4 (5.3%) were in the scrotum. Malignancy was detected in 2/71 patients (2.8%). By location, 2/16 patients (12.5%) with intra-abdominal testis and 0/55 patients (0%) with extra-abdominal testis demonstrated malignancy (p=0.048).Conclusions:Among males with cryptorchidism ages 10 years and older without differences of sexual development, 2/16 patients with intra-abdominal testis and 0/55 patients with extra-abdominal testis demonstrated malignancy. In older boys and adolescents, orchiectomy or biopsy is indicated for intra-abdominal testes but may not be necessary for extra-abdominal undescended testes.

Post-pubertal management of undescended testes from the malignancy risk point of view: a systematic review

“…Both patients had intraabdominal UDT and underwent unilateral orchiectomy in which the histopathological finding revealed seminomas. 19 The most recent report in January 2023 was published by Faruk et al, in which the authors found a right testicular seminoma in a 24-year-old man with uncorrected bilateral UDT. In the study, the patient underwent right orchiectomy and left orchidopexy followed by close monitoring every four months for the first year, every six months for the second year and then annually for the third to fifth years.…”

Open controversies on the treatment of undescended testis: An update

“…The authors suggest that according to the relevant clinical data and the rate of testicular growth, surgery should be performed in children with cryptorchidism before the age of 1 year. Xu et al ( 52 ) analyzed the pathological reports of testicular specimens of boys with cryptorchidism aged 10 or above at a pediatric hospital from 1994 to 2016. The results showed malignant changes in 12.5% of boys with IAT but not in boys with extra-abdominal testis.…”

This Month in Pediatric Urology

“…Xu et al (page 694) from Boston, Massachusetts look at this question in a single-institution retrospective review of pathology reports. 1 Excluding patients with differences of sexual development, they compared the malignancy rates and types between intra-abdominal testicles and all other undescended testicles. With a median age of intervention of 15 years, 12.5% of the intra-abdominal testicles had a malignancy, whereas none of the other undescended testicles had a malignancy.…”