Testicular tumours in children: an approach to diagnosis and management with pathologic correlation

Abstract

Testicular tumours are rare in children. Painless scrotal mass is the most frequent clinical presentation. Tumoural markers (alpha-fetoprotein, beta-human gonadotropin chorionic) and hormone levels (testosterone) contribute to the diagnosis and management of a testicular mass in boys. Ultrasonography is the best imaging modality to study testicular tumours. A benign tumour is suggested when ultrasonography shows a mainly cystic component, well-defined borders, echogenic rim or normal to increased echogenicity lesion when compared to the healthy testicular parenchyma. Malignant tumour is suspected when ultrasonography shows inhomogeneous, hypoechoic, not well-circumscribed or diffuse infiltration lesion. However, these ultrasonographic findings may overlap. Colour Doppler, power Doppler, elastography and contrast-enhanced ultrasonography are useful complementary methods to characterise the focal testicular lesions. Chest computerised tomography and abdominopelvic magnetic resonance are necessary to establish the extension in case of malignant proved tumours.Benign tumours are more frequent in prepuberal boys and malignant tumours in pubertal boys. Mature teratoma prepubertal-type is the most common histologic type. Testicular sparing surgery is the choice in benign tumours. Radical inguinal orchiectomy is indicated in malignant tumours. Prognostic is excellent.The purpose of our study is to show an approach to the diagnosis and management of the most frequent testicular tumours in children according to clinical manifestations, imaging findings and tumour markers levels based on histologically confirmed tumours in our hospital.

The role of scrotal ultrasonography from infancy to puberty

“…The US findings are nonspecific: the tumor may be detected as a large, focal hypoechogenic solid lesion, round or oval, of homogeneous or heterogeneous echogenicity. Occasionally, the tumor may also be detected as a diffuse mass that can occupy the entire testis so that the only US finding may be diffuse testicular enlargement 22,50,53,54 . Yolk sac tumor is often hypervascularized on color Doppler examination 50…”

Case Report: Rare Presentation of Mixed Germ Cell Tumor in an Infant

“…A thorough physical exam is conducted to rule out other diagnoses such as inguinal hernia, epididymitis, or testicular torsion. Duplex Doppler ultrasonography should be utilized to characterize the lesion, allowing for a non-invasive assessment while also maintaining a sensitivity of nearly 100% in detecting GCTs ( 13 ). In addition to ultrasonography, tumor markers can prove beneficial.…”

Scrotal Lipoblastoma with Radiological and Histological Correlation

“…US with color Doppler is the preferred initial imaging modality for any intrascrotal mass, although CEUS and sonoelastography have recently demonstrated promise as adjunct modalities. 10 14 Lipoblastomas usually demonstrate a homogenously hyperechoic, well-circumscribed paratesticular mass with scant blood flow on Doppler. 3 9 10 However, they may also have focal hypoechoic regions on US, with areas of increased vascularity, owing to their myxoid component.…”

“…Knowledge of current testicular imaging paradigms, including ultrasound (US) and magnetic resonance imaging (MRI), as well as newer, advanced US techniques such as contrast-enhanced ultrasonography (CEUS), and sonoelastography, can assist the radiologist in making the diagnosis, and ensuring the proper surgical approach of the lesion. 10 …”