Testis-sparing Surgery for Pediatric Leydig Cell Tumors: Evidence of Favorable Outcomes Irrespective of Surgical Margins

Zu’bi, Fadi; Koyle, Martin A.; Rickard, Mandy; Beaiti, Mohammed; Kahn, Nathan; Blais, Anne‐Sophie; Hannick, Jessica H.; Lopes, Roberto Iglesias; Lorenzo, Armando J.

doi:10.1016/j.urology.2019.09.016

Cited by 14 publications

(11 citation statements)

References 26 publications

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“…Our observations correlate with this finding, as 89% of lesions in our cohort were benign. TSS has, therefore, become an attractive option to avoid unnecessary orchidectomy in this age group [ 2 , 9 , 10 ]. Preserving testicular tissue has significant cosmetic and psychological advantages for children and important implications for future fertility [ 12 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…Despite FSE being widely accepted in the management of adult testicular and para-testicular pathology, there remains limited published data from paediatric practice. Most are small case series focussing on TSS [ 5 , 9 , 10 , 18 ]. Radford et al remark that despite FSE showing almost 100% specificity, it is not always performed in childhood testicular lesions [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…Despite extensive data from adult literature showing the efficacy of frozen-section analysis in the diagnosis of benign and malignant testicular lesions [ 6 – 8 ], the use of frozen-section examination (FSE) as a diagnostic tool in paediatric testicular and para-testicular tumours remains limited. Most reports are small case series focussing on TSS [ 9 – 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Frozen-section examination in the management of paediatric testicular lesions

et al. 2021

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Purpose Paediatric testicular and para-testicular lesions have traditionally been managed according to adult protocols. Testis-sparing surgery (TSS) has gained popularity as it has become apparent benign lesions predominate in childhood. Frozen-section examination (FSE) for intra-operative diagnosis has been extensively utilised in adults, though its use in paediatric practice remains limited. We reviewed our experience of FSE in paediatric patients with an aim to identify the utility and efficacy of this tool in the management of testicular and para-testicular pathology. Methods A retrospective, single-centre review of paediatric patients who underwent intra-operative FSE for a range of testicular and para-testicular lesions was performed. FSE results were compared to final pathology. TSS was performed if appropriate, and was utilised in adolescent patients, and in lesions with a diameter greater than 20 mm. Results Nine males underwent FSE from 2013 to 2020. Median age at surgery was 9 years (range 1–15). Eight (89%) patients had benign pathology. FSE result correlated with the final pathological examination in 100% of cases. FSE facilitated TSS in 7/9 cases. Conclusion FSE has 100% diagnostic accuracy for paediatric testicular and para-testicular pathology. We would recommend all lesions be evaluated by FSE to guide intra-operative decision making and facilitate TSS in appropriate cases.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Frozen-section examination in the management of paediatric testicular lesions

et al. 2021

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“…Among patients with SCST in this review, 74.6% of LCTs and 37.5% of SCTs have been treated with TSS in which no recurrence has been reported. LCTs in children are suggested to associate with a good prognosis and tend to behave less aggressive in children than in adults, which makes TSS a reasonable surgical approach [ 54 ]. Even though less is reported on SCTs in the pediatric population, SCTs also tend to behave benign with the exception of SCTs in older patients [ 2 , 55 ].…”

Section: Discussionmentioning

confidence: 99%

Testis Sparing Surgery in Pediatric Testicular Tumors

Kooij

Hulsker

Kranendonk

et al. 2020

Cancers

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Objective: The purpose of this review is to evaluate the outcomes of testis sparing surgery (TSS) and to investigate under which circumstances TSS can be considered a safe treatment option in pediatric patients with testicular tumors. Methods: A database search was performed in Cochrane, Pubmed, and Embase for studies that focused on TSS as treatment for testicular tumors in the pediatric population, excluding reviews and single case reports. Results: Twenty studies, describing the surgical treatment of 777 patients with testicular tumors, were included in the analysis. The majority of pediatric patients with benign germ cell tumors (GCTs) (mean age: 3.7 years) and sex cord-stromal tumors (SCSTs) (mean age: 6.6 years) were treated with TSS, 61.9% and 61.2%, respectively. No cases of testicular atrophy occurred. Four of the benign GCTs, i.e., three teratomas and one epidermoid cyst, recurred. No cases of recurrence were reported in patients with SCSTs. Of the 243 malignant GCTs (mean age: 4.2 years), only one patient had TSS (0.4%). Conclusion: TSS is a safe treatment option for prepubertal patients less than 12 years of age with benign GCTs and low grade SCSTs.

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“…In turn, LCTs that had favorable pathology or were benign were treated via conservative testes-sparing procedures whereby tumor enucleation is completed. 13,14 This approach to treatment has preserved testicle functionality preserving fertility in these patients. 6 Observation is thought to be sufficient post-operatively to manage patients with benign LCT.…”

Section: Discussionmentioning

confidence: 99%