Clinical Experience of Testicular Germ Cell Tumor in Infants and Children

Yoon, Sang Jin; Kim, Yong Tae; Lee, Ahnkie; Oh, Seung June; Kim, Kwang Myung; Choi, Hwang

Abstract

PURPOSE: The relative rarity of prepubertal testis tumors has resulted in poor understanding about incidence, histologic distribution and prognosis of germ cell tumors in children. We attempted to elucidate overall clinical features of testicular germ cell tumors in infants and children, to analyze risk factors for relapse in stage A yolk sac tumor(YST) and to find out possibility of testis-sparing surgery in prepubertal testicular teratoma.
MATERIALS AND METHODS
Retrospectively, we reviewed 74 cases of primary testicular germ cell tumors of infants and children(under 15 years old) experienced in Seoul National University Hospital from January 1970 to November 1995.
RESULTS
There were 38 YSTs(stage A, 34 cases, stage B; 3, stage C; 1), 32 teratomas(all stage A) and 4 teratocarcinomas(stage A, 3, stage C; 1). Median age of presentation was 2.0(range 0.4-15.0) years. Preoperative serum alpha-fetoprotein (alpha-FP) elevation was observed in 37 patients(100%) with YST, 2(7%) with teratoma, 3(100%) with teratocarcinoma and elevated serum beta human chorionic gonadotropin(beta-HCG) was observed in one patient(33%) with teratocarcinoma. Orchiectomy including 4 partial orchiectomy(all with teratoma) was done in all patients, chemotherapy in all patients with teratocarcinoma and stage B, C YST. Two-year survival rate was 92%(22 out of 24 patients who had been followed up) and 100%(19/19) with teratoma. Out of 4 patients with teratocarcinoma, 2 patients with stage A disease showed no evidence of disease, one patient progressed to death and follow-up was lost in the other one patient with stage C. In 9 patients with YST who had ultimately presented recurrence, initial symptoms and signs for recurrence were as follows; marker elevation(4), abdominal mass(3), inguinal mass(1) and scrotal mass(1). Their mean duration of relapse after surgery was 7.0 months. On pathologic review, 7 patients among total 34 patients with YST had at least one risk factors such as epididymal involvement(2), microangioinvasion(3) and focal embryonal component(2). Out of them(7), 5 patients proved to have relapse. There was statistically significant relationship between having risk factors and relapse(Fisher's exact test, p=0.0086). Complete remission rate after chemotherapy In all relapsed patients was 83%(5/6). Until now, there is no evidence of recurrence in 4 patients with teratoma who underwent partial orchiectomy
CONCLUSIONS
YST is characterized as early presentation, high relapse rate and short relapse interval and had high response rate to chemotherapy and high survival rate. Therefore, careful surveillance is needed at least for 2 year in stage A patients with high risk group on pathology(microangioinvasion etc). Testis-sparing surgery may be considered as one of treatment options in prepubertal teratoma.