Stein R, Dürken M, Zahn K, Younsi Nina
Zentrum für Kinder‑, Jugend- und rekonstruktive Urologie, Medizinische Fakultät Mannheim, der Universität Heidelberg, Universitätsklinikum Mannheim GmbH, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
Klinik für Kinder- und Jugendmedizin, Medizinische Fakultät Mannheim, der Universität Heidelberg, Universitätsklinikum Mannheim GmbH, Mannheim, Deutschland.
Urologe A. 2020 Mar;59(3):278-283. doi: 10.1007/s00120-020-01120-0.
In prepubertal boys, testicular tumors are rare with an incidence between 2 and 5/million. In contrast to testicular tumors in adolescents and adults, more than 2/3 of these tumors are benign. Unfortunately, in Germany in most cases, only malignant tumors (usually yolk sac tumors) are reported to the study center (MAKEI IV and now V). Therefore, the incidence in Germany is unknown. Since the introduction of polychemotherapy in the 1970s, the prognosis of malignant testicular tumors has improved enormously and has become a curable disease, even in the case of recurrence. Today the orchiectomy, which was usually carried out in the past, appears to be no longer justified in most prepubertal boys due to the high incidence of benign tumors. It has been shown in various studies that organ-sparing surgery in germ cell tumors (epidermoid cysts, teratoma); gonadal stoma tumors (Sertoli, Leydig and granulosa cell tumors) and cystic lesions (intratesticular cysts and tubular ectasia of the rete testis) is reliable and safe. In cases with preoperative significantly increased AFP (caution: norm values not valid in the first year of life) and a clear testicular tumor in the ultrasound (yolk sac tumor) or if no testicular parenchyma is sonographically detectable, orchiectomy can still be carried out. Today orchiectomies in prepubertal boys should be an exception and the reasons for an orchiectomy must be well documented.
在青春期前男孩中，睾丸肿瘤很少见，发病率为每百万2至5例。与青少年和成人的睾丸肿瘤不同，这些肿瘤中超过2/3是良性的。不幸的是，在德国，大多数情况下，只有恶性肿瘤（通常是卵黄囊瘤）会被报告给研究中心（MAKEI IV，现在是V）。因此，德国的发病率尚不清楚。自20世纪70年代引入多药化疗以来，恶性睾丸肿瘤的预后有了极大改善，即使复发也已成为可治愈的疾病。如今，由于良性肿瘤发病率高，过去通常进行的睾丸切除术在大多数青春期前男孩中似乎不再合理。各种研究表明，在生殖细胞肿瘤（表皮样囊肿、畸胎瘤）、性腺间质肿瘤（支持细胞瘤、间质细胞瘤和颗粒细胞瘤）以及囊性病变（睾丸内囊肿和睾丸网管状扩张）中进行保留器官手术是可靠且安全的。在术前甲胎蛋白显著升高的情况下（注意：出生后第一年的正常数值无效），且超声检查发现明确的睾丸肿瘤（卵黄囊瘤），或者超声检查无法检测到睾丸实质时，仍可进行睾丸切除术。如今，青春期前男孩的睾丸切除术应为例外情况，且进行睾丸切除术的原因必须有充分记录。
