Santos María, Bois Juan, Flores Paula, Garzón Luz, Freitas Pedro, Mendoza Iván, Sierralta Consuelo, Arboleda-Bustan Jenny E, García Jorge, Rodríguez Jorge, Acuña Carolina, Reed Francisco, Machado Marcos, Cadena Yair, Corbetta Juan P, Moldes Juan Manuel, López E Pedro -José
Clinica Alemana Santiago, Av. Vitacura 5951. Vitacura, Santiago, Chile.
Hospital Italiano, Buenos Aires, Argentina.
Pediatr Surg Int. 2023 Mar 28;39(1):162. doi: 10.1007/s00383-023-05444-8.
Testicular tumors (TT) are infrequent in pediatric patients, representing 1% of pediatric solid tumors; benign testicular tumors (BTT) are the most common. We present a multicenter study aiming to describe the incidence, histology and surgical technique of BTT, with special emphasis on which approach could present better outcomes.
The records of pediatric patients diagnosed with BTT between 2005 and 2020 from 8 centers in 5 different countries in Latin-America, were reviewed.
Sixty two BTTs were identified. 73% tumors presented as a testicular mass, and 97% underwent testicular ultrasound as the initial imaging study, all of them had findings suggestive of a benign tumor. 87% had preoperative tumor markers (AFP and BHCG). In 66%, an intraoperative biopsy was done and 98% of the intraoperative biopsies were concordant with the final pathology report. Tumorectomy was performed in 81% of patients and total orchiectomy in the remaining 19%. Six percentage of patients underwent a subsequent orchiectomy. Mean follow-up was 39 months (1-278 months) where no cases of atrophy were observed clinically or on ultrasound. Fertility was not evaluated in this series.
Proper management of BTTs is essential to avoid unnecessary orchiectomies. Preoperative ultrasound associated with intraoperative biopsy seems accurate in identifying benign pathology, thus enabling conservative testicular surgery with safety margins. Based on this multicenter series, we suggest performing an intraoperative biopsy with subsequent tumorectomy preserving healthy testicular tissue in BTT.
睾丸肿瘤（TT）在儿科患者中并不常见，占小儿实体瘤的1%；良性睾丸肿瘤（BTT）最为常见。我们开展了一项多中心研究，旨在描述BTT的发病率、组织学和手术技术，特别强调哪种方法可能会带来更好的结果。
回顾了2005年至2020年间来自拉丁美洲5个不同国家8个中心诊断为BTT的儿科患者的记录。
共识别出62例BTT。73%的肿瘤表现为睾丸肿块，97%的患者最初进行了睾丸超声检查，所有检查结果均提示为良性肿瘤。87%的患者有术前肿瘤标志物（甲胎蛋白和β人绒毛膜促性腺激素）。66%的患者进行了术中活检，98%的术中活检结果与最终病理报告一致。81%的患者进行了肿瘤切除术，其余19%的患者进行了睾丸全切术。6%的患者随后进行了睾丸切除术。平均随访39个月（1 - 278个月），临床或超声检查均未观察到萎缩病例。本系列未评估生育能力。
正确处理BTT对于避免不必要的睾丸切除术至关重要。术前超声检查结合术中活检似乎能准确识别良性病变，从而实现具有安全切缘的保守性睾丸手术。基于这个多中心系列研究，我们建议在BTT患者中进行术中活检，随后进行肿瘤切除术以保留健康的睾丸组织。
