Testicular germ cell tumors in children: management and outcome in a series of 20 patients

Testicular germ cell tumors (GCT) occurring during childhood are extremely rare. This study reports the clinical presentation, pathological diagnosis, treatment modalities and outcome in a series of 20 boys aged between 3.5 months and 16 years (median: 1.5 years, 19 were prepubertal), who were treated between 1963 and 2003. Histologically, mature teratoma was present in 7, immature teratoma in 4 and yolk sac tumor in 9. Nineteen patients were stage I, one patient only was stage IV. Of the 11 teratomas, 10 were treated by orchiectomy and 1 by testis-sparing tumor excision only. All patients have survived and show no evidence of disease between 10 and 28 years after surgery. The 9 patients with yolk sac tumor were managed by orchiectomy, in 2 plus retroperitoneal lymphadenectomy, and in 8 plus chemotherapy. One patient is in remission for 10 months, 7 are alive with no evidence of disease for 5.5-23 years, and one patient died from a T-cell ALL, two years after the end of treatment of the testicular tumor. A gradual switch towards less invasive treatment has been observed over the years. This study confirms the excellent cure rates obtained in children with testicular germ cell tumor, provided diagnosis is prompt and treatment accurate.