Testis Tumors

Neonatal and pediatric testicular tumors are rarely initially seen in the emergency department. The majority are first recognized by a parent/caregiver or by primary care physicians during routine well-child examinations. Although yolk sac tumors, gonadal stromal tumors, and teratomas are most commonly encountered in the neonatal period, recent reviews have identified teratoma as the most common underlying pathologic diagnosis of a solid testicular mass in pediatric patients (Levy et al. 1994; Pohl et al. 2004). History is often consistent with a gradually enlarging, painless, scrotal mass and physical examination will identify a nontender firm mass involving or replacing the ipsilateral tes-tis (Fig. 8.47). Blood work for testicular tumor markers including alpha-fetal protein (AFP) and beta-human chorionic gonadotropin (B-HCG) as well as scrotal US shouldbe performed as soon as possible. Newborn and infant AFP levels may be normally elevated in the 1st year of life and, therefore, cautious interpretation of a seemingly elevated AFP level in an infant with a tes-ticular tumor must be undertaken and rationalized within the context of the entire clinical scenario. Scrotal US is key to the diagnosis and will demonstrate an in-traparenchymal mass compressing the surrounding normal testicular tissue. Intralesional calcification and cystic spaces maybe seen and are more likely identified in those with teratoma (Fig. 8.48).

Any pediatric patient with a suspected testicular tumor should be approached via an inguinal incision with early control of the spermatic cord and, depending on the initial AFP and B-HCG levels, undergo either radical or partial orchidectomy. Those with clearly elevated AFP and/or B-HCG levels consistent with a germ

Fig. 8.47. Clinical appearance of a large right testicular mass. Pathological analysis was consistent with mature teratoma following partial orchidectomy

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