Review articleBenign scrotal masses in children – some new lessons learned
Section snippets
Methods
A retrospective review was undertaken of all pediatric patients at this institution undergoing surgical excision of intrascrotal masses between January 2008 and June 2015. Cases were identified from both the theater database and the histopathology database. Malignant testicular and paratesticular tumors and tumors in patients with disorders of sex development were excluded from further review. Medical records of cases with benign intratesticular masses were reviewed to determine demographics,
Results
Twenty-one children underwent surgery for excision of intrascrotal masses, eighteen of whom were pre-pubertal males. Nine of the twenty-one had malignant intrascrotal masses. Seven malignancies occurred in the pre-pubertal age group, four of which were malignant yolk-cell tumors, all with elevated serum AFP. The other three were paratesticular rhabdomyosarcoma. All cases with clinical features of malignancy underwent up-front radical orchidectomy. The two malignancies in the post-pubertal age
Discussion
There is increasing evidence that pre-pubertal testicular tumors are a distinct entity from tumors occurring in the adult testis [3]. Benign testicular tumors occur more commonly than malignant tumors in the pre-pubertal population, and consideration should thus be given to TSS [3], [4], [6]. Pre-pubertal testicular malignancy treated with orchidectomy has a good prognosis with survival rates of 99% at 5 years [1], [6]. Radical orchidectomy for the more common benign tumors results in organ loss
Teratoma
Four of the 11 benign pre-pubertal cases were testicular teratoma. Teratoma accounts for 45–50% of childhood testicular tumors in studies [4], [5], [10], [11]. It usually presents at the median age of 13 months (range 0–18 months) [1]. Teratomas are mostly benign in pre-pubertal males but often harbor malignancy post-pubertally [12], [13], [14]. On ultrasound they often have a heterogenous appearance with areas of calcification [1]. Histology is often pure with diploid DNA content containing all
Conclusion
Unlike post-pubertal lesions, a large proportion of pre-pubertal lesions are benign. The most common lesions were benign teratoma followed by epidermoid and dermoid cysts. Rare cases included cystic dysplasia of the rete testis, Leydig cell hyperplasia and large simple testicular cyst. To our knowledge, this series is the first to report recurrence of a benign epidermoid cyst. It is also the first to demonstrate signs of precocious puberty limited to the ipsilateral hemiscrotum in a child with
Conflict of interest
The authors all agree that they have no financial and personal relationships with other people or organizations that could inappropriately influence (bias) their work. This study has no sponsors or funding source.
Ethical approval
I have read the policy of the journal on ethical consent and this work has institutional approval: GEKO number 5422.
Acknowledgement
We would like to acknowledge the work of Dr. Amanda Ireland and Dr. David Paton, pathologists at Princess Margaret Hospital who provided histopathology imaging and descriptions. Furthermore, the work of Dr. Ronald Cohen, urolopathology consultant, who provided further clarification and information on pathology of testicular tumors.
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