小儿睾丸畸胎瘤35例临床分析

目的总结小儿睾丸畸胎瘤的诊治经验。方法回顾性分析首都儿科研究所外科2001年6月-2013年4月收治的小儿睾丸畸胎瘤患儿35例,平均年龄3．6岁（1个月～10岁）。多以缓慢生长的阴囊无痛性肿块就诊,其中成熟畸胎瘤32例（91％）;不成熟畸胎瘤3例（9％）。结果全部患儿完整切除肿瘤,肿瘤切除率100％,其中保留睾丸手术33例（94％）,睾丸全切2例（6％）。术中冰冻切片病理检查与术后石蜡切片病理检查符合率100％。术后平均随访时间75（5～142）个月,均无复发,血清甲胎蛋白（AFP）正常,睾丸生长发育良好,无睾丸萎缩坏死发生。结论术前详细询问病史,仔细查体,AFP检测,B超、CT、MRI等影像学检查能够做出比较明确的临床诊断,术中冰冻病理检查有助于手术方式的选择;对于有部分正常睾丸组织的睾丸畸胎瘤患儿行保留睾丸手术是实用、可行的。     

保留睾丸的肿瘤剜除术治疗儿童良性睾丸肿瘤

目的评价保留睾丸的肿瘤剜除术治疗儿童良性睾丸肿瘤的临床疗效。方法回顾性分析1998年10月到2009年3月收治的29例保留睾丸的肿瘤剜除术患儿临床资料。患儿平均发病年龄为42．6个月（4个月至12岁）,临床表现均为无痛性阴囊肿块,除1例术前AFP升高外,其余术前AFP均在正常范围。结果均行保留睾丸的肿瘤剜除术,术后病理诊断：21例为成熟性畸胎瘤,2例为表皮囊肿,4例为皮样囊肿,1例为囊肿性病变伴肉芽肿形成,1例为未成熟畸胎瘤（后行睾丸切除术）。25例冰冻切片均诊断为良性病变。21例B超下计算肿瘤体积为（1．25±2．05）mL,患侧睾丸体积（含肿瘤）为（4．56±5．07）mL,肿瘤占睾丸体积比例为（54．3±30．11）％（6．04％～100％）。7例最近1次门诊随访术侧平均睾丸体积为（0．78±0．31）mL,与健侧比较无统计学意义。20例平均获随访34个月（4～72个月）,无一例复发,患侧睾丸发育良好。结论保留睾丸的肿瘤剜除术可作为小儿睾丸良性肿瘤的首选治疗方法。     

小儿睾丸肿瘤23例诊治体会

目的 探讨小儿睾丸肿瘤的诊治方法.方法 回顾性分析深圳市儿童医院2005 ～ 2009年收治的23例睾丸肿瘤患儿临床资料,年龄2个月至9岁.多以无痛性阴囊肿块就诊.术前常规进行血清AFP、胸部CT、睾丸及腹膜后超声检查,睾丸MRI检查.采用高位精索离断式睾丸切除、睾丸瘤体剔除、腹膜后淋巴结清扫等术式,术中均行冰冻病理切片,术后根据瘤体性质进行相应化疗.随访6个月至5年,监测血清AFP动态变化,以及阴囊、腹股沟、腹膜后超声和胸片检查.结果 23例中,病理检查结果提示卵黄囊瘤11例,畸胎瘤8例,横纹肌肉瘤1例,精原细胞瘤1例,皮样囊肿2例.高位精索离断式睾丸切除术13例,睾丸肿瘤剔除术10例.获随访21例,平均随访时间19个月,卵黄囊瘤Ⅰ期9例,术后化疗1个疗程;Ⅱ期2例,术后1个月复查AFP阳性,PET检查提示阴囊残留复发1例,腹膜后转移1例.畸胎瘤8例,皮样囊肿2例,行保留睾丸的瘤体剔除术,均无瘤存活.结论 睾丸恶性肿瘤应行根治性睾丸切除术,卵黄囊瘤Ⅱ、Ⅳ期应采取手术加化疗.良性睾丸肿瘤可行肿瘤剔除术而保留睾丸组织.     

睾丸肿瘤41例临床分析

目的总结小儿睾丸肿瘤的诊治经验。方法对我院1991年1月～2002年2月收治41例睾丸肿瘤患儿的临床资料进行分析。结果本组发病年龄3个月～6岁,其中<2岁25例,睾丸卵黄囊瘤24例,睾丸畸胎瘤16例,睾丸横纹肌肉瘤1例,均行根治性睾丸切除术,其中17例卵黄囊瘤和1例横纹肌肉瘤行腹膜后淋巴结清扫术,恶性肿瘤均行联合化疗。睾丸畸胎瘤患儿均存活,卵黄囊瘤随访21例,生存16例,死亡5例。结论B超是鉴别睾丸肿瘤有效方法之一,CT扫描对了解有无转移灶有益;甲胎蛋白(AFP)测定对鉴别诊断及预后判断有极大帮助,术后多药联合规则化疗对提高睾丸恶性肿瘤的生存率起重要作用。     

保留睾丸手术治疗睾丸良性肿瘤疗效分析

目的 探讨保留睾丸手术治疗睾丸良性肿瘤的疗效。方法回顾性分析1996～2003年收治睾丸良性肿瘤16例，术中均行冷冻切片活检，病理证实为睾丸良性肿瘤后行保留睾丸手术。对14例患儿进行术后随访，随访时间6个月～7年，平均4．5年。结果术中冷冻切片病理结果均与术后石蜡切片病理结果完全一致，睾丸囊性成熟型畸胎瘤10例，睾丸表皮样囊肿4例，睾丸黏液囊肿2例。随访患侧睾丸大小正常，无肿瘤复发迹象。结论 保留睾丸手术是睾丸良性肿瘤行之有效的治疗方法；该手术保留睾丸组织，对患儿心理发育、内分泌功能及生育能力等方面至关重要。     

保留睾丸的肿瘤切除术治疗小儿良性睾丸肿瘤

目的总结保留睾丸的肿瘤切除术治疗小儿良性睾丸肿瘤43例的临床经验。方法2003年12月至2009年12月作者收治43例小儿良性睾丸肿瘤,年龄5个月至13岁,平均年龄4岁7个月。左侧28例（65％）,右侧14例（33％）,双侧1例（2％）。多以阴囊内无痛性肿块或阴囊沉重感就诊。超声检查提示为畸胎瘤或表皮样囊肿,39例术前甲胎蛋白（AFP）正常,4例高于正常（正常值0—20ng／mL）。35例取阴囊切口,8例取腹股沟切口,切开睾丸白膜,完整剥离肿瘤,缝合睾丸。术后随诊5—88个月（平均33个月）。结果43例均采取保留睾丸的肿瘤切除术,切除瘤体包膜完整无破溃。术后病理诊断：成熟畸胎瘤27例（63％）,不成熟畸胎瘤2例（5％）,皮样囊肿12例（28％）,单纯性囊肿2例（5％）。40例获随访,无一例复发。结论术前超声检查结合血清甲胎蛋白（AFP）测定可作为判断睾丸肿瘤性质的方法之一,对诊断为良性睾丸肿瘤者可采取保留睾丸的肿瘤切除术,预后良好;在辅助检查结果不确切的情况下需做术中睾丸病理检查。     

核除术治疗小儿睾丸良性肿瘤

1994～2002年．我科收治29例小儿睾丸良性肿瘤(皮样囊肿6例．成熟畸胎瘤23例)，为探讨保留了睾丸的效果及意义，我们对核除术后的患儿，进行了随访观察，现报告如下。     

小儿腹膜后畸胎瘤29例诊治体会

目的总结腹膜后畸胎瘤的诊治体会。方法回顾性分析本院2000年5月至2012年3月收治的29例腹膜后畸胎瘤患儿的临床资料,分析其临床表现、超声、CT、MRI等影像学检查结果、术前血AFP测定及病理组织学分类情况。结果29例患儿均行完整肿瘤切除术,均治愈出院。术中出现血管、脏器损伤5例,行血管及脏器修补术;术后发生并发症4例,经再次手术探查或保守治疗后治愈。29例中,成熟畸胎瘤21例,未成熟畸胎瘤I级2例,Ⅱ级2例,Ⅲ级4例。结论小儿腹膜后畸胎瘤肿块相对较大,位置深,术前应充分了解与周围器官、组织的关系,以减少术中损伤及术后并发症;利用术前AFP测定判断肿瘤性质时要考虑年龄因素。     

小儿睾丸白膜、鞘膜、附睾纤维性假瘤一例

患儿:男,5个月.因右侧睾丸无痛性肿大4d入院,患儿有右侧腹股沟斜疝反复嵌顿病史,于4d前斜疝再次嵌顿行手法复位后,发现患儿右侧睾丸无痛性肿大,来我院就诊,检查:右侧睾丸附睾均弥漫性增大,质地偏硬,无压痛.查AFP正常,彩超提示右侧睾丸下部不均匀团块.行右侧疝囊高扎及右侧睾丸探查术,见右侧睾丸及附睾均弥漫性增大,色泽苍白,质地变硬,未触及明显正常睾丸组织,考虑睾丸肿瘤.恶性可能,并侵及整个睾丸,遂行睾丸切除术.     

睾丸附件扭转33例

目的 分析小儿睾丸附件扭转的临床特点和治疗方法.方法 回顾性分析本院1999年8月-2007年8月收治的33例小儿(3.2～14.0岁)睾丸附件扭转临床治疗.20例于治疗前行彩色多普勒超声(CDFI)检查,记录检查结果.33例分为手术组23例和保守治疗组10例,记录手术组术中所见睾丸附件情况及切除福建的病理检查结果,比较二组患儿平均住院时间、平均阴囊红肿消退时间.结果 睾丸附件扭转以阴囊肿痛为主要表现,CDFI检查表现为睾丸上极附近无血流回声团.手术组和保守治疗组均取得满意疗效.手术组阴囊红肿消除时间为(5.0±1.0)d,保守组为(9.1±5.2)d;住院时间分别为(5.2±2.3)d和(8.9±6.6)d,二组比较,均有显著性差异(t=2.26, 3.12 P<0.05).对病程长、症状轻的病例,在阴囊红肿消退时间和住院时间等方面手术组均优于保守组,术后B超显示睾丸附件可恢复正常.结论 CDFI检查哈在小儿睾丸附件扭转的诊断中具有重要意义,早期手术治疗睾丸附件扭转有利于睾丸及附睾炎性反应得吸收.     

Prepubertal testicular teratomas.

Testicular teratomas in prepubertal children are distinct from adult testicular teratomas as well as from teratomas located elsewhere in the body, both with respect to their pathologic features and biologic behavior. Over a period of 12 years, testicular teratomas comprised 25% (5 of 20) of all testicular tumors in prepubertal children, treated at our institution. Their clinical presentation and pathologic profile was analysed. Their mean age at presentation was 6.7 m (range 1 m to 18 m) with the mass having been noted at birth in 3 infants. The right testis was involved in all except one patient. Serum AFP was elevated preoperatively in only one case with an immature (grade II) teratoma containing fetal liver tissue. Immunohistochemical staining for AFP and alfa-1-antitrypsin were positive in these fetal liver cells. Serum AFP levels returned to normal after orchiectomy in this patient. While a high inguinal orchiectomy was the standard operative procedure, testicular-sparing surgery was planned in the last two patients. However the tumor had replaced the entire testis in one of these patients, while in the other, the mass was homogeneous, with no visible cystic areas or dermal elements on cut section. Hence both of these patients also underwent orchiectomy. Histologic examination and immunohistochemical staining for AFP were performed on the specimen. Peri-tumor testicular parenchyma was found to be unremarkable and did not stain for placental alkaline phosphatase, a marker for carcinoma in situ. All these children are doing well with no evidence of residual or recurrent disease at a mean follow-up of 4.7 years (range 4 m to 11 yrs).     

Bilateral testicular teratoma in infancy: report of a rare case treated by testis-sparing surgery.

Testicular tumors are rarely seen in childhood, with germ-cell tumors as the most common type. Teratoma is second only to yolk sac tumor in frequency. Bilateral testicular teratoma is extremely rare. Orchiectomy has been the standard treatment for most tumors of the testes in the past. However, in children, testis-sparing surgery has become the treatment of choice for benign lesions including teratoma. A 10-month-old infant with synchronous bilateral testicular teratomas, one of which was disclosed by ultrasonography, is presented here. While the larger teratoma required unilateral orchiectomy, the smaller tumor in the contralateral testicle was enucleated by testis-sparing surgery. The follow-up at three years was uneventful with normal development of the testis and the boy. Testicular teratoma may reside in both testicles without clinical symptoms. Ultrasound of both testes provides coherent preoperative diagnosis, allowing the surgeon to consider testicular-sparing procedures, thus preventing anorchia in these rare occurrences.     

Surgery in infants and children with testicular and paratesticular tumours: a single centre experience over a 25-year-period

Testicular and even more paratesticular tumours in children are rare. The aim of the study is to characterise the spectrum of these lesions with focus on the feasibility and effectiveness of testis sparing surgery. Twenty-four boys treated between 1980 and 2004 at the University Leipzig Medical Centre were evaluated. At presentation patients were between 5 months and 18 years old (median 23 months). Generally a high rate of malignant or potentially malignant tumours was observed. The majority of these tumours occurred in the first three years of age. The spectrum of testicular tumours comprised 13 germ cell tumours (6 yolk sac tumours, 6 teratomas, 1 embryonal carcinoma) and 4 sex cord stromal tumours (2 Leydig's cell, Sertoli's cell, granulosa cell). Both Leydig's cell tumours were endocrine active. Further on, we observed 3 boys with paratesticular rhabdomyosarcoma (RMS), and three with testicular and paratesticular metastases (Wilms' tumour, neuroblastoma, leukaemia). Serum alpha1-fetoprotein (AFP) was clearly elevated in 5 of 6 yolk sac tumours but remained within normal limits concerning the other entities. Human chorionic gonadotrophin was normal in all cases tested. During the observation period high inguinal orchidectomy was the surgical standard method. Dependent on tumour histology, stage and the recommended treatment schedule postoperative chemotherapy was added. Testis sparing surgery was performed in 3 boys with primary testicular tumours (2 Leydig's cell, mature cystic teratoma). Local relapses were not observed. Systemic relapses occurred in 3 cases (2 RMS, leukaemia). During a median follow up of 5 years all patients with primary testicular tumours survived event free. Meta-analysis of the recent literature revealed that testis sparing surgery is feasible and save in prepubertal boys after exclusion of a malignant tumour. If a testis sparing approach is planned, the following criteria are essential: 1. The presence of a well defined circumscribed nodule confirmed by imaging. 2. Normal levels of serum AFP and hCG. 3. The presence of sufficient healthy testicular parenchyma. However, the high rate of malignant or potentially malignant tumours suggests that high inguinal orchidectomy should remain the surgical standard of therapy.     

Testicular tumors in children and adolescents

ObjectiveTo analyze the spectrum of testicular tumors in children in an unselected population-based series, as well as the results of testis-preserving surgery.Patients and methodsOur hospital database was analyzed for operations for testicular tumors from 1981 to 2006. The clinical data and findings during follow up (4.7 years) were recorded.ResultsThirty-four patients were operated on because of testicular tumors. In 23 (68%) the tumor was benign: benign teratoma (16), Leydig-cell tumor (2), epidermoid cyst (2), Sertoli-cell tumor (1), cystic dyplasia (1), intratesticular focal fibrosis (1). Eleven patients (32%) had a malignant tumor: yolk-sac tumor (6), embryonal carcinoma (5). Twenty out of the 26 (77%) prepubertal boys had a benign tumor in contrast to only three of the eight (38%) adolescent males (P = 0.079). Testis-preserving surgery was performed in 10 patients. In eight, the tumor was curatively excised and remaining testis preserved. Two patients with benign teratoma had a recurrence due to incomplete primary resection. In one patient who underwent orchiectomy for benign teratoma, two metachronous teratomas were detected in the contralateral testis 6 years after primary surgery.ConclusionsIn children, most testicular tumors are benign, especially before puberty. If testis-preserving surgery is contemplated, complete excision of the tumor should be ascertained. The possibility of metachronous bilateral tumors should be considered in the follow up of testicular teratomas.     

A case of immature teratoma originating in intra-abdominal undescended testis in a 3-month-old infant

Teratomas in an undescended testis are rare in infants. This report was the youngest case of immature teratoma originating in intra-abdominal undescended testis. A 3-month-old infant with cryptorchism was seen because of an asymptomatic palpable mass in the right abdomen. Ultrasonography and computed tomography revealed a multicystic large tumor with focal calcifications in the right side and serum tumor markers within normal limits. Complete resection of the tumor was performed and the histopathological diagnosis was made as immature teratoma of the right testis. Because retroperitoneal lymph nodes metastasis was observed in 3-month follow-up postoperatively, retroperitoneal lymphadenectomy and chemotherapy including bleomycin, etoposide, and cisplatin were performed. Presently, the infant has been free of recurrence for 3 years. We suggest that nonpalpable testis should undergo a careful evaluation and prompt resolution and that the subsequent finding of an intra-abdominal mass should make us think on the possibility of intra-abdominal testicular germ cell tumor. Postoperative adjuvant chemotherapy in combination with complete resection of the tumor is necessary for pediatric immature teratomas originating in intra-abdominal undescended testis.     

Late sequelae of gonadal, mediastinal and oral teratomas in childhood

Thirty-two patients with gonadal or non-sacrococcygeal extragonadal teratomas who underwent operation in childhood were evaluated for different late sequelae. Follow-up times ranged from 5.0 to 40 years. Physical abnormalities resulting from surgery were seen in eight patients who had had oral or mediastinal primary teratomas. Radiographs revealed multiple spina bifida occulta lesions in three patients. The males, but not the females, showed signs of gonadal dysfunction. Impaired semen quality or abnormal serum concentrations of testosterone or gonadotrophins were found in five of 10 adult men who had had testicular or mediastinal teratomas. Thus, some late sequelae may be predicted from the site of the primary teratoma, but gonadal dysfunction in males and vertebral anomalies may occur irrespective of where the teratoma is situated.