Primary testicular tumors in children. Apropos of 23 cases

: 23 cases of primary testicular tumors (TT) were observed in 6 different French divisions of Pediatric Surgery during a 10 year period. This series combined with a survey of the literature serve to stress the rarity of such tumors in boys under the age of 15 years. Yolk sac tumors are the most frequent ones (40%), followed by teratomas (32.5%) which, in children and in this localization, are almost always benign tumors of nongerminal origin, in particular rhabdomyosarcomas and tumors of sexual cords, represent 22% of an TT. They are different from what is observed in adults, in whom the most frequent tumors are seminomas, embryonal carcinomas and teratocarcinomas. Most testicular tumors reveal themselves as unilateral testicular masses. High serum alpha-foeto-protein is specific to yolk sac tumors and its post-operative surveillance is mandatory. Scrotal ultrasonography constitutes the main investigation in view of diagnosis and also serves to detect less evident tumors in case of precocious puberty, gynecomastia. Since lymphatic invasions are unusual in children, surgical exploration of the retro-peritoneal space is no longer considered necessary for the stagging and is replaced nowadays by ultrasonography and CT scan. In case of teratomas and others benign tumors, high inguinal orchiectomy is sufficient; in certain cases (well-delineated and superficial tumor in single-testis), tumorectomy alone is possible. As concerns Yolk sac tumors, the addition of chemotherapy from the age of 2, cures more than 90% of stage I tumors; radiotherapy is necessary when it comes to stage II or III. As for testicular rhabdomyosarcomas, in which prognosis is better than in others areas, the combination of surgery, chemotherapy and perhaps radiotherapy is able to cure from 80 to 90% of them.