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).