Diagnosis and Management of Testicular Tumours in Children and Adolescents

Testicular tumours can occur at any age but are most common in adolescents and young men. The tumours are histologically heterogeneous and can be derived from several cell types. Germ cells are by far the most common cell of origin, followed by Leydig cells and other somatic cells. Testicular tumours in children and adolescents/young adults differ from each other in many aspects, including pathogenesis and biological features, in particular the association with germ cell neoplasia in situ and isochromosome 12p of only post-pubertal TGCT. Hence the management options must be based on careful imaging, histopathological analysis, tissue and serum markers, and age-specific staging. Treatment outcomes are usually very good in any age: Testicular location contributes to an early diagnosis in many patients, and surgery alone is successful in the vast majority of patients. The extent of surgery depends on the tumour type; in malignant germ cell tumours radical orchiectomy is usually practiced, while testis-sparing surgery should be considered in boys with teratomas and in all patients with benign somatic tumours. Chemotherapy is used mainly in malignant tumours and in the disseminated disease. Young age of the survivors of testicular cancer requires close attention to the late effects of disease and treatment, hence different specialists (urologists, oncologists, paediatricians, endocrinologists, andrologists) ought to be included in the management team.