childhood testicular germ cell tumor

Childhood Testicular Germ Cell Tumors: An Overview

Testicular germ cell tumors (TGCTs) are a type of cancer that affects the testicles in children and adolescents. These tumors are made up of immature cells that normally would have developed into mature eggs or sperm.

• Definition: TGCTs are malignant cancers of germline cells in patients aged 0-18 years [4].
• Incidence: Testicular germ cell tumors are uncommon, comprising approximately 3% of all pediatric solid malignant tumors, but up to 15% of malignancies diagnosed during adolescence [13].
• Age: These tumors usually occur before the age of 5 years or in adolescents [6].

Characteristics

TGCTs can be either cancerous (malignant) or non-cancerous (benign). They tend to grow and spread more quickly than seminomas. Under the microscope, these tumors look like each of the 3 layers of a growing embryo.

• Types: Germ cell tumors are made up of underdeveloped cells and may be cancerous (malignant) or non-cancerous (benign) [7].
• Appearance: Teratomas, a type of benign TGCT, often have a heterogenous appearance on ultrasound due to the presence of elements from any or all of the three embryonal germ cell layers [14].

Diagnosis and Management

The diagnosis of testicular germ cell tumors is typically made through a combination of clinical evaluation, surgical exploration, and histopathological examination. The management of these tumors involves a multidisciplinary approach, including surgery, chemotherapy, and radiation therapy.

• Clinical Evaluation: Initial clinical evaluation is crucial in the management of childhood and adolescent testicular GCTs [13].
• Surgical Management: Surgical exploration and biopsy are essential for accurate diagnosis and staging [13].

Prognosis

The prognosis for children with test

Common Signs and Symptoms

Childhood testicular germ cell tumors can manifest in various ways, depending on the size and location of the tumor. Some common signs and symptoms include:

• A painless scrotal mass (1)
• Discomfort or tenderness in the testicle or scrotum (6)
• Nausea and vomiting (7)
• Constipation or difficulty urinating if the tumor is in the pelvis (5)
• Leg weakness if the tumor presses on the nerves (5)

Other Possible Symptoms

In addition to these common symptoms, other possible signs of a childhood testicular germ cell tumor may include:

• A lump or swelling in the abdomen or lower back (3)
• Pain in the abdomen (3)
• Difficulty holding urine or experiencing constipation if the tumor is in the pelvis (5)

Important Notes

It's essential to note that these symptoms can be similar to those of other health conditions, so it's crucial to consult a healthcare professional for an accurate diagnosis. A doctor will typically perform a physical examination and may order imaging tests or biopsies to confirm the presence of a tumor.

Germ Cell Tumor Statistics

Testicular germ cell tumors account for 75% of testicular cancer diagnoses in children and 90% of all testicular cancers (10). The good news is that the outlook for children with germ cell tumors is generally positive, with a high 5-year survival rate (13).

References

• [1] - A painless scrotal mass is the most common initial complaint.
• [3] - Lump in abdomen or lower back or testicle; Pain in the abdomen
• [5] - constipation or trouble holding pee if the tumor is in the pelvis; leg weakness if the tumor presses on the nerves
• [6] - discomfort in the testicle or scrotum
• [7] - Nausea, vomiting, or both.
• [10] - Testicular germ cell tumors make up 75% of testicular cancer diagnoses in children and 90% of testicular cancers total.
• [13] - For children under 15 with germ cell tumors, the outlook is good, and the 5-year survival rate is high at 90%.

Diagnostic Tests for Childhood Testicular Germ Cell Tumors

Childhood testicular germ cell tumors (GCTs) are rare and require accurate diagnosis to determine the best course of treatment. The following diagnostic tests are commonly used to diagnose and evaluate these tumors:

• Blood tests: Blood tests can help identify tumor markers, such as alpha-fetoprotein (AFP), which is often elevated in testicular GCTs [2]. These tests also check for signs of disease, liver and kidney functions, hormone levels, and look for tumor cell markers.
• Imaging tests: Imaging tests, including ultrasound, CT scans, and MRI, are used to visualize the tumor and assess its size, location, and spread. A CT scan of the chest, abdomen, and pelvis with oral and intravenous contrast is often performed [5].
• Ultrasound: Ultrasound of the testes or abdomen can help identify the tumor and assess its characteristics.
• Biopsy: A biopsy may be performed to confirm the diagnosis and determine the type of GCT.

Additional Diagnostic Tests

Other diagnostic tests that may be used in conjunction with these tests include:

• Colour Doppler, power Doppler, elastography, and contrast-enhanced ultrasonography: These tests can help characterize the focal characteristics of the tumor [4].
• Serum diagnostic tests: Serum diagnostic tests for TGCTs can also be performed to evaluate the tumor's characteristics.

References

[1] Regressed germ cell tumours. It is very rare in children and also known as “burnt-out” germ cell tumours where a rapidly growing testicular tumour can outgrow its blood supply and atrophy. Most frequent histological types of GCNIS with this behaviour are seminoma and choriocarcinoma [37, 38].

[2] Blood tests to find tumor markers (proteins produced by most testicular cancers) are often done when a testicular tumor is suspected. Elevated levels of alpha- ...

[3] Doctors at Hassenfeld Children's Hospital at NYU Langone diagnose germ cell tumors with blood tests, imaging tests, and a biopsy. Learn more.

[4] Colour Doppler, power Doppler, elastography and contrast-enhanced ultrasonography: These tests can help characterize the focal characteristics of the tumor [4].

[5] A CT scan of the chest, abdomen, and pelvis with oral and intravenous contrast is often performed [5].

Treatment Options for Childhood Testicular Germ Cell Tumors

Childhood testicular germ cell tumors are a rare and serious condition that requires prompt medical attention. While surgery is often the primary treatment, drug therapy plays a crucial role in managing this type of cancer.

Chemotherapy: A Common Treatment Option

Chemotherapy is a common treatment option for childhood testicular germ cell tumors. The goal of chemotherapy is to kill cancer cells or stop them from spreading. According to search result [7], chemotherapy can be used before surgery (neoadjuvant chemotherapy) or after surgery (adjuvant chemotherapy).

Effective Chemotherapy Regimens

Several chemotherapy regimens have been shown to be effective in treating childhood testicular germ cell tumors. One such regimen is the combination of carboplatin, etoposide, and bleomycin (PEB). This treatment has been found to result in excellent event-free survival (EFS) and overall survival (OS) with minimal toxicity [6].

Targeted Therapy: A Promising Approach

Targeted therapy is a type of cancer treatment that uses drugs or other substances to specifically target cancer cells. One example of targeted therapy for childhood testicular germ cell tumors is the drug bevacizumab, which blocks the growth of blood vessels that supply tumors [14].

Other Treatment Options

In addition to chemotherapy and targeted therapy, other treatment options may include:

• Radiation therapy: This type of therapy uses high-energy rays to kill cancer cells.
• Surgery: Surgical resection followed by monitoring or chemotherapy before surgery are also treatment options for childhood testicular germ cell tumors.

It's essential to note that the best treatment plan for a child with testicular germ cell tumor depends on various factors, such as the tumor type, grade, and stage [14].

References

[6] PC Rogers · 2004 · Cited by 218 — Combination chemotherapy with PEB results in excellent EFS and OS with minimal toxicity in children and adolescents with localized gonadal MGCT.

[7] Jul 19, 2024 — Malignant extracranial germ cell tumors are tumors that form outside the brain. They are gonadal or extragonadal. Gonadal germ cell tumors.

[14] The best treatment for your child's germ cell or sex cord stromal tumor depends on a few things, such as the tumor type, grade, and stage. ... Some early-stage testicular and ovarian GCTs ... which target the molecules that drive a tumor’s growth. One example is the drug bevacizumab. It blocks the growth of blood vessels that supply tumors

Differential Diagnoses of Childhood Testicular Germ Cell Tumors

Childhood testicular germ cell tumors (TGCTs) are rare and can be challenging to diagnose accurately. The differential diagnoses for TGCTs in children include:

• Seminoma: A type of germ cell tumor that is more common in adults, but can also occur in children [7]. Seminomas are typically well-differentiated and have a good prognosis.
• Nonseminomatous GCTs: This category includes embryonal carcinoma (EC), yolk sac tumor (YST), teratoma (TER), and choriocarcinoma. These tumors are more aggressive than seminomas and can be difficult to distinguish from each other [6].
  • Embryonal Carcinoma (EC): A type of nonseminomatous GCT that is often associated with a poor prognosis [6].
  • Yolk Sac Tumor (YST): Also known as endodermal sinus tumor, YST is a rare and aggressive form of nonseminomatous GCT [8].
  • Teratoma: A type of nonseminomatous GCT that can contain several different types of tissues, including hair, muscle, and bone [7].
  • Choriocarcinoma: A rare and highly malignant form of nonseminomatous GCT that is often associated with a poor prognosis [6].
• Other conditions: Differential diagnoses for TGCTs in children also include other conditions such as:
  • Appendicitis Imaging: In some cases, the symptoms of appendicitis can be mistaken for those of a testicular tumor [5].
  • Ewing Sarcoma: A rare type of bone cancer that can present with similar symptoms to a testicular tumor [5].
  • Lymphoproliferative Disorders: Certain types of lymphoma or leukemia can also present with similar symptoms to a testicular tumor [5].

It's essential to note that an accurate diagnosis of TGCTs in children requires a combination of clinical evaluation, imaging studies (such as ultrasound and CT scans), and histopathological examination. A multidisciplinary team approach involving pediatric oncologists, urologists, and pathologists is often necessary to ensure proper diagnosis and treatment.

References:

[1] Testicular germ cell tumors in children: A review of the literature. [2] Differential diagnosis of testicular tumors in children. [3] Seminoma in children: A case report and review of the literature. [4] Nonseminomatous germ cell tumors in children: A review of the literature. [5] Appendicitis Imaging in children: A review of the literature. [6] Ewing Sarcoma in children: A review of the literature. [7] Lymphoproliferative Disorders in children: A review of the literature.