Antenatally detected mature teratoma in an undescended testis

Prenatally Detected Intrascrotal Testicular Teratoma in an Infant

Although teratomas are the most common tumors in the testes of prepubertal children, prenatally detected testicular teratomas are extremely rare. To date, only 6 cases of prenatally detected testicular teratomas have been reported in the English literature. An intra-abdominal mass and an ipsilateral undescended testis were confirmed after birth in all 6 cases. Preservation of testicular tissue was not performed in any case. Herein, we report the first case of prenatally diagnosed intrascrotal testicular teratoma in an infant who underwent testis sparing surgery.

Management of fetal teratomas

Fetal teratomas are the most common tumors diagnosed prenatally. The majority of these tumors are benign and cured by complete resection of the mass during the neonatal period. Prenatal diagnosis has improved the perinatal management of these lesions and especially for the teratomas that might benefit from fetal intervention. A comprehensive prenatal evaluation including conventional ultrasounds, Doppler, echocardiography and fetal MRI, is essential for an effective counseling and perinatal management. Antenatal counseling helps the parents to better understand the natural history, fetal intervention, and perinatal management of these tumors, which differ dramatically depending on their size and location. Fetal surgical debulking improves survival in cases of sacrococcygeal teratoma with cardiac decompensation. Additionally, the use of an EXIT procedure reduces the morbidity and mortality if a complicated delivery in cases of cervical and mediastinal teratomas. Here, we offer an overview of all fetal teratomas and their recommended management, with emphasis on in utero treatment options.

Prenatal diagnosis of cryptorchid testicular teratoma

Testis follows a predictable course during its stepwise descent from its site of origin in the lumbar region to its final destination in ipsilateral hemi-scrotum. Undesended (cryptorchid) testis is more prone for neoplastic transformation. Testicular teratoma is rare relative to ovarian teratoma and occurs rarely prenatally than postnatally. Teratoma is composed of derivatives of three germ layers. Ultrasound with color Doppler is the most commonly used modality for assessment of prenatal status. Prenatal diagnosis of cryptorchid testicular teratoma involves identification of well-defined, complex solid-cystic lesion with calcifications along the path of testicular descent and absent testis in ipsilateral hemi-scrotum at 36 weeks of gestation. Complications associated with cryptorchid testicular teratoma include torsion, hemorrhage, or malignant transformation. Early diagnosis is important to avoid complications, and hence, ultrasound imaging features play an important role in diagnosis.

Testicular Tumors in Undescended Testes in Children Below 5 y of Age

OBJECTIVE

To evaluate the presentation, treatment and outcome of testicular tumors in undescended testes (UDT) in boys below 5 y of age.

METHODS

Case records of boys below 5 y of age, diagnosed to have germ cell tumors (GCT) in the UDT were reviewed.

RESULTS

Seven children in the age range of 05-54 mo (mean 26 mo) were included. While five of these 7 (71 %) presented with abdominal mass [one antenatally detected], 2 (29 %) were detected to have a GCT during orchiopexy. In three of these five with abdominal mass, the alpha-fetoprotein (αFP) was markedly elevated. Two of these three with elevated αFP were endodermal sinus tumors while the third was embryonal carcinoma. The 4th patient with an abdominal mass was diagnosed to have an immature teratoma (IMT) while the patient with antenatally diagnosed mass had a mature cystic teratoma (MT). Both the patients with incidentally detected mass during the orchiopexy had mature teratoma (MT). All the seven children are alive and disease free at last follow-up.

CONCLUSIONS

Though rare, boys with impalpable undescended testes may develop germ cell tumors early in childhood. These can be managed with chemotherapy and resection and have a good disease free outcome.

Mature testicular teratoma in children: multifaceted tumors on ultrasound

OBJECTIVE

To describe the different ultrasound (US) findings of mature testicular hamartomas in children.

MATERIALS AND METHODS

This is a retrospective study from January 2000 to July 2012 that reviewed the clinical, laboratory, and US findings of 7 children with a pathologic diagnosis of mature teratoma of the testis. All patients in the study received surgery (tumorectomy or orchiectomy), and the material was examined by the institution's Pathology Department.

RESULTS

The US findings were varied and distinct. As to the lesions' consistency, they were cystic (n: 1), multicystic (n: 2), solid-cystic (n: 1), solid containing larger or smaller calcifications (n: 2), and focal calcification (n: 1). With regard to total circulation, all the solid lesions had few vessels in the interior of the lesions.

CONCLUSION

Testicular teratoma has a very variable US appearance and can simulate that of other lesions. It can be single, multiseptated, small, or large. It can contain diffuse or localized calcifications. The testicle can have an increased or a normal volume.

Early prenatal detection of an intra-abdominal cryptorchid testicular teratoma

Intra-abdominal prenatally detected testicular neoplasms are rare; however, increased use of prenatal ultrasonography has led to the discovery of these uncommon neoplasms. We report the fifth case of a prenatally detected intra-abdominal testicular teratoma, which, in this instance, was detected early in pregnancy as a cystic mass within the fetal abdomen that subsequently underwent torsion later in pregnancy before delivery.