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Spontaneous Shrinkage of Testicular Teratoma in a Prepubertal Child
ARTICLE IN PRESS
Images in Clinical Urology Spontaneous Shrinkage of Testicular Teratoma in a Prepubertal Child Kimihiko Moriya, Shota Yamamoto, Michiko Nakamura, Yoko Nishimura, Mutsumi Nishida, Takahito Iwai, Yukiko Kanno, Takeya Kitta, and Nobuo Shinohara Limited numbers of pediatric intratesticular cystic lesions have been reported. Although the majority of pediatric intratesticular cystic masses are benign, natural history of testicular cystic lesion in children has been rarely reported so far. We report a case of intratesticular cystic lesion in a prepubertal child who underwent testis sparing surgery after shrinkage during conservative follow-up. As an initial strategy for intratesticular cystic lesions in prepubertal children, observational approach with serial ultrasonographic evaluations may be a management of choice. UROLOGY ■■: ■■–■■, 2017. © 2017 Elsevier Inc.
A
2-month-old boy presented with right undescended testis and left scrotal swelling. Ultrasonography at 3 months showed cystic lesion occupying most of the left testis in a hydrocele (Fig. 1A). At 6 months, the cystic lesion shrank and the testicular parenchyma became thicker (Fig. 1B). Because he had congenital bronchostenosis and recurrent pneumonia, surgery was postponed until they were controlled, observing the cystic lesion with serial ultrasonography. At 23 months, the cystic lesion shrank further to approximately 1 mm and was surrounded by relatively thick wall (Fig. 1C). The preoperative alpha fetoprotein and human chorionic gonadotropin beta were 4.4 ng/mL (within the normal range for this age1) and <0.5 mIU/mL (<0.5), respectively. Then, right orchiopexy, left hydrocelectomy, and enucleation of the Financial Disclosure: The authors declare that they have no relevant financial interests. From the Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan; the Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan; and the Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan Address correspondence to: Kimihiko Moriya, M.D., Ph.D., Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, North15, West-7, Kita-Ku, Sapporo 060-0824, Japan. E-mail: [email protected] Submitted: December 30, 2016, accepted (with revisions): February 22, 2017
© 2017 Elsevier Inc. All rights reserved.
cystic mass were performed (Fig. 1D). Pathologic diagnosis was mature teratoma. The natural history of testicular cystic lesion in children has been rarely reported. Few case series demonstrated the spontaneous shrinkage of intratesticular cystic lesion.2,3 Because the majority of pediatric intratesticular tumors are benign,4 conservative observation with serial ultrasonography may be an initial option in prepubertal children, especially with simple cystic lesion. When imaging suggests growth or increasing complexity, testis sparing surgery, if possible, may then be performed. References 1. Blohm ME, Vesterling-Horner D, Calaminus G, Gobel U. Alpha 1-fetoprotein (AFP) reference values in infants up to 2 years of age. Pediatr Hematol Oncol. 1998;15:135-142. 2. Hoag NA, Afshar K, Youssef D, Masterson JS, Murphy J, Macneily AE. Cystic intratesticular lesions in pediatric patients. J Pediatr Surg. 2013;48:1773-1777. 3. Friend J, Barker A, Khosa J, Samnakay N. Benign scrotal masses in children—some new lessons learned. J Pediatr Surg. 2016;51:17371742. 4. Liniger B, Fleischmann A, Zachariou Z. Benign cystic lesions in the testis of children. J Pediatr Urol. 2012;8:226-233.
http://dx.doi.org/10.1016/j.urology.2017.02.034 0090-4295
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ARTICLE IN PRESS
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Figure 1. (A) Ultrasonography at 3 months showed intratesticular unilocular cystic lesion (*) occupying most of the left testis in a hydrocele. (B) At 6 months, the cystic lesion (*) shrank and the left testicular parenchyma became thicker. (C) At 23 months, the cystic lesion, which was contracted to approximately 1 mm, was surrounded by relatively thick wall (arrowhead). (D) At surgery, white mass (arrow) was identified within the left testis. (Color version available online.)
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UROLOGY ■■ (■■), 2017
Images in Clinical Urology Spontaneous Shrinkage of Testicular Teratoma in a Prepubertal Child Kimihiko Moriya, Shota Yamamoto, Michiko Nakamura, Yoko Nishimura, Mutsumi Nishida, Takahito Iwai, Yukiko Kanno, Takeya Kitta, and Nobuo Shinohara Limited numbers of pediatric intratesticular cystic lesions have been reported. Although the majority of pediatric intratesticular cystic masses are benign, natural history of testicular cystic lesion in children has been rarely reported so far. We report a case of intratesticular cystic lesion in a prepubertal child who underwent testis sparing surgery after shrinkage during conservative follow-up. As an initial strategy for intratesticular cystic lesions in prepubertal children, observational approach with serial ultrasonographic evaluations may be a management of choice. UROLOGY ■■: ■■–■■, 2017. © 2017 Elsevier Inc.
A
2-month-old boy presented with right undescended testis and left scrotal swelling. Ultrasonography at 3 months showed cystic lesion occupying most of the left testis in a hydrocele (Fig. 1A). At 6 months, the cystic lesion shrank and the testicular parenchyma became thicker (Fig. 1B). Because he had congenital bronchostenosis and recurrent pneumonia, surgery was postponed until they were controlled, observing the cystic lesion with serial ultrasonography. At 23 months, the cystic lesion shrank further to approximately 1 mm and was surrounded by relatively thick wall (Fig. 1C). The preoperative alpha fetoprotein and human chorionic gonadotropin beta were 4.4 ng/mL (within the normal range for this age1) and <0.5 mIU/mL (<0.5), respectively. Then, right orchiopexy, left hydrocelectomy, and enucleation of the Financial Disclosure: The authors declare that they have no relevant financial interests. From the Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan; the Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan; and the Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan Address correspondence to: Kimihiko Moriya, M.D., Ph.D., Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, North15, West-7, Kita-Ku, Sapporo 060-0824, Japan. E-mail: [email protected] Submitted: December 30, 2016, accepted (with revisions): February 22, 2017
© 2017 Elsevier Inc. All rights reserved.
cystic mass were performed (Fig. 1D). Pathologic diagnosis was mature teratoma. The natural history of testicular cystic lesion in children has been rarely reported. Few case series demonstrated the spontaneous shrinkage of intratesticular cystic lesion.2,3 Because the majority of pediatric intratesticular tumors are benign,4 conservative observation with serial ultrasonography may be an initial option in prepubertal children, especially with simple cystic lesion. When imaging suggests growth or increasing complexity, testis sparing surgery, if possible, may then be performed. References 1. Blohm ME, Vesterling-Horner D, Calaminus G, Gobel U. Alpha 1-fetoprotein (AFP) reference values in infants up to 2 years of age. Pediatr Hematol Oncol. 1998;15:135-142. 2. Hoag NA, Afshar K, Youssef D, Masterson JS, Murphy J, Macneily AE. Cystic intratesticular lesions in pediatric patients. J Pediatr Surg. 2013;48:1773-1777. 3. Friend J, Barker A, Khosa J, Samnakay N. Benign scrotal masses in children—some new lessons learned. J Pediatr Surg. 2016;51:17371742. 4. Liniger B, Fleischmann A, Zachariou Z. Benign cystic lesions in the testis of children. J Pediatr Urol. 2012;8:226-233.
http://dx.doi.org/10.1016/j.urology.2017.02.034 0090-4295
1
ARTICLE IN PRESS
A
B
C
D
Figure 1. (A) Ultrasonography at 3 months showed intratesticular unilocular cystic lesion (*) occupying most of the left testis in a hydrocele. (B) At 6 months, the cystic lesion (*) shrank and the left testicular parenchyma became thicker. (C) At 23 months, the cystic lesion, which was contracted to approximately 1 mm, was surrounded by relatively thick wall (arrowhead). (D) At surgery, white mass (arrow) was identified within the left testis. (Color version available online.)
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UROLOGY ■■ (■■), 2017