Imaging
- Ultrasound of both testes, measurement of tumor size, exclusion of
paratesticular tumor [Level I, Grade A].
- Testicular MRI is currently used more frequently to distinguish
between benign lesions, Leydig cell tumors, other SCSTs and GCTs
[Level III, Grade C].
- Pelvic-abdominal ultrasound focussing on paraaortal lymph nodes in
case of right-sided and renal lymph nodes in case of the left-sides
tumors is recommended [Level II, Grade A].
- TSCSTs are most commonly detected as small tumors, limited to the
testis, and they extremely rarely metastasize.6–8Thus, more intensive staging is not recommended in case of SCSTs in
prepubertal patients [Level IV, Grade A].
- Pelvic-abdominal MRI is recommended only if ultrasound does not allow
assessment of the retroperitoneal lymph nodes [Level III, Grade
A]. CT can also be used but bears the disadvantage of radiation
exposure in children [Level III, Grade B].
- Chest X-ray can be done, however is not recommended to avoid radiation
exposure, as lung metastases are not expected [Level III, grade
D]. In particular, chest CT is not recommended [Level II, Grade
E].
Therapy
- Orchiectomy after high inguinal incision and first ligation of the
spermatic cord constitutes the gold standard and constitutes the only
treatment for most patients [Level III, Grade
A].6, 7
- Considering the patient’s potential wish, a testicular prosthesis can
be inserted during the same surgical session [Level IV, Grade B].
- Considering the overall favourable prognosis, there has been some
debate as to whether tumor excision after scrotal excision or organ
sparing surgery (e.g. enucleation of the tumor) may also be
appropriate. These strategies have not yet been validated
prospectively, and it is unclear whether organ sparing surgery may
indeed contribute to further reproductive function and increase
quality of life [Level IV, Grade C].9
- In case of complete but organ sparing enucleation of a testicular SCST
with an inguinal approach, a second look surgery and orchiectomy is
not mandatory, at least in prepubertal children with non-metastatic
tumors [Level IV, Grade D]. Moreover, in the same group of
patients a second look surgery in case of transscrotal surgery is not
considered mandatory, either [Level IV, Grade D].
- Organ sparing surgery should be attempted as an individual approach in
non-metastatic bilateral tumors [Level IV, Grade B]].
- Biopsy of a contralateral testis, which is not suspicious on palpation
and/or ultrasound, is not required [Level IV, Grade D].
- Retroperitoneal lymph node dissection is recommended only in rare
cases of suspicious lymph node spread detected by ultrasound and/or
MRI [Level IV, Grade B].
- The extremely rare metastatic tumor should be treated according to the
corresponding concept for metastatic OSCST [Level V, Grade
B].1
Follow-up (FU)
- Despite the excellent prognosis, regular follow-up is recommended at
least for the first two years [Level III, Grade A]. As up to 5%
of patients may develop metachronous contralateral tumors, long-term
follow-up may be offered, in particular in patients with suspected
genetic predisposition (Table I ) [Level IV, Grade B].
- Follow-up investigations include anamnesis, physical examination and
measurement of serum tumor markers only, if these have been elevated
peri-operatively [Level IV, Grade A].
- Imaging follow-up includes pelvic, abdominal and scrotal ultrasound
[Level IV, Grade A].
- Abdominal and pelvic MRI is recommended in case of equivocal findings
on US during follow-up [Level IV, Grade A].
- Routine chest X-ray is not recommended for follow-up [Level IV,
Grade E].