title: Prepubertal testicular tumours: Should testicular-sparing surgery be considered? A single-institution experience and review of the literature.
abstract: OBJECTIVE
  To review our 10-year experience with uncommon testicular tumours in children (prepubertal testicular and paratesticular), to review previous reports, and to determine the appropriate management of these rare tumours, specifically the role of testicular-sparing surgery.
  
  
  METHODS
  We retrospectively reviewed all cases of testicular tumours managed at our institution between 1999 and 2009. Boys aged <16 years were included in the study. The patients' characteristics, presentation, the diagnostic tools, tumour markers, mode of treatment, pathological findings and outcome were assessed. We reviewed previous reports that addressed testicular and paratesticular tumours in prepubertal boys, using a Medline/PubMed search.
  
  
  RESULTS
  From 80 patients, 13 boys (median age 8.7 years) presented with testicular tumours (16%) and were included in the study. Two boys presented with precocious puberty and one with gynaecomastia. The level of α-fetoprotein was high in three boys, and the human chorionic gonadotrophin level was elevated in one, and both markers were high in one. Testicular-sparing surgery was performed in three boys. Six of the 13 tumours were malignant and seven were benign. None of the patients developed a recurrence or testicular atrophy after testicular-sparing surgery. From the review of previous reports we devised an evidence-based algorithm for managing prepubertal testicular tumours.
  
  
  CONCLUSIONS
  Paediatric testicular tumours are rare but they require an inguinal approach for either orchidectomy or testicular-sparing surgery; we recommend the latter option as long as frozen sections are analysed and a safety margin is maintained.
authors.affiliation: Urology and Nephrology Center, Mansoura University, Mansoura 35516, Egypt.
authors.forename: Mohamed H
authors.initials: MH
authors.lastname: Zahran
authors.affiliation: Urology and Nephrology Center, Mansoura University, Mansoura 35516, Egypt.
authors.forename: Tamer E
authors.initials: TE
authors.lastname: Helmy
authors.affiliation: Urology and Nephrology Center, Mansoura University, Mansoura 35516, Egypt.
authors.forename: Ashraf T
authors.initials: AT
authors.lastname: Hafez
authors.affiliation: Urology and Nephrology Center, Mansoura University, Mansoura 35516, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Dawaba
keywords: AFP, α-fetoprotein; HCG, human chronic gonadotrophin; Orchidectomy; Paediatric; RPLND, retroperitoneal lymph node dissection; Testicular tumours; US, ultrasonography