Malignant testicular GCTs in prepubertal males

The role of surgery at diagnosis for germ cell tumors (GCTs) depends on patient age and tumor site, and treatment must be individualized. All malignant testicular GCTs should be resected. Resection may be followed by subsequent excision of residual masses after chemotherapy.

Testicular GCTs in children occur almost exclusively in boys younger than 5 years.[1,2] The initial surgical approach to evaluate a testicular mass in a young boy is important because a trans-scrotal biopsy can risk inguinal node metastasis.[3,4] Radical inguinal orchiectomy with initial high ligation of the spermatic cord is the procedure of choice.[5]

Computed tomography or magnetic resonance imaging evaluation, with the additional information provided by elevated tumor markers, appears adequate for staging. Retroperitoneal dissection of lymph nodes is not beneficial in the staging of testicular GCTs in young boys.[3,4] Therefore, there may be no reason to risk the potential morbidity (e.g., impotence and retrograde ejaculation) associated with lymph node dissection.[6,7]

A revised risk stratification was developed by the Malignant Germ Cell Tumor International Consortium (see Figure 4).[8]