Testicular and paratesticular pathology in the pediatric population: A 20 year experience at Riley hospital for children

Abstract

The goals of this study are to define the spectrum, incidence, and relative frequency of testicular and paratesticular lesions in a typical North American population of 6 million based on the analysis of pathology specimens. Twenty years of pathology reports from 1990 to 2009 of all testicular and paratesticular specimens were retrieved and analyzed from computerized databases of the single major pediatric hospital in the state of Indiana. We showed that the three most common benign lesions were vanishing testis, atrophy/cryptorchidism, and testis torsion, all showed left-sided predominance. The incidence and trends of the major pathology entities were also studied. Neoplasms represented roughly 10% of the total, with leukemia, rhabdomyosarcoma, teratoma, and mixed germ cell tumor occurring in decreasing frequency. Many of the neoplasms occurred at characteristic narrow age ranges, with overall interesting bimodal distribution or some with unique genetic background.

Introduction

For practicing pathologists, pediatric urologists, and pediatricians in general, it is essential to know the spectrum of lesions, their relative frequencies, and their usual age of occurrence for any particular anatomic site. There is a wide variety of diseases that may involve the testis and paratesticular region in the pediatric population. For each individual entity, there is a detailed medical literature; however, there is a relative paucity of data regarding the full spectrum and relative frequencies of pediatric testicular and paratesticular lesions. At this time, there are only two studies that have generated some data in this regard – one from an institution in North Adelaide, Australia [1] and the other from a tertiary referral center in London, UK [2]. The sample size from both studies was relatively small, and the UK study, because of its exclusively referral basis, is likely not representative of a more generalized experience. The current study covers 20 years of experience from the largest and only comprehensive children's hospital in the state of Indiana, which serves a North American population base of 6.3 million. It is our hope that this report will provide helpful information regarding the diagnostic possibilities when pathologists, especially pediatric pathologists, pediatric surgeons, especially urologists and pediatricians, are confronted with testicular and paratesticular lesions in children.