Çocukluk Çağı Testis Tümörlerinde İkincil Cerrahi

Öz

Amaç: Testis tümörleri çocukluk çağı solid tümörlerin %1’ni oluşturmaktadır. Kliniğimizde testis tümörü tanısı ile tedavi edilmiş olan olguları geriye dönük değerlendirerek, ikincil cerrahi nedenlerini ve sonuçlarını literatür bilgisi ışığında tartışmayı amaçladık.Gereç ve Yöntemler: 2009-2013 yılları arasında testis tümör tanısı ile opere edilmiş olan olgular hastane kayıtlarından geriye dönük olarak değerlendirildi.Bulgular: İki ay-17 yaş arasındaki on yedi olgu testis tümörü tanısı ile kliniğimizde opere edildi. Sekiz olgu benign patolojiye sahipti; matür teratom (n=2), rest tümörü (n=1) , sertoliform adenom (n=1), keratinöz kist (n=1), basit mezotelyal kist (n=2), leydig hücreli tümör (n=1). Dokuz olgu malign patolojiye sahipti; paratestikuler rabdomyosarkom (n=1), yolk sac tümör (n=6), mikst germ hücreli tümör (n=2). Beş olguya testis koruyucu cerrahi, on iki hastaya yüksek orşiektomi uygulandı. Testis koruyucu cerrahi uygulanmış olan beş olguda komplikasyon gelişmedi. Başka merkezlerde skrotal girişim uygulanmış olan dört olguya hemiskrotektomi yapıldı. Hemiskrotektomi yapılan olgulardan birinde rezidü tümör saptandı. Retroperitoneal lenf nodu diseksiyonu yapılan üç olgudan birinin patolojisinde malignite saptandı.Sonuç: Testis tümörleri çocukluk yaş grubunda özellikle prepubertal dönemde nadir görülmekte ve genellikle benign karakterdedir. Cerrahi girişim her zaman inguinal kesi ile olmalı, testis koruyucu cerrahinin uygun görülmediği hastalara yüksek orşiektomi uygulanmalıdır. Germ hücreli tümörlerde sebat eden retroperitoneal hastalık varlığında lenf nodu diseksiyonu gerekliliği yönünden olgular değerlendirilmelidir.

Anahtar Kelimeler

• Çocuk, Testis tümörleri

Redo Surgery in Childhood Testicular Tumors

Öz

Objective: Testicular tumors make up 1% of childhood solid tumors. We retrospectively evaluated the patients who had been treated at our clinic with a diagnosis of testicular tumors and aimed to discuss the causes for redo surgery in the light of the literature.Material and Methods: We retrospectively analyzed patients who had been operated with the diagnosis of testicular tumors between 2009 and 2013 from the hospital records.Results: Seventeen patients with an age range from 2 months to 17 years were operated in our clinic with a diagnosis of testicular tumor. Eight patients had a benign pathologic results consisting of mature teratoma (n=2), rest tumor (n=1), sertoliform adenoma (n=1), keratinous cyst (n=1), simple mesothelial cyst (n=2), and Leydig cell tumor (n=1). Nine patients had a malign result consisting of paratesticular rhabdomyosarcoma (n=1), yolk sac tumor (n=6), and mixed germ cell tumor (n=2). Testis-sparing surgery was performed in five cases while high orchiectomy was performed in twelve cases. No complication was seen in the five patients who underwent a testis-sparing surgery. Hemiscrotectomy was performed in four patients who had undergone scrotal orchiectomy at other medical centers previously. Malignant residual tumor was found in a patient who underwent hemiscrotectomy. Malignancy was detected in one of three patients who underwent retroperitoneal lymphadenectomy. conclusion: Testicular cancers are seen rarely in childhood and especially in the prepubertal period and are usually benign. Surgery should always be with inguinal incision, and high orchiectomy should be administered in patients not appropriate for testis-sparing surgery. Retroperitoneal lymph node dissection (Redo surgery) can be required for the recurrence or residual retroperitoneal disease in the treatment of germ cell tumors

Anahtar Kelimeler

• Child, Testicular neoplasms

Kaynakça

1. Green DM. Testicular tumors in infants and children. Semin Surg Oncol 1986;2:156-62.
2. Balcı Ö, Karaman A, Şahin G, Karaman İ, Bozkurt C, Ertürk A, ve ark. Çocuklarda testis tümörleri: Tek merkez deneyimi. Türkiye Çocuk Hast Derg 2015;3:167-70.
3. Kay R. Prepubertal testicular tumor registry. Urol Clin North Am 1993;20:1-5.
4. Heidenreich A, Albers P, Hartmann M, Kliesch S, Kohrmann KU, Krege S, et al. Complications of primary nerve sparing retroperitoneal lymph node dissection for clinical stage I nonseminomatous germ cell tumors of the testis: Experience of the German Testicular Cancer Study Group. J Urol 2003;69:1710-4.
5. Murphy AM, Mc Kierman JM. Re operative retroperitoneal lymph- node dissection for testicular germ cell tumor. World J Urol 2009;27:501-6.
6. Scavuzzo A, Noveron NR, Rios ZAS, Angel JRM. Redo retroperitoneal lymphadenectomy for germ cell tumor of the testis: Incan experience (Instituto Nacional de Cancerologia, Mexico City) and review of literature. Urol Nephrol Open Access J 2015;2: 00027.
7. Weissbach L, Altwein JE, Steins R. Germinal testicular tumors in childhood. Eur Urol 1984;10:73-85.
8. Thomas JC, Ross JH , Kay R. Stromal testis tumors in children; a report from Prepubertal Testis Tumor Registry. J Urol 2001;116: 2338-40.

9. Cortez JC , Kaplan GW . Gonadal stromal tumors, gonadoblastoma, epidermoid cyst and secondary tumors of the testis in children. Urol Clin North Am 1993;20:15-26.
10. Krege S, Beyer J, Souchon R, Albers P, Albrecht W, Algaba F, et al. European consensus conference on diagnosis and treatment of germ cell cancer: A report of the second meeting of the European Germ Cell Cancer Consensus Group (EGCCCG): part II. Eur Urol 2008;53:497-513.
11. Nowroozi M, Ayati M, Arbab A, Jamshidian H, Ghorbani H, Niroomand H, et al. Postchemotherapy retroperitoneal lymph node dissection in patients with nonseminomatous testicular cancer: A single center experiences. Nephrourol Mon 2015;7:27343.
12. Donohue JP, Leibovitch I, Foster RS, Baniel J, Tognoni P. Integration of surgery and systemic therapy: Results and principles of integration. Semin Urol Oncol 1998;16:65-71.
13. McKiernan JM, Motzer RJ, Bajorin DF, Bacik J, Bosl GJ, Sheinfeld J. Reoperative retroperitoneal surgery for non seminomatous germ cell tumor: Clinical presentation, patterns of recurrence, and outcome. Urology 2003;62:732-6.
14. Ehrlich Y, Rosenbaum E, Baniel J. Late relapse of testis cancer. Curr Urol Rep 2013;14:518-24.
15. Heidenreich A, Ohlmann C, Hegele A, Beyer J. Repeat retroperitoneal lymphadenectomy in advanced testicular cancer. Eur Urol 2005;47:64-71.
16. Willis SF, Winkler M, Savage P, Seckl MJ, Christmas TJ. Repeat retroperitoneal lymph-node dissection after chemotherapy for metastatic testicular germ cell tumor. BJU Int 2007;100:809-12.
17. Donohue JP, Thornhill JA, Foster RS, Bihrile R, Rowland RG, Einhorn LH. The role of retroperitoneal lymphadenectomy in clinical stage B testis cancer: The Indiana University experience (1965 to1989). J Urol 1995;15:85-9.
18. Liu B, Su H, Cheng G, Li P, Hua L, Song N, et al. Experienes and outcomes of organ sparing surgery for teticular tumor with benign tendency. Can Urol Assoc J 2015;9:E785-8.
19. Steiner H, Holtl L, Maneschg C, Beerger AP, Rogatsch H, Bartsch G, et al. Frozen section analysis- guided organ-sparing approach in testicular tumors: Technique, feasibility, and long-term results. Urology 2003;62:508-13.