Horizon Interdisciplinary Journal (HIJ). ISSN: 2992-7706
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Original Article
Pediatric testicular tumors: 10 years of clinical
approach at the Antiguo Hospital Civil de Guadalajara.
José Antonio Gutiérrez-Ureña , Guillermo Yanowsky-Reyes
1*
, Andrea Paola Ramos-
Mora
2
, Zacnicté Viridiana Corona-Guzmán
3
, Carlos Guillermo Abascal-Medina ,
Laura Olivia Montaño-Ángeles , Julio Edgardo Flores-Revilla , Jesús Antonio
Aguilar-Mata .
1
Hospital Civil de Guadalajara Fray Antonio Alcalde/ Servicio de Cirugía Pediátrica.
Guadalajara, Jalisco, México.
2
Universidad de Guadalajara. Facultad de medicina, Centro Universitario de Ciencias de la
Salud. Guadalajara, Jalisco, México.
3
Universidad de Guadalajara. Facultad de medicina, Centro Universitario de Tonalá. Tonalá,
Jalisco, México.
* Corresponding author: Guillermo Yanowsky-Reyes, Hospital Civil de Guadalajara Fray
Antonio Alcalde/ Servicio de Cirugía Pediátrica, Calle Hospital 278, Colonia El Retiro, C.P.
44280, Guadalajara, Jalisco, México. E-mail: gyanowsky@gmail.com. 0000-0003-2891-8561
Sent: 09/25/2023 Accepted: 12/12/2023 Published: 02/29/2024
Abstract. - Introduction: In recent decades, the prevalence of testicular cancer has increased. The
prevalence of testicular cancer in children under 19 years of age worldwide represents the sixth
position in terms of frequency. The estimated prevalence is 0.3-3.1, incidence 0.17-1.4 and mortality
0.02-0.1 per 100,000. Considering the increase in the prevalence of testicular cancer, we conducted
this study with the intention of knowing the clinical characteristics, the diagnostic and therapeutic
approach, as well as the incidence and mortality in our environment. Methods: A case series of
pediatric patients attended from January 1, 2013 to January 1, 2023 at the Antiguo Hospital Civil de
Guadalajara Fray Antonio Alcalde was carried out. Age, risk factors, clinical presentation, tumor
markers (BHCG, AFP, LDH), imaging studies, therapeutic management, tumor size and
histopathological study were reviewed. The data was collected by reviewing clinical records; these
data were downloaded into the Office Excel program and transferred to SPSS version 25. Results: We
analyzed the records of 11 pediatric patients who met the inclusion criteria, 4 patients had a testicular
tumor and 7 patients had a paratesticular tumor, estimating an incidence of 0.15/100 000. The mean
for age at diagnosis was 14 years with a deviation of 8 with respect to the mean, only 2 patients (18.18%)
presented cryptorchidism as a risk factor, all patients presented increased testicular size at diagnosis,
tumor markers were positive in 41.6% of the cases in which it was measured. Ultrasound was
performed in all cases, the mean size of the masses was 3 cm, 1 patient presented benign histology,
while 3 patients presented positivity to malignancy. Five orchiectomies were performed, one
lumpectomy and five are still under follow-up and surveillance. Conclusion: testicular and
paratesticular tumors are infrequent in pediatric age, nevertheless, understanding them is of great
importance in order to make an early diagnosis and offer an individualized therapeutic approach,
considering limiting radical orchiectomy to cases in which malignancy is suspected.
Keywords: Testicular tumor; Paratesticular tumor; Pediatric patient; Tumor markers; Clinical
presentation; Diagnosis; Treatment; Risk factor; Histopathology.
Horizon Interdisciplinary Journal (HIJ). ISSN: 2992-7706
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1. Introduction
Testicular masses in prepubertal and
post-pubertal pediatric patients are two
distinct entities considering their
epidemiology, diagnostic approach and
treatment
1
. Most prepubertal tumors are
usually benign, with patients most often
presenting teratomas, whereas
postpubertal tumors are similar to those
diagnosed in adults and probably
associated with greater malignancy
2
.
The prevalence of testicular cancer has
increased in recent decades, especially in
industrialized countries
3
. In patients
under 19 years of age, its estimated
prevalence is 0.3-3.1, incidence 0.17-1.4
and mortality 0.02-0.1 per 100,000
population
4
, in Mexico, according to the
same source, a prevalence of 3.5, a
mortality of 0.34 and an incidence of 1.3
per 100,000 is reported.
Testicular and paratesticular masses in
pediatric patients are not part of the main
motives for pediatric consultation at the
Antiguo Hospital Civil de Guadalajara
Fray Antonio Alcalde, nevertheless, it is
important to establish the initial
management that patients with testicular
masses should receive and to provide an
early diagnosis, offering a therapeutic
approach according to the clinical
characteristics, ultrasonographic and
histopathological findings.
In order to approach the diagnosis, we
can make use of tools such as imaging
studies and tumor markers, and
depending on the results, we may or may
not be able to offer a preserving surgery
5–
7
.
Moreover, it is essential to know the main
histological strains of testicular and
paratesticular tumors that occur in
patients under 18 years of age, since
depending on age, due to the influence of
gonadotropins, patients are more likely
to present some histological subtypes,
also, in the case of adolescents (post-
puberty), the risk of presenting a
malignant neoplasm is higher, so it is
essential to perform an appropriate
approach
5,8
.
Establishing an early diagnosis is crucial
since the short and long term prognosis
of patients treated in early stages of
testicular cancer is better. In addition to
being useful for the creation of
prevention strategies and establishing a
starting point for future research that
will contribute to generate more
knowledge on this topic.
Considering the above, we conducted a
case series report with the aim of
analyzing and documenting the cases of
pediatric testicular and paratesticular
tumors (under 18 years of age) treated at
the Antiguo Hospital Civil de Guadalajara
that occurred during the period from
January 1, 2013 to January 1, 2023, in order
to determine the incidence, clinical
characteristics, diagnostic and
therapeutic approach in each one of
them, as well as the mortality caused by
this pathology.
2. Method
A case series study was performed at the
Antiguo Hospital Civil de Guadalajara.
The population corresponded to those
patients diagnosed with a testicular or
paratesticular mass, while the sample
was according to patients who met the
inclusion criteria.
The inclusion criteria were pediatric
patients diagnosed with testicular or
paratesticular mass, patients under 18
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years of age at the time of diagnosis,
having been treated in the pediatric
surgery service at the Antiguo Hospital
Civil de Guadalajara Fray Antonio Alcalde,
patients with a complete electronic
and/or physical clinical record and
having been cared for in the period from
January 1, 2023 to January 1, 2023.
We excluded pediatric patients treated in
other institutions, patients diagnosed
with testicular mass over the age of 18
years, incomplete clinical records, and
patients who did not have diagnostic
support tests prior to definitive
treatment.
Data collection was performed by means
of clinical records and no data that could
identify the patient were considered.
Quantitative and qualitative variables
were taken into account. Quantitative
variables included age, tumor markers
such as alpha-fetoprotein beta subunit of
human chorionic gonadotropin and
lactate dehydrogenase, tumor size and
stage. The qualitative variables
considered were risk factors, clinical
picture, ultrasonographic findings,
treatment, and as dichotomous variables,
histologic findings and mortality.
The data were imported into Microsoft
Excel and transferred to SPSS (Statistical
Package Social Science) Version 25. For
the statistical analysis of categorical
variables, frequency and percentages
were used, and for numerical variables,
medians and mode were used. The data
are represented in bar and sector graphs
depending on the type of variable.
3. Results
We conducted a review of 12 records of
pediatric patients who met a diagnosis of
tumor of uncertain or unknown behavior
of the testicle at the Antiguo Hospital
Civil de Guadalajara for 10 years from
January 1, 2013 to January 1, 2023.
Out of a total of 12 patients, 11 patients
met inclusion criteria and 1 patient met
exclusion criteria. Of the 11 cases
included in the present study, 4 patients
had a testicular tumor and 7 patients had
paratesticular tumors.
The mean age of diagnosis was 14 years
(range, 29 days to 15 years). Of the total
cases 45.45% (5 patients) were
prepubertal (Tanner pubertal stage I) and
54.55% (6 patients) were pubertal or
postpubertal.
Regarding risk factors, it can be seen
in Figure 1 that 9 patients were free of
risk factors (81.82%), while 2 of the
patients presented cryptorchidism
(18.18%), one of them being right
cryptorchidism and the other left
cryptorchidism.
Figure 1. Presence of risk factors for
testicular cancer in the evaluated sample.
18.18%
81.82%
Present Abscent
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The most common form of presentation
was testicular enlargement in all cases,
and in 6 patients (55.45 %) this was
accompanied by pain. Only 2 patients had
reactive hydrocele and 1 patient had
gynecomastia. As for the
transillumination test, in 54.55 % of the
cases it was positive and in 45.45 % it was
negative. Figure 2 shows that the tumor
was unilateral in 90.9% of the cases and
only 9.1% presented a bilateral tumor.
Figure 2. Type of presentation of testicular
tumor.
During diagnostic evaluation of tumor
markers, the level of human chorionic
gonadotropin hormone beta fraction was
measured in 8.4% (1 patient), alpha-
fetoprotein in 33.3% (4 patients) and
lactate dehydrogenase in 41.6% (5
patients). Only 41.6% (5 patients) had
positive tumor markers.
As shown in Figure 3, ultrasound was
performed in all cases, 3 patients had a
solid tumor, 5 patients had an
epididymal cyst, 2 patients had
microcalcifications and 1 patient had
increased intratesticular flow. The
mean size of painful masses was 3 cm
(2-4) and of non-painful masses 3.98
cm (1-10).
Figure 3. Type of ultrasonographic finding.
A total of 5 radical orchiectomies were
performed, of which 80% (4 patients) had
a solid testicular tumor and 20% (1
patient) a paratesticular tumor with
testicular infiltration. Lumpectomy was
performed in only 9.09% of the cases (1
patient). In 5 of the cases, 45.5%, benign
pathology was found and did not require
intervention and so far they are under
follow-up and surveillance.
Figure 4 shows that, out of the 11 patients,
4 had testicular tumors, of which 1 patient
had benign histology, while 3 patients
had histology positive for malignancy.
The distribution of the histology of the
testicular tumors was one pure germinal
tumor of prepubertal mature teratoma
type (benign), one mixed germinal tumor
90% teratoma and 10% embryonal
carcinoma, one prepubertal yolk sac
90.90%
9.10%
Unilateral Bilateral
3
5
2
1
Solid Tumor
Epididymal cyst
Microcalcifications
Increased intratesticular flow
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germinal tumor and the remaining case
was negative for malignancy.
The other 7 patients had testicular
adnexal tumors, 5 corresponded to
epididymal cysts, 1 paratesticular tumor,
which was positive for malignancy
(embryonal rhabdomyosarcoma) while
the remaining case continues to be
followed up (probable embryonal
rhabdomyosarcoma).
Figure 4. Histology of the presented tumors.
Of the total number of patients with
testicular tumors, those that were
positive for malignancy, 2 patients were
stage I (PTIB) and 1 patient was stage III
(PT2). The stage III patient was the only
one with retroperitoneal metastases
(mass measuring 23.5 x 10.5 x 7.3 cm).
In addition to the initial surgical
treatment, 2 patients with testicular
tumors received adjuvant chemotherapy,
one of them based his scheme on
etoposide, bleomycin and carboplatin,
while the other patient's cycles consisted
of vincristine, actinomycin D and
cyclophosphamide.
No cases of death were reported for the
patients included in the present study.
The tables show the characteristics of
each of the patients analyzed with the
presence of testicular tumors, and Table
2 shows the patients with paratesticular
tumors. It is worth mentioning that so far
no deaths were reported in the follow-
up.
Table 1 shows the characteristics of each
of the patients analyzed with the
presence of testicular tumors and
paratesticular tumors
3
7
1
Positive to malignancy
Negative to malignancy
Currently under study
Https://doi.org/10.56935/hij.v2i1.11
Case
Age
Risk Factors
Presentation
Tumor markers
Ultrasound
Therapeutic
management
Tumor size
Histology
Stage
1
1 year
No
Painful mass,
transillumination negative.
Positive
AFP: 1.4
LDH: 319
Solid tumor with reactive
hydrocele
Radical orchiectomy
4 x 2.5 x 2.5 cm
Pure germinal tumor
of prepubertal mature
teratoma type.
PT1B, Stage I.
2
15 years
No
Non painful mass,
transillumination negative.
Positive
AFP: 525.5
BHCG: 387. 6
LDH: 209
Solid tumor with
characteristics of germ cell
tumor + right varicocele
grade II
Radical orchiectomy
10 x 7 x 6 cm
Mixed germinal tumor
90% teratoma and
10% embryonal
carcinoma
PT2, Stage III.
3
2 meses
No
Painful mass,
transillumination negative.
Not reported.
Calcifications and
hypoperfusion
Radical orchiectomy
2 x 3 x 2 mm
Negative for malignancy
4
11 meses
Right cryptorchidism
Palpable, non-painful mass,
transillumination negative.
AFP: 4587
LDH: 346
Solid tumor with increased
intratesticular flow
Radical orchiectomy
3.5 x 2 x 2cm
Prepubertal yolk sac
germinal tumor
PT1B, Stage I.
5
14 years
No.
Painful mass,
transillumination positive.
LDH: 227
Epididymal cyst
Under follow-up
6
9 years
No.
Painful mass,
transillumination positive.
Negative
Bilateral epididymal cyst
Under follow-up
7
14 years
No.
Painful mass, positive
transillumination.
Negative
Epididymal cyst
Under follow-up
8
12 years
No.
Painful mass, positive
transillumination.
Negative
Epididymal cyst
Under follow-up
9
14 years
No.
Non painful mass, positive
transillumination.
Negative
Epididymal cyst
Tumorectomy
2 cm diameter
Serous cyst of
epididymis
10
8 years
No.
Non painful mass, negative
transillumination.
AFP: 2.27
LDH: 482
Testicle with hyperechogenic
lobulated structures, with
increased intratesticular flow
Radical orchiectomy
3.4 cm in
greatest
diameter
Paratesticular
embryonal
rhabdomyosarcoma,
with infiltration of the
epididymis and
testicular network
11
29 days
Left cryptorchidism
Painful mass, negative
transillumination.
Negative
Heterogeneous mass with
microcalcifications, nodal
growth in both inguinal
canals
Under follow-up
(probable embryonal
rhabdomyosarcoma).
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4. Discussion.
Testicular tumors currently account for
1-2% of all pediatric tumors
1
, with an
incidence of 0.05-2 per 100,000 infants
2
.
There is a bimodal age distribution, with
the first peak occurring during the first 2
years of life and the second around 15
years of age
1-3
. The increased incidence of
tumors after 9 years of age could be
associated with the high hormonal levels
at puberty
9,10
. These tumors usually have
a good prognosis, with an approximate
benignity of 50% and an overall survival
of 99% at five years
1,5
. In our study we
found an incidence of 0.15, similar to the
overall estimate, with no deaths reported
during the follow-up period.
The histology of testicular tumors varies
according to the cell line from which they
originate. Among prepubertal
intratesticular tumors, 90% are germ cell
tumors and only 10-15% are epidermoid
cysts
10,11
. Benign germ cell tumors are
frequent, approximately 40-50% are
teratomas
9,13,14
. Epidermoid cysts are
always benign. Malignant germ cell
tumors are mainly represented by yolk
sac tumors 8-30%
9,14,15
. On the other
hand, among non-germ cell derived
tumors, Leydig cell tumors are usually
the most frequent, followed by juvenile
stromal granulosa cell tumors
9,14,16
.
Regarding prepubertal testicular
malignant neoplasms, 5-year survival is
97% in boys with localized tumors, while
only 73% in those with distant disease
17,18
.
Moreover, in post-pubertal boys most
tumors are malignant and mixed germ
cell tumors predominate among them
14,19
,
from the data obtained we found
similarity in the presentation of benign
and malignant tumors, however, the most
frequent histology was that of germ cell
tumors.
In post-pubertal adolescents aged 15 to
19 years, the incidence increases and
represents 12% of all cancers in
adolescents
17,18
. In this population, there
is a higher probability of malignancy and
includes immature teratomas, mixed
non-seminomatous germ cell tumors and
embryonal carcinomas
6
. In young adults,
95% of testicular cancers are malignant
germ cell tumors and 50% of these
correspond to seminomas
17,21
.
The malignant potential of germ cell
tumors increases rapidly after the age of
9 years, whereas benign tumors tend to
be more frequent in young children
17
. The
etiology of pediatric testicular tumors is
unknown, however, a possible
association with prenatal
diethylstilbestrol exposure has been
postulated
10
.
Some risk factors for testicular tumors
have been identified, such as
cryptorchidism, gonadal dysgenesis,
Klinefelter's syndrome, history of
testicular cancer in a first-degree
relative, presence of contralateral tumor
and infertility
20,22
. In addition, bilateral
abnormal external genitalia and late
descended or uncorrected testes are risk
factors for the development of
malignancy in cryptorchidism, this being
the association found in 2 cases of
germinal tumors
17,23
.
Tumorogenesis depends on the action of
gonadotropins in the testis, since
gonadotropin levels follow the same age-
adjusted pattern of testicular cancer
incidence. Thus, the disease would begin
in fetal life, with alterations in the
formation of primordial cells, giving rise
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to neoplastic cells in situ that remain
quiescent until stimulated by
gonadotropin-mediated signals
5,25
.
The clinical presentation of testicular
tumors is usually as a painless testicular
mass (82-90%) and less than 10% as a
painful mass secondary to hemorrhage or
necrosis. Only a few patients present
with hydrocele, scrotal pain or history of
trauma. About 10-25% of patients with
malignant tumors usually present with
hydrocele
23
.
Tumor markers are an important
diagnostic tool for evaluating pediatric
testicular tumors, including alpha-
fetoprotein, beta-subunit of human
chorionic gonadotropin and lactate
dehydrogenase
17,24
.
Serum alpha-fetoprotein values are
generally higher in children than in adults
and are usually reduced to normal levels
by 1 year of age (<10 ng/ml). Thus, in
children <1 year with testicular tumors,
the level of alpha-fetoprotein may be
elevated in those with benign tumors,
whereas in those >1 year a normal level of
alpha-fetoprotein usually indicates a
benign tumor
25
.
An elevated serum alpha-fetoprotein
level is strongly associated with >90% of
yolk sac tumors, whereas immature
teratomas may have only a slightly
elevated serum alpha-fetoprotein level
25
.
25 Alpha-fetoprotein should be measured
prior to any therapeutic management
and after surgery to assess for adequate
lowering of the level
17
. Currently, it is
discouraged to base treatment solely on
elevated alpha-fetoprotein when its
levels are stable and <25 ng/mL
26
.
Human chorionic gonadotropin beta
subunit is elevated in embryonal
carcinomas, choriocarcinomas or
seminomas, which are extremely rare in
prepubertal children, but can be seen in
postpubertal patients. Therefore, it is not
useful in the diagnosis of prepubertal
boys with a testicular tumor, but is useful
in adolescents presenting with a
testicular mass
27
.
Lactate dehydrogenase may serve as a
diagnostic tool, since high serum levels
are associated with bulky disease and
increasing levels after therapy may
signify disease recurrence, however, they
are only elevated in 20% of low-stage
germ cell tumors
17,26
.
Ultrasonography is the imaging modality
of choice in the study of testicular
tumors, with a sensitivity of 100% and a
negative predictive value of almost
100%
23,28,29
. Testicular tumors are
predominantly homogeneous
hypoechoic, but in some cases may be
heterogeneous with solid, cystic or
calcified components, in which they
reflect the underlying histological
features
8
. In the case of Doppler
ultrasound, most malignant masses show
elevated blood perfusion, whereas benign
tumors are usually well demarcated with
decreased blood flow
2,30
.
Contrast-enhanced ultrasound helps in
the discrimination of focal testicular
lesions, it can show microvascularization
and in case of hyperenhancement it is
indicative of a malignant tumor
6,31
.
Elastography increases diagnostic
accuracy by assessing the stiffness of the
lesions. It should be noted that malignant
neoplastic lesions are harder due to the
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higher density of tumor cells and vessels
than in normal testicular tissue
31,32
.
MRI is usually used as a complementary
imaging technique in those exceptional
cases in which scrotal ultrasound
findings are inconclusive or non-
diagnostic, in the evaluation of abdominal
cryptorchidism and in the extension of a
histologically confirmed malignant
testicular tumor
23
.
Therapeutic management requires
clinical suspicion and ultrasonographic
confirmation of an intratesticular lesion,
determination of serum markers (alpha-
fetoprotein and beta subunit of human
chorionic gonadotropin, hormone levels
(testosterone) and lactate
dehydrogenase. Percutaneous testicular
biopsy is not usually performed due to
the risk of lymphatic tumor seeding
23,33
.
The traditional treatment of choice for
testicular masses is radical orchiectomy;
however, due to the benignity in children,
in recent years the medical-surgical
approach has been re-evaluated, where
lumpectomy (conservative surgery) is
considered depending on tumor markers
(alpha-fetoproteins or beta subunit of
human chorionic gonadotropin), tumor
size and histological findings
9
.
Testicular sparing surgery is limited in
infants in whom normal testicular tissue
is seen to be salvageable by ultrasound
and tumor markers within normal serum
values, i.e. in those where malignancy is
not suspected. In some cases
intraoperative frozen section
examination can be used to confirm a
pathological tumor, as well as to justify
the choice of conservative surgery
9,19,23
.
Cases of malignant testicular tumors are
rare and usually occur in older children,
so radical orchiectomy with
postoperative follow-up is recommended
in patients 5 years of age or older
9
.
When specific tumor markers are found
to be increased, radical inguinal
orchiectomy is considered. In addition,
adjuvant chemotherapy is required in
malignant testicular tumors
9,23
. Some
short- and long-term treatment-related
complications may occur. Adverse effects
include the risk of infertility,
hemorrhagic cystitis and the
development of a secondary
malignancy
10
.
After surgical treatment, infants should
be monitored with physical examination,
scrotal ultrasound and tumor
markers
23,34,35
. Especially in the case of
malignant testicular tumors, follow-up is
performed according to the type of
testicular cancer (seminoma, non-
seminoma or advanced stages) and is
based on evaluating four parameters:
physical examination, tumor markers,
chest x-ray and abdomino-pelvic
computed axial tomography, which,
depending on the year of follow-up, are
requested more and more frequently. In
advanced stages, chest or brain
tomography may be requested in
particular cases
26
.
On the other hand, paratesticular tumors
are a heterogeneous group of infrequent
tumors. Approximately 70% of
paratesticular tumors are benign, among
which lipomas, leiomyoma, dermoid cyst
and adenomatoid tumors are the most
frequent
36,37
. However, malignant tumors
represent the other 30% and
rhabdomyosarcoma and leiomyosarcoma
are common, in some cases malignant
mesothelioma and adenocarcinoma of
the rete testis and epididymis have been
described
36
.
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In pediatric patients, rhabdomyosarcoma
is the most frequent malignant
paratesticular tumor. Its age of
distribution is bimodal, with a peak at 3-
4 months and another at 16 years of age
38
.
It develops from the mesenchymal
tissues of the spermatic cord, epididymis
and tunica testicularis
39
. The clinical
presentation is a large painless mass and
metastatic in up to 40% at the time of
presentation.
On ultrasound it is seen as a large
heterogeneous mass with no other
differentiating findings. It can locally
infiltrate adjacent tissues and
metastasize by hematogenous and
lymphatic routes; in 70% of patients it
metastasizes regionally and 25% to the
lung and bone
2
. The treatment of choice
in this type of tumor depends on the age
and size of the primary tumor; however,
radical orchiectomy with radical
retroperitoneal lymphadenectomy is
usually performed. In those patients
where there is evidence of lymphatic
involvement after lymphadenectomy,
radiotherapy and chemotherapy with
vincristine, actinomycin D and
cyclophosphamide is also administered
2
.
Survival is greater in prepubertal children
than in adolescents, being 90% at 3 years
in children aged 3-4 months and only
63% respectively. Age older than 7 years,
alveolar histology, unresectable
retroperitoneal dissemination or distant
metastases should be considered
indicators of poor prognosis in this type
of tumor
2
.
5. Conclusions
Testicular and paratesticular tumors are
not so frequent entities in pediatric
patients; however, knowledge of these
tumors is of great importance for an
adequate diagnosis and treatment,
considering the clinical, imaging and
histological characteristics of each tumor
mass.
It is of great relevance to determine the
initial management and follow-up that
should be given to patients with
testicular and paratesticular masses
under study, in order to establish an early
diagnosis and offer an individualized
therapeutic approach, taking into
account the clinical manifestations, age,
ultrasonographic findings, tumor
markers, among other variables.
Likewise, by individualizing the
treatment, it is possible to offer patients
who meet the selection criteria
lumpectomies instead of radical
orchiectomies, which allows the
preservation of healthy testicular tissue
in those cases with no risk of malignancy.
It should be considered that the
histologic strains of testicular and
paratesticular masses are different
depending on whether the patients are
prepubertal, pubertal or postpubertal
due to the influence of gonadotropins on
cell differentiation. In addition, the
probability of malignancy is higher in
pubertal and postpubertal patients, so
that timely diagnosis and treatment
could improve the prognosis and survival
of patients.
Horizon Interdisciplinary Journal (HIJ). ISSN: 2992-7706
Volume 2 (1): e11. January-March. 2024.
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6. Statements
6.1 Conflict of interest
The authors declare no conflict of
interest.
6.2 Funding
No funding was required to carry out
this research.
6.3 Ethical considerations
The ethical considerations that
guarantee the privacy, dignity and well-
being of the patient under investigation
were respected in the development of
this study. This study did not entail any
risk for the patient, as it was a research
study in which only documents with a
retrospective approach were handled,
given that no intervention was given.
6.4 Acknowledgments
We thank all the staff of the Pediatric
Surgery Service of the Hospital Civil de
Guadalajara Fray Antonio Alcalde for
welcoming us with open arms and
providing full support and facilities.
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