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Präpubertäre Hodentumoren

Diagnose, Therapie und Nachbeobachtung

Management of pediatric testicular tumors

Diagnosis, therapy, and follow-up

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Zusammenfassung

Basierend auf den Ergebnissen der nationalen MAHO/MAKEI-Studien und des präpubertären Hodentumorregisters der urologischen Sektion der „American Academy of Pediatrics“ werden Empfehlungen zur Behandlung der seltenen kindlichen Hodentumoren gegeben. Präpubertäre testikuläre Raumforderungen mit normalem AFP sind fast immer Teratome und erlauben u. U. ein organerhaltendes operatives Vorgehen. Maligne Tumoren sind bei älteren Säuglingen und Kleinkindern fast ausschließlich Dottersacktumoren. Im Stadium I erfordern diese Tumoren aufgrund einer 15%igen Metastasierungswahrscheinlichkeit ein engmaschiges Follow-up. Höhere Stadien sind in der Präpubertät extrem selten. Bei Rezidiv oder Metastasen erfolgt eine Polychemotherapie. Die operative Entfernung des befallenen Hodens besteht in einer Ablatio testis über einen hohen inguinalen Zugang. Eine retroperitoneale Lymphadenektomie wird nur im Fall von residualen Tumoren nach induktiver Chemotherapie empfohlen. Metastasierte Sertoli-Zell- und undifferenzierte Stromatumoren erfordern eine individualisierte, aggressive Therapie.

Abstract

Based on findings from the Prepubertal Testis Tumor Registry by the Urologic Section of the American Academy of Pediatrics and collaborative data in the literature, a modern algorithm for the surgical management of prepubertal testis tumors is presented. Following testicular surgery, patients with universally benign tumors, such as teratoma, may be released from oncological follow-up. Children with stage I yolk sac tumors should be monitored closely with periodic AFP tumor marker evaluation and imaging according to the primary dissemination (e.g., ultrasound, chest x-ray, and computed tomography). Patients with recurrent or metastatic yolk sac tumors should be treated with platinum-based chemotherapy and appropriate follow-up. Retroperitoneal lymph node dissection is not recommended except for patients with residual retroperitoneal masses following chemotherapy. Aggressive treatment is warranted for metastatic Sertoli cell and metastatic undifferentiated stromal tumors.

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Authors and Affiliations

  1. Klinik für Urologie und Kinderurologie, St. Antonius-Hospital, Dechant-Deckers-Straße 8, 52249, Eschweiler, Deutschland

    J. Steffens & A. Treiyer

  2. Klinik für Pädiatrische Hämatologie und Onkologie, Universität, Münster, Deutschland

    G. Calaminus

Authors
  1. J. Steffens
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  2. A. Treiyer
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  3. G. Calaminus
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Corresponding author

Correspondence to J. Steffens.

Anhang

Anhang

MAKEI-Studienzentrale:

Klinik und Poliklinik für Kinder- und Jugendmedizin, Pädiatrische Hämatologie und Onkologie Münster

Studienleiterin: Dr. Gabriele Calaminus

Tel.: (0251) 83-58060

Studiendokumentarin Carmen Teske

Tel.: (0251) 83 - 58061

Fax: (0251) 83 - 57874

E-Mail: makei@uni-muenster.de

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Steffens, J., Treiyer, A. & Calaminus, G. Präpubertäre Hodentumoren. Urologe 48, 359–363 (2009). https://doi.org/10.1007/s00120-009-1944-1

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  • DOI: https://doi.org/10.1007/s00120-009-1944-1

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