Tumorregister und Realität – Differenzialdiagnose von Hodentumoren im Kindesalter – Übersicht mit eigenem Patientengut

Zusammenfassung

Jede verhärtet tastbare skrotale oder testikuläre Raumforderung im Kindesalter ist für den Kliniker eine vielschichtige Herausforderung. Primäre präpubertäre Hodentumoren sind selten. Bei der Differenzialdiagnostik kann die Hodensonografie wichtige Hinweise liefern. Wenngleich in Analysen der nationalen und internationalen Tumorregister maligne Hodentumoren überrepräsentiert sind, ist für den Kliniker die wichtigste Initialinformation aus klinischen Serien kinderurologischer Zentren, dass präpubertäre Hodentumoren bis zum 12. Lebensjahr meist gutartige Entitäten darstellen. Daher wird heute bei unauffälligem alpha-Fetoprotein und abgrenzbarem Restparenchym eine hodenerhaltende Tumorexzision empfohlen. Die wohl bekannten onkologischen Prinzipien gelten auch im Kindesalter, Staginguntersuchungen werden aber in der Regel erst nach Erhalt der definitiven Histologie durchgeführt. Die Patienten werden im Tumorregister erfasst und in Einzelfällen kann je nach Studienlage und Verlauf eine adjuvante Therapie nötig sein. Neben den Erkenntnissen der Tumorregister sollen die möglichen Differenzialdiagnosen, die Problematik der hodenerhaltenden Chirurgie und die Bedeutung der testikulären Mikrolithiasis im Kindesalter diskutiert werden.

Abstract

Painless scrotal swelling must always be considered as a potential malignant testicular tumour until proven otherwise. Prepubertal testicular tumours are seldom entities, for their differential diagnosis testicular sonography is gaining increasing importance. Although, according to national and international tumour registries, most patients tend to have malignant tumours, some clinical series from paediatric centres confirm that prepubertal testicular tumours are mainly benign lesions, especially up to the age of 12 years. Testis-sparing procedures are favoured when AFP is in a normal range and testicular parenchyma is detected sonographically. Oncological principles should be applied to paediatric patients consequently, staging examinations should be requested when a definite histology is proven. Cases should be reported to national tumour registries and, in addition to close surveillance, in some cases adjuvant therapy is necessary. In addition to the clinical guidelines from the tumour registries, differential diagnosis, testis-sparing surgery and the presence of TIN in the paediatric population should be discussed.

Schlüsselwörter

präpubertäre Hodentumoren - Kindesalter - hodenerhaltendes Vorgehen

Key words

prepubertal testicular tumours - childhood - testis-sparing surgery

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