Pediatrik Olgularda Testis Tümörlerine Yaklaşım
Özet
Çocukluk çağında nadir görülen testis tümörleri, yetişkinlere kıyasla daha iyi huylu ve az agresif bir seyir izler; 2 yaş civarı ve puberte olmak üzere iki pik dönemi mevcuttur. Saptanan kitlelerin büyük kısmı iyi huylu olup, primer tümörler çoğunlukla germ hücre kaynaklıdır. Germ hücreli tümörler arasında en sık Endodermal Sinüs Tümörü görülürken, stromal kaynaklı olanlar puberte prekoks bulgularıyla ortaya çıkabilir. Etiyolojide inmemiş testis, aile öyküsü, perinatal faktörler ve genetik anomaliler suçlanmaktadır. Tanıda yüksek duyarlılığa sahip ultrasonografi ile AFP, β-hCG ve LDH gibi tümör belirteçlerinden yararlanılır; evreleme için Bilgisayarlı Tomografi tercih edilir. Tedavi algoritmasında, pubertal dönemde ve malignensi durumlarında altın standart yüksek inguinal radikal orşiektomi iken, prepubertal çocuklarda fertilitenin korunması amacıyla konservatif yaklaşım ve testis koruyucu cerrahi her zaman ön planda tutulmalıdır. Operasyon sırasında şüpheli durumlarda frozen biyopsi yol göstericidir. Tedavi sonrası özellikle ilk yıllarda nükslerin takibi için klinik, radyolojik ve biyokimyasal izlem büyük önem taşır.
Testicular tumors, which are rare in childhood, follow a more benign and less aggressive course compared to adults, with two peak periods around the age of 2 and puberty. Most detected masses are benign, and primary tumors are mostly of germ cell origin. While Endodermal Sinus Tumor is the most common among germ cell tumors, stromal tumors may present with symptoms of precocious puberty. Undescended testis, family history, perinatal factors, and genetic abnormalities are implicated in the etiology. Diagnosis utilizes highly sensitive ultrasonography and tumor markers such as AFP, β-hCG, and LDH; Computed Tomography is preferred for staging. In the treatment algorithm, while high inguinal radical orchiectomy is the gold standard during the pubertal period and in cases of malignancy, conservative approaches and testis-sparing surgery should always be prioritized in prepubertal children to preserve fertility. Frozen biopsy during operation guides management in suspicious cases. Post-treatment clinical, radiological, and biochemical follow-up is of great importance for monitoring recurrences, especially in the first years.
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