Prepubertal-type mature cystic teratoma of the testis in an infant: a rare benign entity with excellent prognosis-managed with testis sparing approach

Abstract

Testicular tumors in infants are rare, accounting for only 1-2% of pediatric solid tumors. Among these, teratomas are the most common type, particularly in the prepubertal age group. Unlike their post-pubertal counterparts, prepubertal-type mature teratomas are usually benign, lack malignant potential, and are remotely associated with germ cell neoplasia in situ (GCNIS). While mature teratomas are typically found in the abdomen, intratesticular prepubertal-type teratomas in infants are infrequent. The present study describes the case of an infant with an intratesticular mature teratoma. Five months old infant presented with painless right sided scrotal swelling detected incidentally. Scrotal ultrasound revealed a large anechoic cystic lesion measuring 28×18 mm with no septation, calcification, or solid component. Blood parameters including tumor markers viz. alpha-fetoprotein (AFP) and beta-human chorionic gonadotropin (β-hCG) were within normal range for age. Surgical tumor enucleation (testis sparing surgery) was performed, and the histopathological examination revealed a benign, prepubertal-type teratoma composed entirely of mature elements. Based on the findings diagnosis of prepubertal-type mature teratoma (MT) was thus made. Child was later was kept under observation in follow-up. Surgical intervention is commonly used for the management of benign testicular tumors in pediatric patients, including prepubertal teratomas. Indeed, testis-sparing surgery is a recommended option in prepubertal age patients with such a presentation of testicular mass with a benign ultrasonography finding like homogeneous, unilocular, non-septated cyst without any internal echoes, no calcification, no solid component and negative serum markers.