Cryptorchidism is associated with a 3 to 10-fold increase in malignancy and the age at which it is undertaken matters; the risk of testicular cancer is doubled in patients undergoing orchidopexy at 13 years of age compared to that treated before this age. For this reason, testicular biopsy may be considered by some at the time of orchidopexy in older boys (and sometimes orchidectomy may be undertaken due to concerns over possible malignancy risk). Here, Xu et al. have undertaken a single centre (Boston Children’s Hospital), retrospective review of boys (1994-2016) undergoing orchiectomy or orchidopexy with testicular biopsy. Seventy-one patients were included. Interestingly, the age range was from 10.1 years to 27.7 years! Median age was 15.3 years. Sixty-seven had unilateral procedures and the remaining four underwent bilateral procedures. Only 2/71 (2.8%) demonstrated malignancy. By testis location, malignancy was found in 0/55 (0%) of extra-abdominal testes, as compared to 2/16 (12.5%) of intra-abdominal testes. Both cases of malignancy were found in older ‘boys’ undergoing unilateral orchiectomy. One was 16 years of age (histology showed intertubular seminoma and intratubular germ cell neoplasia) and the other patient was 26 years of age with developmental delay (classic type seminoma and intratubular germ cell neoplasia on histology). The study findings are useful as a clinical guide to those undertaking orchidopexies in their patient populations. They suggest that even in older boys and adolescents, undescended testes that are extra-abdominal (i.e. inguino-scrotal in position) may not need to be removed or even biopsied at time of orchidopexy. However, if the testis is intra-abdominal, a biopsy at minimum is likely indicated. The study does not distinguish between primary undescended testes and ascending testes (i.e. those that ascend over time due to the cord being ‘tight’); these two populations most likely carry different malignancy risks; an ascending testis will probably not have the same malignancy risk but the authors note differentiating between the two may be challenging. The take home message is that the late presentation of an inguinal testis should not necessarily lead to orchidectomy.
Malignancy yield of testis pathology in older boys and adolescents with cryptorchidism.
Xu R, McQuaid JW, Paulson VA, et al.
JOURNAL OF UROLOGY
2022;207:694-700
