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Genital Tumors
Genital tumors in children and adolescents are rare and differ from those seen in adults. They primarily affect the gonads—the ovaries and testicles—but can also arise in the vulva, vagina, uterus, paratesticular tissues, or, in rare cases, the penis. Treatment aims for a cure while preserving fertility, pubertal development, and organ function as much as possible.
In children, an ovarian or testicular mass may be benign or malignant. Age, whether the lesion is solid or cystic, blood markers, and imaging findings help guide the diagnosis, but a histopathological examination is often essential.
Preserve the gonad whenever it is safe to do so
Conservative surgery may be recommended for several benign lesions and in certain selected situations. If cancer is suspected, the procedure must follow oncological guidelines, avoid rupturing the tumor, and preserve the other gonad.
For girls
Ovarian tumors are the most common genital tumors in girls. The majority of pediatric ovarian masses are benign. Germ cell tumors are the main type of malignant ovarian tumors in adolescent girls.
Dysgerminoma, yolk sac tumor, immature teratoma, and mixed tumors. Some secrete AFP or beta-hCG.
Granulosa cell tumors, Sertoli-Leydig cell tumors, and other rare forms. They can cause precocious puberty or virilization.
Rare in children. They include benign, borderline, and, in rare cases, malignant tumors.
A tumor occurring in a dysgenetic gonad, associated with certain variations in sexual development and the presence of Y chromosome material.
Leukemia, lymphoma, or metastases can affect the ovary. Treatment depends on the underlying disease and does not involve routine ovarian surgery.
Very rare. They include, in particular, rhabdomyosarcomas and germ cell tumors, for which the treatment strategy differs from that used for gynecologic cancers in adults.
Lymphoma involving the ovaries is not treated the same way as a primary ovarian tumor
When the ovary is affected by leukemia or lymphoma, treatment is directed at the hematologic disease. An oophorectomy is not routinely performed.
For boys
Testicular tumors are very rare in children. Their nature varies with age. Before puberty, many masses are benign. After puberty, malignant germ cell tumors become more common and resemble those seen in adolescents and young adults.
A mature teratoma is often benign. The yolk sac tumor is the most common malignant germ cell tumor in young children and is usually associated with elevated AFP levels.
Seminoomas and nonseminoomatous tumors may occur. Their management follows the protocols for adolescents and young adults.
Although they are often benign, they can lead to precocious puberty, gynecomastia, or other hormonal symptoms.
It originates in the tissues of the spermatic cord or the tunicae, not in the testis itself. Treatment involves a combination of chemotherapy and local control.
In rare cases, leukemia or lymphoma can affect the testicle. Treatment is the same as for the underlying disease.
It occurs in a dysgenetic gonad and requires coordinated care involving oncology, endocrinology, genetics, and surgery.
A large cyst isn't always a tumor
Hydrocele, hernia, infection, or testicular torsion are more common. However, a hard lump in the testicle, persistent swelling, or acute pain require prompt evaluation.
Symptoms
Enlarged abdomen, pelvic mass, enlarged ovary, or a larger, harder testicle.
Persistent or acute pain, sometimes caused by a sprain or tear.
She orders an urgent workup for testicular torsion, which must be treated promptly.
Precocious puberty, vaginal bleeding, virilization, breast enlargement, or other unusual changes.
They can occur when a pelvic mass compresses the bladder, ureter, or intestine.
Fatigue, weight loss, or fever may occur, but these symptoms are nonspecific.
Two Emergencies You Should Know About
Sudden abdominal pain accompanied by vomiting may indicate ovarian torsion. Sudden testicular pain may indicate spermatic cord torsion. In both cases, urgent surgical evaluation is essential.
The Diagnosis
Imaging
An abdominal and pelvic ultrasound is the first test performed to evaluate an ovarian mass. A scrotal ultrasound with Doppler analyzes a testicular mass and its blood supply. A pelvic MRI or CT scan may be used to complete the workup. A chest CT scan is performed to look for metastases when clinically indicated.
Blood Markers
AFP, beta-hCG, and LDH aid in the diagnosis and monitoring of germ cell tumors. AFP levels must be interpreted according to age, as they are physiologically elevated in infants. Hormone levels, including inhibin, anti-Müllerian hormone, testosterone, or estradiol, may be useful for certain tumors of the sex cords.
Diagnostic surgery
The procedure is planned based on the risk of malignancy. For a suspicious ovarian mass, rupture and dissemination within the abdomen must be prevented. For a testicular mass, the inguinal approach allows for examination of the cord. A frozen-section analysis may help determine whether conservative surgery is appropriate in certain situations, though it does not replace the definitive pathological examination.
The markers may be normal
Normal AFP or beta-hCG levels do not rule out a malignant tumor. Dysgerminomas, seminomas, and several stromal tumors may not secrete these markers.
Treatments for Ovarian Tumors
Treatment depends on the histological type, stage, markers, and whether the ovary can be preserved. For a benign mass, a cystectomy or conservative tumorectomy is preferred whenever possible.
For a localized malignant germ cell tumor, a unilateral adnexectomy removing the affected ovary and fallopian tube may be necessary, while preserving the uterus and the contralateral ovary. A routine biopsy of the healthy ovary is not indicated if it appears normal. Chemotherapy is prescribed based on histology, stage, and changes in tumor markers, and not solely in cases of metastasis.
Preventing Tumor Rupture
Laparoscopic lumpectomy may increase the risk of rupture for certain large masses. The choice between laparoscopy and open surgery depends on the size and appearance of the tumor and the ability to remove it intact.
Treatments for Testicular Tumors
In prepubertal boys, conservative surgery may be recommended when imaging and biomarkers suggest a benign lesion and rapid histopathological analysis is available. A suspected yolk sac tumor or a malignant mass generally requires an inguinal orchiectomy.
In postpubertal adolescents, the management strategy is similar to that for testicular tumors in young adults. Chemotherapy depends on the tumor type, stage, and markers following surgery. A contralateral biopsy is not routinely performed.
Puberty changes the strategy
A testicular teratoma in a young child generally behaves like a benign tumor, whereas a germ cell tumor that develops after puberty is classified and treated differently.
Preserving Fertility and Hormonal Function
Fertility preservation is discussed before any treatment that could affect the gonads. The strategy depends on age, pubertal development, urgency, and the planned treatments.
Unilateral surgery generally preserves hormonal and reproductive function if the opposite gonad is healthy.
It may be offered after puberty and before gonadotoxic chemotherapy.
It may be discussed with some women before they undergo treatment that poses a high risk to fertility.
Puberty, menstrual cycles, sex hormones, and development are monitored over the long term.
Children, adolescents, and their parents receive information tailored to their age and situation.
Care combines oncology, endocrinology, genetics, surgery, and psychological support, with a particular focus on confidentiality and informed consent.
Follow-up
Follow-up depends on the diagnosis and treatment. It combines a clinical examination, biomarker monitoring (when levels were elevated), and appropriate imaging. It is designed to detect a relapse, monitor the contralateral gonad, and provide support regarding puberty, fertility, and psychological health.
Patient Care at Gustave Roussy
The Department of Pediatric and Adolescent Oncology coordinates patient care with the teams in pediatric surgery, urology, gynecology, imaging, pathology, endocrinology, genetics, reproductive medicine, and supportive care. The diagnosis and treatment strategy are discussed during multidisciplinary team meetings.
Surgeries are organized in collaboration with partner teams possessing the necessary surgical expertise, with a constant focus on oncological safety and functional preservation.
Key Points
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Rare and Highly Diverse Tumors
The nature of these tumors varies depending on the organ, age, and stage of puberty.
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Ovarian masses are often benign
However, any complex or solid mass requires a specialized evaluation.
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Markers provide guidance but are not sufficient
AFP, beta-hCG, and LDH levels must be interpreted in conjunction with the patient’s age and imaging results.
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Surgery is scheduled
It must prevent rupture and preserve the gonad when it is oncologically safe to do so.
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Chemotherapy is not limited to metastatic tumors
Its use depends on the diagnosis, stage, and biomarkers.
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Fertility is a goal of the treatment plan
It is discussed before high-risk treatments and monitored over the long term.