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quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "The survival of children with testis tumours depends on the histology of the tumour and the presence or absence of metastatic disease. Children with teratomas, epidermoid cysts, and benign stromal tumours do well with excision alone. No long-term follow-up is required. Patients with yolk sac tumour require a metastatic evaluation consisting of a CT scan of the abdomen and pelvis, a chest x-ray or chest CT scan, and determination of the serum AFP level. The half-life of AFP is 5 days. Approximately 80% of patients will have stage 1 disease (disease limited to the testicle) confirmed by a negative radiographic evaluation and normalization of the AFP level. These patients may be observed closely without adjuvant therapy. Historically, follow-up has included CT scans every 2 months and chest x-rays and AFP levels monthly for 2 years, followed by observation at longer intervals. However, consideration should be given to decreasing the frequency of CT scanning by relying more on AFP levels and MRI, to minimize the long-term risks of radiation exposure from multiple CT scans. The relapse rate for stage 1 yolk sac tumour patients is approximately 20% but virtually all patients can be salvaged with chemotherapy. Patients who present with metastatic disease are treated with adjuvant chemotherapy, and survival is nearly 100% for this group as well. Radiation plays no role in the primary treatment of these tumours. Metastatic stromal tumours, though exceedingly rare, are resistant to treatment. Survival is low for this group."

quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "Retroperitoneal lymph node dissection (RPLND) plays a very limited role in prepubertal testis tumours. Unlike adults, only a minority of prepubertal patients with metastases have metastases limited to the retroperitoneum, and metastatic disease is very responsive to chemotherapy. Furthermore, the complication rate following RPLND is significantly higher in children than in adults. The only relative indications for retroperitoneal surgery in a prepubertal patient are to biopsy an equivocal node or to excise a persistent retroperitoneal mass following chemotherapy—a rare occurrence."

quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "If, based on the AFP level, a tumour is felt to be malignant, then an inguinal orchiectomy is performed. Tumours that are likely to be benign based on AFP level should be managed initially with an excisional biopsy and frozen section analysis. Even tumors that appear on ultrasound to replace the testis may be enucleated, leaving significant residual testicular tissue. If a benign histology is confirmed, then the testis is closed with absorbable suture and returned to the scrotum. If the biopsy reveals a malignant tumour (usually yolk sac) or potentially malignant tumour (such as an undifferentiated stromal tumour or a Sertoli cell tumour in an older child), then an inguinal orchiectomy should be performed. If a teratoma is diagnosed and the child is near pubertal age, the surrounding parenchyma should be examined for its pubertal status. If the tubules are immature, then the tumour may be treated as benign, but if the tubules show evidence of maturation, the tumour should be treated as potentially malignant because some adult teratomas behave in a malignant fashion."

quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "Generally speaking, a child over 1 year of age with a testicular mass and an elevated AFP can be assumed to have a yolk sac tumour."

quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "Most testicular tumours present as a painless, hard mass, though rarely they may present with pain related to an acute bleed. On physical examination, a mass that cannot be separated from the testis is assumed to be a testis tumour until proven otherwise. Ultrasound is very helpful in making this distinction when the physical examination is unclear. Rarely, testis tumours may present with a reactive hydrocele. If a hydrocele is large and firm enough to preclude palpation of the testis, an ultrasound should be obtained."

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quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "These lesions are best resected within the first 24 h after birth, because the gut is usually not colonized in the first 24 h, reducing the risk of infection if the field is contaminated by stool during the resection. Perioperative antibiotics are given immediately before surgery commences and continued for 24–48 h postoperatively."

quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "An abdominal ultrasound will determine the size and consistency of any pelvic or abdominal component. It may be necessary to fill the bladder with water to allow it to be used as a sonic window. MRI should clearly distinguish between sacrococcygeal teratoma and anterior meningocele, and may be able to detect the occasional extension of the tumour through the sacral hiatus into the spinal canal."

Quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "Dermal sinuses must be differentiated from benign coccygeal pits, which end blindly and never extend intraspinally, and therefore do not require further imaging evaluation or treatment. Dermal sinus tracts are found above the natal cleft and are usually directed superiorly. By comparison, coccygeal pits are found within the natal cleft, below the top of the intergluteal crease, with a tract extending either straight down or inferiorly. Coccygeal pits occur over the lower sacrum and coccyx and are anatomically located below the level of the subarachnoid space. They are encountered in nearly 5% of newborns, and although they are present from birth, they rarely manifest themselves before adult life. In later years, these small pits or dimples may become pilonidal sinuses or abscesses."