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 -

"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 -

"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."