Retrospective Evaluation of Childhood Germ Cell Tumors: A Single-Center Experience

Abstract

Highlights What are the main findings? Gonadal germ cell tumors were more frequent than extragonadal tumors, with the sacrococcygeal region representing the most common primary site in early childhood. High overall and malignant survival rates were achieved using risk-adapted multimodal treatment, despite heterogeneity in tumor site, histology, and disease stage. What are the implications of the main findings? Increased clinical awareness of typical presenting symptoms, combined with routine use of ultrasonoraphy and AFP testing, may facilitate earlier diagnosis and reduce advanced-stage presentation. Early referral to specialized pediatric oncology centers and complete surgical resection are essential to achieving high survival rates while minimizing treatment intensity and long-term morbidity.Highlights What are the main findings? Gonadal germ cell tumors were more frequent than extragonadal tumors, with the sacrococcygeal region representing the most common primary site in early childhood. High overall and malignant survival rates were achieved using risk-adapted multimodal treatment, despite heterogeneity in tumor site, histology, and disease stage. What are the implications of the main findings? Increased clinical awareness of typical presenting symptoms, combined with routine use of ultrasonoraphy and AFP testing, may facilitate earlier diagnosis and reduce advanced-stage presentation. Early referral to specialized pediatric oncology centers and complete surgical resection are essential to achieving high survival rates while minimizing treatment intensity and long-term morbidity.Abstract Background: Germ cell tumors are benign or malignant tumors that originate from the human embryo's primordial germ cells. This study aims to conduct a retrospective analysis of germ cell tumors followed up at our institution, including their epidemiological data, treatment, and prognosis. Patients and Methods: Ninety-three cases were included and retrospectively evaluated for socio-demographic features, clinical data, presenting symptoms, histopathological findings, localization, staging, treatment protocol, and survival analysis. Results: Patients were diagnosed between 10 days and 17 years 10 months (median 27.2 months); 37 (40.7%) were male, 54 (59.3%) female. The tumors were located in the sacrococcygeal region (33.3%), ovaries (26.8%), testes (25.8%), abdomen (7.5%), CNS (2.1%), liver, adrenal gland, anterior mediastinum, and spine. Thirty-nine lesions were benign, and 54 were malignant. Mature cystic teratomas (40.8%), endodermal sinus tumors (28.0%), mixed germ cell tumors (12.9%), immature teratomas (9.7%), germinoma (6.5%), gonadoblastoma (1.1%), and choriocarcinoma (1.1%) were the different types of histology. We observed metastases in 17 malignant cases, with the lungs being the most commonly affected (10.7%). Stages I, II, III, and IV included 16, 17, 11, and 10 cases, respectively. Survival rates for all cases were 95.8%, and for malignant tumors, they were 92.7%. For malignant cases, the event-free survival rate was 84.2%. Conclusions: The findings provide comprehensive epidemiological and clinical data on germ cell tumors, enhancing understanding of their distribution, treatment outcomes, and prognosis. The high survival rates observed highlight the effectiveness of current treatment protocols, as well as the importance of early diagnosis and appropriate management.