Ultrasonografia dopplerowska w diagnostyce nowotworów jąder u dzieci

Bibliogr. s. 76

Malignant testicular tumors account for approximately 1-2% of all pediatric malignancies. We evaluated the usefulness of Color Doppler and contrast-enhanced Color Doppler ultrasonography in the detection and diagnostic differentiation of testicular tumors in children. Thirty boys were treated for testicular tumors. They ranged in age from 4 months to 16 years (mean: 4.6 years). All were staged according to the Pediatric Oncology Group/ Children Cancer Study Group staging system. Diagnostic assessment included in all cases conventional ultrasonography (US), Color Doppler (CD), and Power Doppler (PD) before and after the administration of contrast agent. Germinal tumors and tumor arising from the endodermal sinus (yolk sac tumors) were the most common. Eight patients had stage III, four stage IV, and eighteen stages I and II. Histologically, 13 patients had pure endodermal sinus tumor (EST), 4 had EST with embryonal carcinoma, 5 had embryonal carcinoma alone, 8 had teratoma, and 1 had non-germinal tumor. In the group of EST patients, the largest number of lesions were enhanced by 2-3 points, embryonal carcinoma by 4-5 points, and teratoma immatrum by over 4 points. EST and embryonal carcinoma presented peak enhancement in a time under 120 sec., and teratomas in a time under 180 sec. Teratomas and embryonal carcinoma had the longest enhancement times. Three patients with teratoma in stage 1 had only the tumor removed, sparing the testis. Twenty patients had unilateral orchiectomy and three had lymphadenectomy. All children received chemotherapy depending on the character of the tumors. We have observed much better prognosis in children with testicular tumors after surgery of the tumor and subsequent intensive chemotherapy. US examination with unenhanced and contrastenhanced Color Doppler is important in achieving the correct diagnosis and better treatment results. US contrast agent (Levovist) is very helpful in precise visualization of pathological vessels inside the tumor mass, and can be considered useful in the initial differentiation between testicular tumor types.