If elevated markers or retroperitoneal disease persists, a biopsy or resection of residual tumor is performed. Prepubertal testicular teratoma, Leydig cell, and Sertoli cell tumors are benign, and an orchiectomy or testicular-sparing surgery with complete excision results in cure. Stage II or higher teratocarcinomas require treatment with cisplatin, bleomycin, and vinblastine. Treatment of gonadoblastoma involves removal of the gonad. In fact, streak gonads are removed routinely due to the risk of malignant degeneration.
Seminoma is rare before puberty and is managed as in the adult.
Perform a radical inguinal orchiectomy for paratesticular rhabdomyosarcoma. If the scrotum is involved, a hemi-scrotectomy should be performed. All children with rhabdomyosarcoma require chemotherapy. Patients with evidence of metastatic disease also may require radiation therapy. Children older than 10 years have a worse prognosis and no well-established treatment protocol exists.