ORIGINAL ARTICLE Testicular and paratesticular pathology in infants and children: the histopathological experience of a tertiary paediatric unit over a 17 year period F. L. Murphy H. Law I. Mushtaq N. J. Sebire Accepted: 3 May 2007 / Published online: 18 July 2007 Ó Springer-Verlag 2007 Abstract To examine the pathological features of paedi- atric testicular and paratesticular lesions from a tertiary referral centre and describe their relative pathological frequency, highlighting relevant epidemiological and his- topathological findings. A search was made of a computer- ised histopathology database covering the period from 1988 to 2004 inclusive to identify cases of testicular and parates- ticular pathologies, and the clinical and histopathological features reviewed. Five hundred and fifty-one appropriate specimens underwent histological examination during the period. Three hundred and eleven (56%) presented with an impalpable testis with or without intersex disorder and 121 (22%) with a testicular/paratesticular mass. While metastatic leukaemic testicular involvement (N = 47) was the com- monest tumour identified in this preselected series, at a peak of 8 years, primary testicular tumours such as yolk sac and teratoma were most commonly identified in infancy. Of 109 (20%) presenting with an acutely painful scrotum, the largest group (47%) represented torsion of the appendix testis. The vast majority of pathological samples arose from children less than 4 years of age in accordance with the predominance of cryptorchidism, ‘vanished’ testis, neonatal torsion and testicular tumours in this age group. The findings of this study demonstrate the spectrum of testicular pathology in childhood. Neoplasms represented >20% of the pathology, but the largest clinical group of pathological specimens in this patient population is associated with clinically impal- pable or the palpably abnormal testis. Keywords Testis Á Pathology Á Tumours Á Cryptorchidism Á Testicular regression Introduction A wide range of pathological lesions may affect the pae- diatric testis, including tumours and non-neoplastic lesions. Some of these entities, such as testicular torsion, are well reported in adult urological literature while others, such as juvenile granulosa cell tumour and the ‘vanished testis’, are essentially unique to childhood. Furthermore, the spectrum of testicular pathology in infancy and childhood is addi- tionally affected by numerous cases of cryptorchidism and intersex anomalies. The pathological features of individual entities affecting the paediatric testis are well described but there is a paucity of literature regarding the relative fre- quencies and spectrum of paediatric testicular lesions in relation to basic demographic data. The aim of this study was to review the pathological features of paediatric testicular lesions from a large series encountered at a single centre, and to describe their relative frequency, highlighting relevant epidemiological and his- topathological findings. Methods The histopathology department at Great Ormond Street Hospital, London, is a tertiary referral centre for paediat- ric pathological diagnoses and assesses specimens both F. L. Murphy (&) Á I. Mushtaq Department of Paediatric Urology, Great Ormond Street Children’s Hospital, Great Ormond Street, London WC1N 3JH, UK e-mail: feilimmurphy@ireland.com H. Law Á N. J. Sebire Department of Histopathology, Great Ormond Street Children’s Hospital, Great Ormond Street, London WC1N 3JH, UK 123 Pediatr Surg Int (2007) 23:867–872 DOI 10.1007/s00383-007-1959-x