Burned-Out Testicular Tumors in Adolescents: Clinical Aspects and Outcome

Purpose: Testicular germ cell tumors are the fourth most common neoplasm in adolescents, accounting for 8% of all tumors in the age group 15-19 years. On rare instances, the primary testicular lesion is not clinically or radiologically evident while nodal or visceral metastases represent the clinical manifestations of the disease. This phenomenon is described as burned-out testicular tumor. In this paper, the authors report a single-institution experience with burned-out testicular tumors in adolescents and discuss their clinical implications.Patients and Methods: All the patients diagnosed with metastatic testicular germ cell tumors at Bambino Gesu Children Hospital between January 1, 2010, and June 30, 2020, were included in the study. Patients were categorized into two groups: primary testicular and burned out. All the patients were staged and treated according to the AIEOP-TCGM 2004 protocol.Results: Eleven patients were classified as primary testicular, and five patients were classified as burned out. Burned-out tumors were associated with the presence of systemic symptoms compared to primary testicular tumors (80 vs. 0%; p = 0.0027) and higher aFP, hCG, and LDH levels (p < 0.00001). The burned-out population had a statistically significant higher incidence of relevant toxicity than the primary testicular population (80 vs. 18%; p = 0.0357) and a worse outcome in terms of both mean overall survival (15 vs. 43 months; p = 0.0299) and mean event-free survival (12 vs. 38 months; p = 0.0164).Conclusion: Burned-out testicular tumors seem to be a well-distinct clinical entity with a high treatment-related toxicity and poor prognosis. Further studies are needed to clarify the burned-out phenomenon and to identify more effective therapeutic strategies for these patients.

Automated summary

Burned-out testicular tumors are a distinct clinical entity characterized by nodal or visceral metastases as clinical manifestations without a clinically or radiologically evident primary testicular lesion. These tumors are associated with systemic symptoms, higher levels of tumor markers, increased treatment-related toxicity, and poorer outcomes compared to primary testicular tumors. Further research is needed to better understand burned-out testicular tumors and develop more effective therapeutic strategies.