Diagnosis Of Testicular Lesions Research Articles

Diagnosis and management of indeterminate testicular lesions.

The sophistication and accessibility of modern-day imaging result in frequent detection of small or equivocal lesions of the testes. Traditionally, diagnosis of a testicular lesion with any possibility of malignancy would usually prompt radical orchidectomy. However, awareness is growing that a substantial proportion of these lesions might be benign and that universal application of radical orchidectomy risks frequent overtreatment. Given the potentially profound effects of radical orchidectomy on fertility, endocrine function and psychosexual well-being, particularly in scenarios of an abnormal contralateral testis or bilateral lesions, organ-preserving strategies for equivocal lesions should be considered. Image-based active surveillance can be applied for indeterminate lesions measuring ≤15 mm with a low conversion rate to surgical treatment. However, these outcomes are early and from relatively small, selected cohorts, and concerns prevail regarding the metastatic potential of even small undiagnosed germ cell tumours. No consensus exists on optimal surveillance (short interval (<3 months) ultrasonography is generally adopted); histological sampling is a widespread alternative, involving inguinal delivery of the testis and excisional biopsy of the lesion, with preoperative marking or intraoperative ultrasonographic localization when necessary. Frozen section analysis in this context demonstrates excellent diagnostic accuracy. Histological results support thatapproximately two-thirds of marker-negative indeterminate solitary testicular lesions measuring ≤25 mm overall are benign. In summary, modern imaging detects many small indeterminate testicular lesions, of which the majority are benign. Awareness is growing of surveillance and organ-sparing diagnostic and treatment strategies with the aim of minimizing rates of overtreatment with radical orchidectomy.

Should Testis Elastography be Performed in All Patients with Scrotal Swelling? A Case Report

Some of testicular tumor cases can present with symptoms like epididymo-orchitis and this condition can cause delay in the diagnosis of testis tumor. Even though scrotal Doppler ultrasound has high sensitivity (up to 100%) in the diagnosis of testicular lesions; it alone may not be sufficient in the differential diagnosis of benign and malign lesions. The delay of the diagnosis can cause progression of stage and consequently worsening prognosis. In this case, it was aimed to present a case that is thought to be testicular tumor according to Elastography which applies with clinical features like epididymo-orchitis and cannot be diagnosed with B-mode scrotal Doppler ultrasound.

Role of ultrasound in the diagnosis of testicular lesions

Ultrasound is the main imaging technique in the assessment of the scrotal contents, providing unparalleled imaging of exquisite resolution. Ultrasound is effectively the sole scrotal imaging technique that a patient will undergo prior to definitive surgery. The accurate assessment of focal intratesticular lesions in the adult patient is of paramount importance, although most focal lesions will be malignant and require an orchidectomy, the recognition of the benign entity is essential to the individual patient. This article covers the salient features of benign and malignant focal intratesticular lesions to allow a confident diagnosis and to prevent unnecessary orchidectomy. We detail the range of intratesticular malignancies from germ cell tumors to lymphoma and metastases. Operator confidence is necessary to establish a benign diagnosis and we highlight important benign lesions that may benefit from a ‘watch and wait’ policy, such as infarction, abscess formation, focal orchitis, rete testis; as well as ...