Testis-sparing Surgery Research Articles

Treatment of Leydig cell tumors of the testis: Can testis-sparing surgery replace radical orchidectomy? Results of a systematic review

IntroductionThe gold standard for Leydig cell tumors (LCTs) is still considered radical orchidectomy, but testis sparing surgery (TSS) in conjunction with intraoperative frozen section (FSE) has been recently attempted with promising results. Acquisition of evidenceStudies were identified by searching electronic databases. A bibliographic search covering the period from January 1980 to December 2012 was conducted using PubMed/MEDLINE and EMBASE database. Studies were excluded if they were single case reports, meeting abstracts and conference proceedings. Synthesis of evidenceThe present analysis is based on a total of 13 studies that fulfilled the predefined inclusion criteria. A total of 247 participants were included in the 13 studies examined in this systematic review. 145 were treated with radical orchiectomy and 102 with TSS. In the radical surgery group, the follow-up varied from 6 to 249 months. In the TSS group, the follow-up varied from 6 to 192 months.Frozen section was performed in a total of 96 patients. Sensitivity was 87.5%.None of the patients treated with TSS presented a metastatic recurrence, while in patients treated with radical orchiectomy three patients presented with metastatic recurrence.In selected cases radical surgery appears excessive and the potential for a shift to TSS as the standard management is gathering momentum. ConclusionsThe results confirm the favorable course of LCT treated with TSS. The results obtained are encouraging and the concept is attractive to become the standard therapy in all patients and not only in people affected by (sub)fertility or with solitary testis.

Testis sparing surgery for treatment of small testicular lesions: Is it feasible even in germ cell tumors?

To evaluate the results of testis-sparing surgery (TSS) in patients, with small testicular lesions and a normal contralateral testicle. In all, 28 patients were treated with TSS for small testicular lesions and a normal contralateral testicle. TSS was considered in patients with testicular lesions smaller than 2 cm and no evidence of metastatic disease. The mean age of patients was 35.3 ± 7.3 years, while the mean diameter of the testicular lesions was 11.4 ± 3.7 mm. After pathological examination, 18 patients (64.3%) were diagnosed with stromal tumors and miscellaneous lesions, while 10 (35.7%) had a germ cell tumor. The median follow-up time for the former group was 33 months and no recurrences were observed. In one patient with germ cell tumor, immediate orchiectomy was performed, while the remaining nine were followed-up (median time, 45 months). One patient developed local recurrence after 39 months. Excellent outcomes for benign lesions could be achieved using TSS. TSS could be offered safely in highly selected patients with germ cell tumors, specifically within a clinical trial but there is more data needed regarding the potential risks and benefits. J. Surg. Oncol. 2017;115:287-290. © 2016 Wiley Periodicals, Inc.

Reliability of Frozen Section Examination in a Large Cohort of Testicular Masses: What Did WeLearn?

Frozen section examination (FSE) for testicular masses is gaining popularity because of the possibility of performing testis-sparing surgery (TSS) on the basis of the FSE results. The aim of our study was to investigate the reliability of FSE in the diagnosis of testicular masses. From 1999 to 2016, 144 of 692 patients who underwent surgery in our tertiary center for testicular masses had FSE. The indications for FSE were: masses< 1 cm, nonpalpable, multiple, or with unusual presentation. Mean follow-up for patients was 25.5 months. The algorithm of surgery determined by FSE was: orchiectomy if malignant or nonconclusive pathology; TSS if benign or nontumor pathology. FSE data were analyzed retrospectively. Specificity and sensitivity of the method was calculated for benign, malignant, seminoma, and nonseminoma tumors. Intraoperative FSE was conducted on 21% of candidates for surgery on testicular masses. The sensitivity and specificity of FSE were 93% and 98%, respectively, for malignant tumors, and 90% and 99%, respectively, for benign tumors. The κ agreement coefficient between FSE and final histopathology was statistically significant (0.76). TSS was performed in 57 (40%) patients, including 6 of 23 monorchid patients. FSE correlates well with final histopathological diagnosis of testicular masses. Thus, it reliably identifies patients who might benefit from TSS. FSE should be considered always in small, nonpalpable, multiple, or uncommonly presenting masses in solitary testis or both testes.

Testicular sparing surgery in small testis masses: A multinstitutional experience.

The incidence of benign testicular tumors is increasing in particular in small lesion incidentally found at scrotal ultrasonography. Primary aim of this study was to perform radical surgery in malignant tumor. Secondary aim was to verify the efficacy of the diagnostic-therapeutic pathway recently adopted in management of small masses with testis sparing surgery in benign lesions. In this multicenter study, we reviewed all patients with single testis lesion less than 15 mm at ultrasound as main diameter. We applied the diagnostic-therapeutic pathway described by Sbrollini et al. (Arch Ital Urol Androl 2014; 86:397) which comprises: 1) testicular tumor markers, 2) repeated scrotal ultrasound at the tertiary center, 3) surgical exploration with inguinal approach, intraoperative ultrasound, and intraoperative pathological examination. Definitive histology was reviewed by a dedicated uro-pathologist. Twenty-eight patients completed this clinical flowchart. The mean lesion size was 9.3 mm (range 2.5-15). Testicular tumor markers were normal except in a case. Intraoperative ultrasound was necessary in 8/28 cases. We treated 11/28 (39.3%) with immediate radical orchiectomy and 17/28 (60.7%) with testis-sparing surgery. Definitive pathological results were: malignant tumor in 6 cases (seminoma), benign tumor in 10 cases (5 Leydig tumors, 2 Sertoli tumors, 1 epidermoid cyst, 1 adenomatoid tumor, 1 angiofibroma), benign disease in 11 (8 inflammation with haemorragic infiltration, 2 tubular atrophy, 1 fibrosis), and normal parenchyma in 1 case. We observed a good concordance between frozen section examination and definitive histology. Any malignant tumor was treated conservatively. Any delayed orchiectomy was necessary based on definitive histology. The incidence of benign lesions in 60% of small testis lesions with normal tumor markers makes orchiectomy an overtreatment. Testicular sparing surgery of single testicular nodules below 15 mm is a safe option, but requires a standardized pathway in diagnosis. Our pathway has shown good reliability and security profile to be applied in a multicenter management for small scrotal masses. Our study has shown the reliability of the diagnostic-therapeutic pathway in the management of single testicular masses. The higher incidence of benign lesions in 60% of patients makes often orchiectomy an overtreatment.

Tratamiento de tumores de células Leydig del testículo: ¿puede la cirugía conservadora de testículo reemplazar la orquiectomía radical? Resultados de una revisión sistemática

IntroductionThe gold standard for Leydig cell tumours (LCTs) is still considered radical orchidectomy, but testis sparing surgery (TSS) in conjunction with intraoperative frozen section (FSE) has been recently attempted with promising results. Acquisition of evidenceStudies were identified by searching electronic databases. A bibliographic search covering the period from January 1980 to December 2012 was conducted using PubMed/MEDLINE and EMBASE database. Studies were excluded if they were single case reports, meeting abstracts and conference proceedings. Synthesis of evidenceThe present analysis is based on a total of 13 studies that fulfilled the predefined inclusion criteria. A total of 247 participants were included in the 13 studies examined in this systematic review. 145 were treated with radical orchiectomy and 102 with TSS. In the radical surgery group, the follow-up varied from 6 to 249 months). In the TSS group, the follow-up varied from 6 to 192 months.Frozen section was performed in a total of 96 patients. Sensitivity was 87.5%.None of the patients treated with TSS presented a metastatic recurrence, while in patients treated with radical orchiectomy three patients presented with metastatic recurrenceIn selected cases radical surgery appears excessive and the potential for a shift to TSS as the standard management is gathering momentum. ConclusionsThe results confirm the favourable course of LCT treated with TSS. The results obtained are encouraging and the concept is attractive to become the standard therapy in all patients and not only in people affected by (sub)fertility or with solitary testis.

Simple intratesticular cyst: A rare finding amenable to testis-sparing surgery

Simple intratesticular cyst: A rare finding amenable to testis-sparing surgery

76 - Outcomes of testis sparing surgery in patients with testicular mass: Experience in 12 patients

76 - Outcomes of testis sparing surgery in patients with testicular mass: Experience in 12 patients

Testis sparing surgery for Leydig cell pathologies in children

The aim was to analyze testis-sparing surgical procedures in boys with Leydig cell pathologies. The hospital records of four boys with Leydig cell hyperplasia who underwent testis-sparing surgery for testicular masses between 2000 and 2012 were analyzed retrospectively. Tumor markers were evaluated and all boys underwent scrotal ultrasonography preoperatively. The hormonal profile was also analyzed for symptoms of precocious puberty. The testis was delivered through a high transverse inguinal incision and the tumor was excised by enucleation. After confirming the benign nature of the tumor with frozen-section examination, the testis was reinserted and fixed into the scrotum with absorbable sutures. All cases were followed-up with physical examination, scrotal ultrasonography, and measurement of β-human chorionic gonadotropin (HCG), α-fetoprotein, and hormone levels. The mean age of the patients was 9.4 years (1.5-15 years). Testicular mass and scrotal asymmetry were detected in all cases. Ultrasonography was the main initial diagnostic modality for detecting testicular masses (Table). β-HCG and α-fetoprotein levels were normal. Three cases had Leydig cell hyperplasia and one patient was diagnosed to have a Leydig cell tumor. Signs of precocious puberty were detected in the four patients. The mean follow-up period was 4.8 years (2-8 years). Neither recurrence nor testicular atrophy developed in the follow-up. Findings of precocious puberty continued in one patient with Leydig cell hyperplasia, in whom a 2-mm contralateral metachronous lesion was detected and enucleated successfully. Testis-sparing surgery with its potential long-term psychological, cosmetic, and functional advantages should be used in pediatric patients in whom a benign Leydig cell pathology is confirmed histopathologically. This intervention with good long-term results can easily be applied through a proper dissection plane in the testicle. Since testicular Leydig cell tumors in childhood have small rates of recurrence, this choice of treatment is efficient in patients with salvageable testicular tissues and normal levels of tumor markers.

The diagnosis, treatment and prognosis of pediatric with benign testicular tumors

Objective To explore the diagnosis, treatment and prognosis of testicular benign tumors in children. Methods The clinical data of 26 boys (aged between 17 days to 12 years and average age was 2.5 years) with testicular benign tumors treated in our center between January 2008 and December 2015 were retrospectively analyzed. The tumors were on the left side in 17 cases, on the right side in 9 cases. Twenty patients presented with painless scrotal mass. 3 with cryptorchidism, 2 cases with hydrocele, and 1 case with varicocele. These boys underwent ultrasound or CT examination, results the enlarged tests with space-occupying lesions in 20 cases, 3 cases were presented as scrotal empty, 3 cases were showed as cystic masses.Twenty- four boys had taken tumor marker detection, which including 3 cases of AFP rised, 2 cases of Neuron-specific enolase slightly higher, 1 case of Ferritin increased. 26 patients were performed surgical treatment, 23 cases have taken testicular tumor resection, and 3 cases underwent orchiectomy because of abnormal morphology, according to the intraoperative findings and quick frozen pathological examination results. Results Postoperative pathological diagnosis showed of maturity teratoma in 14 cases, not maturity teratoma in 3 cases, gonadoblastoma in 3 cases, interstitial cell tumor in 2 cases, epidermoid cyst in 2 cases, fibrocellular tumor and testicular inflammatory granuloma in 1 case respectively.The 23 cases were followed up for 3-70 months. All respondents children were alive, and no complications were found such as residual tumor atrophy or tumor recurrence and metastasis. Conclusions Early diagnosis and treatment is the key to obtaining a good effect of testicular tumors. Detailed specialist examination, preoperative ultrasound, CT and determination of tumor markers are important ways to diagnose testicular cancer; rapid intraoperative frozen check may manifest nature of the tumors. For pediatric testicular benign tumor, testis-sparing surgery should be considered. Key words: Pediatric; testicular tumors; diagnosis; treatment

Colour Doppler and ultrasound characteristics of testicular Leydig cell tumours.

To assess the colour Doppler and ultrasound features of testicular Leydig cell tumours (LCTs) in a population of 38 surgically proven lesions. From August 2008 to March 2015, we retrospectively included 38 surgically proven LCTs in 36 patients. Clinical data, scrotal colour Doppler, B-mode ultrasound and videos images were reviewed for each patient. The volume, echotexture of the testis, size, shape, echogenicity and the vascularization pattern of the lesion were evaluated. The tumour margins were categorized as either smooth or lobulated. The vascularization was classified as intense, moderate or without any hypervascularization. We defined the vascularization pattern groups as central, peripheral and mixed (the latter meaning both central and peripheral). 26 patients were referred for infertility [5 patients were subsequently diagnosed with Klinefelter syndrome (KS) and 5 patients with cryptorchidism]. 28 patients underwent testis-sparing surgery, while 8 patients underwent a radical orchiectomy. The LCTs were mostly infracentimetric (68.4%), with a median size of 7.0 mm (ranging from 4.0 to 11 mm). 50% of the lesions had lobulated margins, and these were significantly larger than the smooth lesions (p < 0.05). The content of the lesions was markedly homogeneous and hypoechoic. All lesions had sharp demarcations from the adjacent pulp. 36/38 lesions exhibited moderate-to-intense hypervascularization, with a mixed intrinsic and peripheral rim pattern. Larger lesions were more hypervascularized (p < 0.05). LCTs in patients with KS had atypical features. Typical sporadic LCTs appeared as isolated hypoechoic, infracentimetric masses, with a clear demarcation from the adjacent pulp. They presented intrinsic and peripheral rim hypervascularization. By undertaking the largest imaging series of LCT to date (to our knowledge), we reassessed the typical sonographical aspects of LCTs, so as to provide guidance in regard to opting for testis-sparing surgery and for follow-up. LCTs present both intrinsic and rim vascularization detectable by colour Doppler ultrasound. Intrinsic vascularization and lobulated margins are common findings in testicular LCTs.

How to manage testicular capillary haemangioma: Editorial Comment on: W. Białek, S. Rudzki, L. Wroniecki: Capillary hemangioma of the testis. A case report of a rare benign tumor.

Testicular tumors are predominantly malignant (95% cases), as opposed to lesions originating from the peritesticular tissue. Unfortunately, preoperative discrimination between benign and malignant tumors is not always straightforward. Moreover, some of the tumors may be extremely complex in terms of the diagnosis and treatment(1). Radical orchidectomy remains the treatment of choice in the case of malignancy, whereas benign testicular tumors should be managed less aggressively: a testis-sparing approach appears to be appropriate from both oncological and functional point of view. The vast majority of small testicular tumors are benign (75%–86% of cases <16 mm in their largest diameter). Similarly, larger lesions (up to 30 mm) also tend to be predominantly benign in as many as 65% of all such cases(2). However, only 10% of all palpable tumors are reported as benign(3). Of note is the fact that these data have been retrospectively collected from men who underwent testis-sparing surgery, hence heavily biased due to the study design. In addition, there are no prospective head-to-head studies comparing testis-sparing surgery and radical orchidectomy in small asymptomatic incidental testicular tumors. Hemangiomas of the testis are an excellent example of rare tumors which can pose a significant diagnostic and therapeutic dilemma. There have been merely 55 similar cases reported since 1946. Their exact etiology, as well as the precipitating risk factors remain largely unknown. Prior irradiation and chemotherapy have been reported as potentially causative in few cases only. Testicular hemangiomas, similarly to their malignant counterparts, may be completely asymptomatic, or present as either indolent or rapidly growing lesions. They are homogenously hypoechoic and hypervascular on ultrasound. However, occasionally they may have a heterogeneous ultrasound appearance(4–6). MRI is not always useful in differentiating between benign and malignant testicular tumors. Nor are tumor markers, which can be normal in some germinal tumors(4, 7, 8). In the majority of reported cases, hemangiomas of the testis have been limited to the organ with only very few invading the tunica albuginea. Additionally, some microscopic features of the capillary, epithelioid and anastomosing hemangiomas may suggest a malignant potential, hence, be misleading and result in unnecessary orchidectomy. Nevertheless, histological examination with immunohistochemical tumor marker staining helps make the correct ultimate diagnosis. In those cases tumor enucleation with testis-sparing approach is appropriate. However, if the exact tumor character is debatable and cannot be determined, it is safer to opt for radical orchidectomy than leave a scrotal scar and a testis containing a malignant neoplasm.

Discussion of standard surgical approach of testis-sparing surgery for testicular tumour with benign tendency.

Discussion of standard surgical approach of testis-sparing surgery for testicular tumour with benign tendency.

Standard surgical approach of testis-sparing surgery for testicular tumour with benign or malignant tendency.

No abstract

Cirurgia conservadora nos tumores do testículo

IntroductionMalignant germ cell tumors represent the majority of testicular masses; according to current knowledge, radical orchiectomy remains the standard of care in the management of this type of cancer. However, testis‐sparing surgery (TSS) can be an alternative to radical surgery in selected cases, particularly in patients with small testicular masses (STM). ObjectiveThe authors conducted a review of the current indications for performing testicular sparing surgery as well as functional and oncological results of it. Material and methodsWe conducted a literature search in Medline database (PubMed) using the keywords: “testis sparing surgery”, “partial orchiectomy”, ‘testis tumor’, ‘small testicular mass/tumor’. The search was limited to article in English language, published from 2010 to the current date. Resultsrandomized controlled trials/studies with high level of evidence that compare TSS with radical orchiectomy were not found. Indications for TSS are still controversial, particularly in patients with normal contralateral testis. The organ sparing surgery seems a viable therapeutic option for patients with small non‐palpable testicular mass (with <20mm major axis), bilateral tumors or single testicle. The frozen section examination plays a decisive role in the technique, since it allows the distinction between malignant and benign neoplasms, as well as assessing the status of surgical margins. The medium and long follow‐up results of the analyzed retrospective studies revealed no significant risk of local and/or distant relapses. ConclusionRegarding the testis, the organ‐sparing surgery can be adopted safely in the treatment of selected cases. Prospective multicentric and high level of evidence studies are needed in order for TSS become a real alternative to radical surgery, as well to evaluate the oncological safety and real functional benefits of preserving the testis.

TESTIS SPARING SURGERY FOR ADULT MATURE TERATOMA OF THE TESTIS; REPORT OF A CASE.

A 25-year-old man presented complaining of a painful, left scrotal swelling. He first noticed a mass in his left scrotum during childhood, but, in the absence of clinical symptoms, did not seek medical attention. We detected a left testicular tumor which was elastic, firm and smooth. Serum levels of alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), and lactate dehydrogenase (LDH) were all within normal range. Magnetic resonance imaging (MRI) and ultrasound revealed a solid tumor with cysts accompanied by intracystic hemorrhage and calcified walls. From the above findings, the tumor was suspected to be benign and, we therefore planned testis-sparing surgery. We performed tumor enucleation under cold ischemia. Since an intraoperative frozen section revealed the tumor to be benign, we preserved the remaining testis as planned. The final pathologic diagnosis was a mature teratoma without a malignant germ cell component. Evidence of recurrence has not been observed five years after the operation. In conclusion, when a mature teratoma that has been present since prepuberty is suspected in an adult, testis-sparing surgery should be considered.

43 Testis sparing surgery instead of radical orchiectomy might be safe and feasible in patients with unilateral small testicular mass with bilateral testis: Results of a multicenter study

43 Testis sparing surgery instead of radical orchiectomy might be safe and feasible in patients with unilateral small testicular mass with bilateral testis: Results of a multicenter study

Incidentally detected non-palpable testicular tumours in adults at scrotal ultrasound: impact of radiological findings on management Radiologic review and recommendations of the ESUR scrotal imaging subcommittee.

The increasing detection of small testicular lesions by ultrasound (US) in adults can lead to unnecessary orchiectomies. This article describes their nature, reviews the available literature on this subject and illustrates some classical lesions. We also suggest recommendations to help characterization and management. The ESUR scrotal imaging subcommittee searched for original and review articles published before May 2015 using the Pubmed and Medline databases. Key words used were 'testicular ultrasound', 'contrast-enhanced sonography', 'sonoelastography', 'magnetic resonance imaging', 'testis-sparing surgery', 'testis imaging', 'Leydig cell tumour', 'testicular cyst'. Consensus was obtained amongst the members of the subcommittee, urologist and medical oncologist. Simple cysts are frequent and benign, and do not require follow up or surgery. Incidentally discovered small solid testicular lesions detected are benign in up to 80%, with Leydig cell tumours being the most frequent. However, the presence of microliths, macrocalcifications and hypoechoic areas surrounding the nodule are findings suggestive of malignant disease. Asymptomatic small testicular lesions found on ultrasound are mainly benign, but findings such as microliths or hypoechoic regions surrounding the nodules may indicate malignancy. Colour Doppler US remains the basic examination for characterization. The role of newer imaging modalities in characterization is evolving. • Characterization of testicular lesions is primarily based on US examination. • The role of MRI, sonoelastography, contrast-enhanced ultrasound is evolving. • Most small non-palpable testicular lesions seen on ultrasound are benign simple cysts. • Leydig cell tumours are the most frequent benign lesions. • Associated findings like microliths or hypoechoic regions may indicate malignancy.

Juvenile Granulosa Cell Tumors of the Testis

The clinical and pathologic features of 70 juvenile granulosa cell tumors (JGCTs) of the testis are presented. The patients were from 30 weeks gestational age to 10 years old; 60 of 67 (90%) whose ages are known to us were 6 months old or younger. Sixty-two underwent gonadectomy, 6 wedge excision, and 2 only biopsy. Twenty-six tumors were left sided and 22 right sided. Six occurred in an undescended testis and 2 in dysgenetic gonads. The most common presentation was a testicular mass (65%), followed by an "enlarging testis" (25%). Six of 14 patients in whom it was measured had "elevated" serum α-fetoprotein (AFP), likely physiologically, and 1 had gynecomastia. The tumors measured 0.5 to 5 cm (mean, 1.7 cm; median, 1.5 cm) and were most commonly well circumscribed and typically yellow-tan; approximately 2/3 had a cystic component, whereas 1/3 were entirely solid. Microscopic examination typically showed a lobular growth, punctuated in 67 cases by variably sized and shaped follicles containing material that was basophilic (21%), eosinophilic (44%), or of both characters (35%); 3 lacked follicles. In nonfollicular areas, the tumor cells typically grew diffusely but occasionally had a corded arrangement (26%) or reticular appearance (29%). The stroma was either fibrous or fibromyxoid; hemorrhage associated with hemosiderin-laden macrophages was focally seen in 16%. The tumor cells were mostly small to medium sized with round to oval nuclei containing inconspicuous nucleoli and moderate to abundant, but occasionally scant, pale to lightly eosinophilic, sometimes vacuolated, cytoplasm; nuclear grooves were infrequent (6%). Focal columnar morphology was seen in 27% of the tumors. Mitoses were plentiful in 37%, and apoptosis was prominent in 46%. Intratubular tumor was seen in 43% and entrapped seminiferous tubules in 70%. Lymphovascular invasion was present in 2 cases, rete testis involvement in 4, and necrosis in 1. Rare features/patterns included: regressed tumor with hyalinization and prominent blood vessels (13%), papillary growth (4%), basaloid morphology (1%), spindle cell predominance (1%), microcystic foci (1%), adult granulosa cell-like (1%) patterns, and hyaline globules (1%). Inhibin (16/18), calretinin (8/9), WT1 (6/7), FOXL2 (12/12), SF-1 (12/12), and SOX9 (6/11) were positive, whereas SALL4 and glypican-3 were consistently negative in the neoplastic granulosa cells. Only 1 of 10 tumors was focally positive for α-fetoprotein. JGCT is a rare neoplasm with a wide morphologic spectrum that also occurs rarely in undescended testes and dysgenetic gonads. The solid and reticular patterns may pose diagnostic challenges, but the lobular appearance and follicular differentiation are characteristic. Immunohistochemical stains may aid in its distinction from other tumors of young male individuals, particularly yolk sac tumor, a neoplasm that peaks at a somewhat later age. Twenty-four patients with follow-up, including 4 of 6 patients treated with wedge resection/biopsy, had no evidence of disease (2 to 348 mo; mean, 83 mo; median, 61 mo). One additional patient was alive at 260 months, but the disease status is unknown. The benign clinical course of all cases of JGCT with follow-up, despite often frequent mitotic activity, supports testis sparing surgery when technically feasible.

Testis-Sparing Surgery in Small Testicular Masses Not Suspected to Be Malignant

BackgroundWe aimed to determine the safety, efficacy, and the concordance of permanent and frozen section analysis (FSA) of testis-sparing surgery (TSS) in patients who had small testicular masses that were not suspected to be malignant. Patients and MethodsFifteen patients who underwent TSS were included in the study. TSS was performed for the patients who had testicular lesions <25 mm and testicular lesion volume <30% of the whole testis. All patients had normal serum tumor marker levels and ultrasonographic evaluation did not indicate malignancy. Surgery was performed via an inguinal approach with temporary cord occlusion and FSA of the lesions. Benign findings allowed for TSS, and cancer prompted total orchiectomy. ResultsThe mean patient age was 25.33 (range, 20-36) years. The predominant complaint was swelling (9 patients). The mean lesion diameter was 16 mm (range, 5-26 mm). Fourteen of all cases (93%) had benign pathology and underwent TSS. Only 1 patient, whose FSA revealed malignant formation, underwent radical orchiectomy. Final pathology of this patient was seminoma. Complete histopathologic concordance was observed between the results of frozen and permanent sections. TSS was performed with no intra- or postoperative complications. After a mean follow-up of 23 months (range, 6-44 months) all patients, except 3 who were lost to follow-up, were free of disease. ConclusionThe main key points for accurate decision-making between TSS and radical orchiectomy are intraoperative FSA and preoperative externalization of possible suspected malignancy with physical examination, ultrasonographic evaluation, and serum tumor marker analysis.

PD2-11 DOES TUMOR SIZE, ULTRASONOGRAPHIC FINDINGS, SERUM HUMAN CHORIONIC GONADOTROPIN(HCG) LEVEL CAN PREDICT THE LIKELIHOOD OF BENIGN TESTICULAR HISTOLOGY?

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Penis/Testis/Urethra: Benign Disease1 Apr 2015PD2-11 DOES TUMOR SIZE, ULTRASONOGRAPHIC FINDINGS, SERUM HUMAN CHORIONIC GONADOTROPIN(HCG) LEVEL CAN PREDICT THE LIKELIHOOD OF BENIGN TESTICULAR HISTOLOGY? Gang Song Gang SongGang Song More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.194AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To predict the likelihood of benign histology for testicular masses and decide more testis-sparing surgeries prior to operation. METHODS During the years Jan 2005 - Mar 2014, 254 consecutive operations of testicular masses were performed in our hospital. The majority (245/254, 96.5%) underwent radical orchiectomy. Only nine (9/254, 3.5%) were testicular preserving surgeries for considering benign tumors, which have been confirmed by histology after operation. We searched for the concordance between age, tumor size, ultrasonographic findings, serum alpha fetoprotein(AFP) and human chorionic gonadotropin(HCG) level, body mass index(BMI) and pathology status(benign vs malignant). RESULTS Benign lesions were found in 69 patients(27.2%), including epidermoid cysts(n=33), tubercular lesions(n=10), cysts(n=6), inflammation lesions(n=6), mature teratoma(n=3), lipoma(n=1), leiomyoma(n=2) and so on. Malignant findings were in the other 185 patients, including seminoma, embryonal carcinoma or mixed germ cell tumor, non Hodgkin's lymphoma, malignant interstitial cell tumor. The median diameter of benign tumor was 2.5 cm(0.5-14.0 cm), the median diameter of malignant tumor was 5.0 cm(0.7-23.0 cm). The tumor size, ultrasonographic findings, serum HCG level had significant difference between the benign and malignant groups. Receiver Operation Characteristic(ROC) analysis showed a cut-off value of 3.4 cm tumor size with 80.6% sensitivity and 76.4% specificity. Logistic regression showed that tumor size, ultrasonographic findings, serum HCG level were independent predictors for benign tumors. If the possibility calculated from the logistic regression was 0.84 or more, the patient might be malignant with 79.0% sensitivity and 90.0% specificity. CONCLUSIONS Tumor size, ultrasonographic findings, serum HCG level can predict the likelihood of benign testicular histology. Testis-sparing surgery should be decided if the possibility of benign histology is high. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e44 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gang Song More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...